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Decision making by suresh aadi8888

  1. 1. DECISION MAKING Presented by:- Mr. Suresh Kumar Sharma RN, ACCN, MSN PSYCHIATRY
  2. 2. Please introduce yourself by answering the following items: • Your name, age, & work experience ? • The most important decision you have taken in your life? • How did you take this decision?
  3. 3. “Importance of decision making” Somewhere along the line of development we discover what we really are, And then we make our real decision for which we are responsible Make that decision primarily for yourself because you can never really live Anyone else life.” Eleanor Roosevelt
  4. 4. In this session … Definition Principles characteristics Types Strategies Process Components
  5. 5. In this session … Techniques Group decision making Models factors tools
  6. 6. DEFINITION: • Decision : Decision making is a act of choosing. Grainger (1990)  Decision : is a solution chosen from among alternatives NURSE NURSE
  7. 7. Definition • Decision-making : is a process of converting information into action. Venigra (1982) • Decision-making process : is the process of selecting an alternative course of action that will solve a problem. • Problem solving: is the process of taking corrective action in order to meet objectives.
  8. 8. Decision making • “It is the process of responding to a problem by searching for and selecting a solution or course of action that will create value for organisational stakeholders”.
  9. 9. PRINCIPLES • Principle of important decision : regard to imp aspect of business & enterprise related to production, finance, & marketing. • Principle of individual self interest: person makes decision satisfy needs ,objects & ambitions has great importance to him . If the employees are satisfied , the organization achieve objectives easily & successfully.
  10. 10. PRINCIPLES • Principle of reasonable behavior: everybody behaves in reasonable manner. As employees , is first a human being than a employee. • Principle of dynamism: • Management is a living science change acc to the circumstances, so objects, rules, policies, procedures may change acc to the feelings &
  11. 11. Principle • Principle of proportion: emphasis on maintaining balance between the objectives of organization & availability of resources if not under utilization. • Principle of alternative: entire possible alternative for solution must be consider.
  12. 12. . • Principle of turning : decision must be taken at right time, as late decision do not serve any purpose. • Principle of maximum benefit: it must be beneficial to organization, increase efficiency of worker and thus productivity & increase profit.
  13. 13. CHARACTERISTICS: 1. goal directed activity. 2. integral part of management. 3. an intellectual activity. 4. involves choices
  15. 15. PROGRAMMED DECISION MAKING • routine and repetitive and specific ways to handle them. • Decision rule is developed. • Decision rule: statement that tells which alternative to choose once they have the information. • E.g- student duty roster, catheterization
  16. 16. PROGRAMMED DECISION MAKING • • • • • • Characteristics: Highly structured Clear and well known goals Procedure already established Sources & channels of information clearly defined Minimum of uncertainty Recurs frequently
  17. 17. NON PROGRAMMED • Typically one shot decision, less structured . • Recurs infrequently, where no previous rule is established • Requires problem solving. Problem solving: is a form of decision making in which the issue is unique & alternatives must be developed and evaluated with the aid of programmed decision rule.
  18. 18. NON PROGRAMMED • • • • • Characteristics: Poorly structured Information not available No clear procedure Goals are vague Non-recuring and non-routine • E.g. staff absenteeism/crisis
  19. 19. Kinds of decision making: Mechanistic Adoptive Managerial Judgmental Analytical
  20. 20. Mechanistic • Routine and repetitive in nature. • Limited number of variables where outcome of each variable is known. • Tools- charts, lists, decision tree etc
  21. 21. Analytical • Helps to solve complex problems. • Large number of decision variables, outcome of each can computed. • Computational technique – linear programming and statistical analysis
  22. 22. Judgemental • Also limited number of variables, but alternatives are unknown. • Useful in marketing investment and solve personal problem.
  23. 23. Adaptive • Large number of variables , outcome is not predictable. • Requires contribution of many people with diverse technical background. e.g. research findings
  24. 24.  Adaptive Decisions  Choices made in response to a combination of moderately unusual problems and alternative solutions  Convergence—a business shift in which two connections with the customer that were previously viewed as competing or separate (e.g., brick-and-mortar bookstores and Internet bookstores) come to be seen as complementary  Continuous improvement—a management philosophy that approaches the challenge of product and process enhancements as an ongoing effort to increase the levels of quality and
  25. 25. Nursing administration decision making Non-routine By directors e.g.- changing ways of care Routine By mid & low level managers Assigning duty roster
  26. 26.  Standard choices made in response to relatively well-defined and common problems and alternative solutions  Typically made under certainty and objective probability  Standards often used to set the framework for making routine decisions
  27. 27. Reservations Hotel Arrival Phone service will be highly The doorman (or first-contact efficient, including: answered employee) will actively greet before the fourth ring; no hold guests, smile, make eye contact, longer than 15 seconds; or, in and speak clearly in a friendly case of longer holds, callmanner Examples of backs offered, then provided decision rules in less than three minutes at Four Seasons hotels Messages and Paging Hotel Departure and resorts Phone service will be highly No guest will wait longer efficient, including: answered before the fourth ring; no longer than 15 seconds than five minutes for baggage assistance, once the bellman is called (eight minutes in resorts)
  28. 28. General classification • Typical, routine, unimportant decisions: no extra ordinary effort, judgment, & authority. dealing with less important problems . Made mostly by low level managers. • Important, vital, or strategic: aim at determining the means & ends of enterprise. it requires through study, analysis, reflective thinking . Usually taken by top managers.
  29. 29. Decision Making- An essence to problem solving
  30. 30. Types of Problems and Decisions • Structured problems * Involved goals that clear. *Are familiar(have occurred before) *Are easily and completely definedinformation about the problem is available and complete. • Programmed decision *A repetitive decision the can be handled by a routine approach.
  31. 31. Problems and Decisions ( cont’d) • Unstructured problems * Problems that are new or unusual and for which information is ambiguous or incomplete. * Problems that will require custom-made solutions. • Non-programmed decisions * Decision that are unique and nonrecurring. * Decision that generate unique responses.
  32. 32. STRATEGIES A strategy is an artful or cleverer plan for applying technique in pursuit of goal. o Optimizing: it yields greatest amount of preferred outcome by - analyzing problem - determine desired goal - predict the consequences of action - select the courses
  33. 33. STRATEGIES o Satisfying: individual chooses a solutions , and select best of remaining options. o Mixed scanning: making a decision that satisfies to remove least promising solutions, and select the best of remaining options. o Opportunistic: making a decision for the solution chosen by problem identifier. o Do nothing: taking decision after the storm to pass.
  34. 34. STRATEGIES o Eliminate critical limiting factor: by removing most powerful obstacle to success. o Maxima: an optimistic approach , the individual chooses that action alternative that will yield largest pay off. o Mini-regret: it minimize the surprise from any action that result mid-way between the most desired & the least out come.
  35. 35. STRATEGIES o Chameleon: taking a decision by making a vague plan, adjust to changing circumstances.
  36. 36. The DecisionMaking Process Define the Problem Gather facts and develop alternatives. Evaluate Alternatives Select the best alternative. Implement the chosen Alternative Follow up and evaluate the chosen alternative.
  37. 37. Six Steps in Decision Making
  38. 38.  The condition under which individuals are: 1. fully informed about a problem, 2. alternative solutions are known, and 3. the results of each solution are known  Both the problem and alternative solutions are totally known and well defined  Exception for most managers
  39. 39. What is Risk?  The condition under which individuals can: 1. 2. 3. 4. define a problem, specify the probability of certain events, identify alternative solutions, and state the probability of each solution leading to a result  Probability: the percentage of times that a specific result would occur if an individual were to make the same decision a large number of times
  40. 40. What is Risk? (cont’d)  Objective probability: the likelihood that a specific result will occur, based on hard facts and numbers  Subjective probability: the likelihood that a specific result will occur, based on personal judgment
  41. 41.  What is Uncertainty?  Condition under which individuals do not have the necessary information to assign probabilities to the outcomes of alternative solutions  May not even be able to define the problem, much less identify alternative solutions and possible outcomes
  42. 42. COMPONENTS
  43. 43. Generate Creative Alternatives • Innovation – The implementation of a new idea • Product innovation (new things) • Process innovation (new way of doing things) • Creativity – A way of thinking that generates new ideas
  44. 44. Stages in the Creative Process Become familiar with the problem; generate as many solutions as possible. Take some time before working on the problem again to gain additional insight. Before implementing the solution, evaluate the alternative to be sure it is practical. Exhibit 4–6
  45. 45. Group Decision-Making Techniques That Foster Creativity Exhibit 4–7
  46. 46. Generating Creative Alternatives • Brainstorming – The process of suggesting many possible alternatives without evaluation. • Quantity is more important than quality • Criticism is withheld • Build on others ideas • Create status-free environment
  47. 47. Generating Creative Alternatives • Synectics – The process of generating novel alternatives through role playing and fantasizing. • Nominal Grouping
  48. 48. Generating Creative Alternatives (cont’d) • Delphi Technique – The process of using a series of confidential questionnaires to refine a solution.
  49. 49. Consensus Decision Making • Consensus is a process for group decision-making • Input of all participants are gathered and synthesized to arrive at a final decision, that is acceptable to all • Through consensus, not only achieve better solutions, but also promote community and trust • As a tool, it follows brainstorming 5-62
  50. 50. Responses That Kill Creativity • • • • “It can’t be done.” “We’ve never done it.” “Has anyone else tried it?” “It won’t work in our department (company/industry).” • “It costs too much.” • “It isn’t in the budget.” • “Let’s form a committee.”
  51. 51. A P P R O A C H E S Individual Authoritarian Group
  52. 52. INDIVIDUAL • Based on personal values and preferences. • It is challenging & difficult as some people depend on others for it. • A conflict of values also affect.
  53. 53. Authoritarian • The decision relies on leader or head of the group. • Sufficient information should gather in order to take decision to be beneficial for the group. • Decision must explain to gain acceptance.
  54. 54. Group • Members brainstorm and share ideas, discuss the considerations & implement the agreed decision. • More effective as every one takes accountability.
  55. 55. Potential Advantages and Disadvantages of Using Group Decision Making • Potential Advantages 1. Better-quality decisions 2. More information, alternatives, creativity, and innovation 3. Better understanding of the decision 4. Greater commitment to the decision 5. Improved morale and motivation 6. Good training • Potential Disadvantages 1. Wasted time and slower 2. Satisficing 3. Domination and goal displacement 4. Conformity and groupthink Exhibit 4–4
  56. 56. MODELS Normative Strategic Decision Tree Optimizing Decriptive Satisfying
  57. 57. Normative • It is the oldest model assumed maximize satisfaction and fulfills “perfect knowledge assumption . • All possible choices & consequences and potential outcome of each known.
  58. 58. process Define and analyze problem Identify alternatives Evaluate pros & cons implement Select alternative Rank alternatives Follow up
  59. 59. Vroom and Yelton’s normative model • Decision making is a social process and emphasis on managers work rather than should behave in their normative way. • It is used when information is objective , problem is structured or routine & outcome is predictable
  60. 60. Vroom and Yelton’s normative model process Autocratic Second variant consultative First variant group
  61. 61. 2- Vroom and yetton normative mode: • They address decision making as a social process and emphasize how managers do rather than should behave in their normative model. • Identified the 5 decision making methods: A = autocratic I = First variant C = Consultative G = Group II = Second variant
  62. 62. They have identified five decision making methods or styles: • AI- You solve the problem or make the decision alone, using information available to you at that time. • AII- You obtain the necessary information from your subordinates, and make a decision. - The role of your subordinates in making the decision is providing the necessary information to you, rather than generating or evaluating alternative solutions. • CI- You share the problem with relevant subordinated individually. - Getting their ideas and suggestions, - Then you make the decision that may or may not reflect your subordinates’ influence
  63. 63. • CII- You share the problem with your group subordinates - obtaining their ideas and suggestions. - Then you make the decision that may or may not reflect your subordinate's influence . • GII- (group decision making) -You share a problem with your subordinates as a group - Together you generate and evaluate alternatives & reach agreement (consensus) on a solution. Your role is much like that of chairman. - Don't try to influence the group to adopt ‘your” solution , & willing to accept and implement group supported solution.
  64. 64. Vroom's seven rules to determine which style is appropriate in a given situation: ( 3 protect decision quality &4 protect acceptance) 1) The information rule: - quality of the decision is important and the leader does not have enough information or experience to solve the problem (AI is eliminated ) 2)The goal congruence rule. - Quality of the decision is important - The subordinates do not share the organizational goals to be obtained in solving the problem (GII is eliminated)
  65. 65. 3) The unstructured problem rule: - quality of the decision is important, - leader not have necessary information or experience to solve the problem by himself - The problem is unstructured, i.e. he does not know exactly what information is needed and where it is located . - involvement of subordinate's interaction with full knowledge of the problem to generate a high-quality solution (AI, AII, and CI are eliminated). 4) The acceptance rule. - If the acceptance of the decision by subordinated is critical to effective implementation - Not certain that an autocratic decision made by the leader would receive that acceptance. - (AI and AII are eliminated)
  66. 66. 5) The conflict rule: - If the acceptance of the decision is critical and autocratic decision is not certain to be accepted - subordinates are likely to be in conflict or disagreement with solution (AI, AII, and CI are eliminated) G 2 may used because finally you must solve problem.
  67. 67. 6) The fairness rule: - If the quality of decision is unimportant - acceptance is critical and not certain to result from an autocratic decision. (AI, AII, CI, & CII are eliminated) 7) The acceptance priority rule: - If acceptance is critical - Not assured by an autocratic decision - If subordinated can be trusted. (AI. AII. CI, and CII are eliminated)
  68. 68. Decision tree • A decision tree is a graphic method . • It helps the supervisor in visualizing the alternative available, outcome, risk & information need for specific problem over a period of time. • It helps to see the possible direction that actions may from each decision point & evaluate consequences of a series of a decision.
  69. 69. Decision tree • The process begins with a primary decision having at least two alternatives • Then predicted outcome of each decision considered and the need for further decision is contenplated.
  70. 70. Decision Tree Exhibit 4–8
  71. 71. • Decision tree For staff training Type of Skill Knowing How Knowing About Delivery of Content Delivery of Content Group Lecture Small Group Discussion Assigned Readings Self-Paced Instruction Role Play Modeling On the job training Performance Appraisal Methods of Performance Appraisal Written tests Discussion Role Play Demos On job Demos Maintenance Methods for enhancing maintenance Train and hope Periodic Retraining Informal Obs and Discussion On Job Assessment & Feedback Summary
  72. 72. The descriptive model • Simon developed. • Assumption: decision maker is a rational person looking for acceptable solution based on known information. • It allows the fact that many decisions are made with incomplete information because of time, money, people limitations and people do not always do best choices. • Simon wrote few decisions would ever made if we always sought optimal solution, we identify acceptable solutions
  73. 73. The descriptive model Establis h goal Define Follow -up Subjective perceptio ns steps Identify Impleme nt Acceptabl e decisions alternativ es Select alternat ives
  74. 74. The strategic model • It is related to long range planning. • In merging of hospitals Nsg dept is also affected. • For application , participants used general and specific information from subordinates to identify complex problems. • To develop potential solutions ,they gather data from hospital documents. • Top managers make decisions using intuitions, formal analysis, knowledge of organizational politics.
  75. 75. Strategic model Selecting the single best solution Identify the cost and benefits Screening solutions by Predetermined criteria
  76. 76. Identifying The problem Searching The single best solution Support activities in decision making Developing the Potential solutions
  77. 77. The optimizing model • Decision maker select the solution that maximally meet the organizational goals. • Assesses the pros and cons of outcome associated with each option.  The goal to select most ideal solution  This process is most expedient and may be the most appropriate when time is issue.
  78. 78. The satisfying model • Decision maker selects the solution that minimally meets the objectives for a decision. • It is more conservative method compared to an optimizing approach • This process is most expedient and may be the most appropriate when time is an issue.
  79. 79. Factors affecting decision making internal external • Physical & emotional status • Personal characteristics & values • Past experience • Interest • Knowledge & attitude • Energy & creativity • Resistance to change • flexibility • • • • • • • Cultural environment Philosophical environment Social background Time Poor communication Cooperation coordination
  80. 80. Decision making tools • Tools are the aids for decision making. • Any aid always result in need for the person to make a final decision & all aids are subject to human error.
  81. 81. 1. Decision grid Alternative #1 #2 #3 #4 Financial effect Political effect Dept effect Time Decision
  82. 82. 2. Judgemental Technique • • • • • Oldest technique &subjective. Based on past experiences & intuition. Useful in making routine decisions. Cheap and non- time consuming. Hazardous due to chance for taking wrong decisions. • Rarely used in large capital commitments.
  83. 83. 3.Operational research technique • It can be defined as the analysis of decision problem using scientific method to provide manager the needed quantitative information in making decisions. • Operational research makes the decision analytical, objective, & quantitative based .
  84. 84. Steps of O R • Construction of mathematical model • Definition of criteria • Procuring empirical estimates of the numerical parameters in the model • Carrying out through mathematical process of finding and series of action which will give optimal solution.
  85. 85. Types of O R A. Linear programming: • This is defined as "How could a company with limited resources make optimum use with their resources, combination for the achievement of the desired objective, or goal was, the central idea of this mathematical technique".
  86. 86. Use of linear programming • To determine a minimal cost nutrition diet or to determine a class size, class hours, and instructors in the school of nursing.
  87. 87. B. Games Theory: Games theory attempts to work out optimum solution in which an individual in a given situation can develop a strategy irrespective of what a competition does with maximizing gains or minimizing losses. It involves mathematical study of tactics under conditions of uncertainty. The player tries to choose of action which will frustrate opponent’s action & help in winning the game .
  88. 88. C. Queuing theory • Queues arise when the short term demand for service exceeds the capacity • It deals with waiting lines or intermittent servicing problem. • It balances the cost of waiting verses the prevention of waiting by increasing the services • A group of items waiting to receive services is known as ‘Queue’ .
  89. 89. Contd……. • By decreasing or eliminating the waiting line , waiting line cost, there is an increase in cost of labor and physical facilities.
  90. 90. D. Programme evaluation and review technique (PERT) • It is a network system model for planning and control under certain conditions. • It involves identifying the key activities in a project , sequencing the activities in a flow diagram & assessing the duration for each phase .
  91. 91. IMPORTANCE • It is appropriate for project work that involves extensive research and development . • Helps to predict time • Helps to determine priorities . • Use of resources can be consider when setting priorities • Assignment can be changes temporarily. • Facilitate the activity flow. • Time can manipulate to move from one phase to another.
  92. 92. E. Critical path method • It is closely related to PERT • it calculates the time required for each activity, the longest possible time. • It is useful where the cost is significant factor.
  93. 93. F. Computers in decision making • • • • • • • • computers can be used for Patient classification system Supplies and material management Staff scheduling Policy & procedure changes & announcement Patient charges Budget information & management Personal records statistical reports, administrative reports, memos etc.
  94. 94. 3.Delphi TECHNIQUE • The Delphi Method is a group decision process about the likelihood that certain events will occur. • Today it is also used for environmental, marketing and sales forecasting. • The Delphi Method uses a panel of experts. • Expert responses to a series of questionnaires are anonymous. • Each round of questionnaires results in a median answer. • The process guides the group towards a consensus.
  95. 95. Delphi TECHNIQUE • The Delphi technique was invented by Olaf Helmer and Norman Dalkey of the Rand Corporation in 1953 for the purpose of addressing a specific military problem. • The object of the Delphi method is to obtain a reliable response to a problem from a group of experts. • In a Delphi study, the participants do not interact with one another, • Delphi technique is used today in business, education, and the social sciences
  96. 96. DELPHI METHOD PROCESS • Fowles (1978) describes ten steps for the Delphi method: • 1.Formation of a Delphi team to undertake a Delphi on a subject. • 2.Selection of expert panel(s). • 3.Development of the first round questionnaire • 4.Testing the questionnaire for proper wording. • 5.Transmission to the panelists. • 6. Analysis of 1st responses • 7. Preparation of 2nd round. • 8. Transmission of 2nd round questionnaires to the panelists • 9.Analysis of the 2nd round responses (7 to 9 may be repeated to get consensus) • 10. Preparation and presentation of
  97. 97. Modified Delphi- The Nominal Group Technique • The Nominal Group Technique is a face to face Delphi based method, allowing group discussion. • It adds a personal dimension to the methodology. • The use of consensus is common to both techniques
  98. 98. Delphi technique-characterstics • • • • free from others influence. Doesn't requires physical presence. Appropriate for scattered group. It is time consuming.
  99. 99. 4. SIMULATION: • This technique is used to test the feasibility and possible outcome of various decision alternatives. • "Simulation is a quantitative technique for evaluating alternative courses of action based upon facts and assumptions with a computerized mathematical model in order to represent actual decision making under conditions of uncertainty.
  100. 100. Nursing implication
  101. 101. Strategies to Improve Decision Making • Make certain you have all necessary information to make a proper decision. • Consider alternatives. • Do not be afraid to revise a decision if circumstances change. • Anticipate questions and outcomes. • Keep notes and other information for reference.
  102. 102. Nurses ethics check • Is it legal? – Does it violate law – Does it violate company policy • Is it balanced? – Is it fair to all – Does it promote win-win • How will it make me feel about myself
  103. 103. strategies • Patients are increasingly knowledgeable about health care and involved in treatment decisions. • Nurses must be aware of patients’ rights in making decisions about their treatments and must assist patients in their decision making. • Nurses must recognize when patients are lacking information and implement teaching in such cases. • Nurses may need to collaborate with others to determine what information has been shared with the patient and family.
  104. 104. • Evaluate their own personal and professional . periodically values and reassess them • Utilize principles that guide ethical decisionmaking in practice: – Autonomy – Beneficence – Caring – Justice – Non-maleficence • Participate in interdisciplinary ethics committees and ethics rounds
  105. 105. • Recognize the values and.standards that guide ethical practice in nursing as represented in: – The ANA Code of Ethics for Nursing – The ANA Scope and Standards of Practice – The International Nursing Council Code of Ethics • Describe laws that govern nursing practice and address the rights of patients • Utilize a decision-making model or framework that will facilitate the recognition and resolution of ethical dilemmas • Ethical Practice and Human Rights for consultation and support in ethical decision-making processes.
  106. 106. RESEARCHES • Decision-making in clinical nursing: investigating contributing factors. Hoffman K, Donoghue J, Duffield C. Source University of Technology, Sydney, Australia • Conclusion:In contrast to other studies, experience and educational level were not found to influence decision-making strongly, the value of role was the most significant predictor. The model developed, however, only accounted for a low amount of variability in decision-making. The findings indicate that there are other factors affecting clinical decision-making that still require identification.
  107. 107. . The nurse's role in end-of-life decision-making for patients and families. • Briggs L, Colvin E. Source Gundersen Lutheran Medical Foundation, La Crosse, Wis, USA. • Abstract This article discusses some of the cultural changes required for organizations to build systems that move beyond mere completion of the advance directive to advance care planning that affects end-of-life decision-making. It specifically describes one organization's educational approach to clarifying the role of the nurse as patient advocate within these cultural changes and suggests strategies to help the nurse gain necessary competence in end-of-life decision-making.
  108. 108. Bibliography • Ann Marriner Tomey, guide to nursing management and leadership,8th edition,(2009);Mosbey, elsevier, Canada,page no 66-95. • Janice Rider Ellis, Celia Love Harrtley, Managing and coordinating nursing care, 3rd edition,(2000); Lippincott US, page no 110-31. • B T Basavanthappa, Nursing Administration, 2nd edition,(2008); jaypee publication, page no 132-57 • Yoder wise ; “ leading & managing in nursing” , mosby publication page no. 110-126 • Russel. C, Swansberg, j. Swansberg, “introductory management & leadership for nurses” 2nd edition, page no. 305-317
  109. 109. Bibliography • s/Artinian_Barbara.pdf • • www. delmarketing .com • • • • 1/9780443070761.pdf • &cad=rja&ved=0CDoQFjAD&url=http%3A%2F%2Fwww.nursingmidwiferyb 41%26dbid%3DAP%26chksum%3D3SWDivwEVXM4K6MsMHxTmw%253D %253D&ei=rQFkUtbqHYSxrgf3loDwCg&usg=AFQjCNGp8V3qApEBx0SS_nm v__KKFndRgQ
  110. 110. .