Mr. Suresh Kumar Sharma
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?
“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.”
In this session …
In this session …
• Decision : Decision making is a act of
Decision : is a solution chosen from among
• Decision-making : is a process of converting
information into action.
• 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.
• “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
• 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.
• Principle of reasonable behavior:
everybody behaves in reasonable manner. As
employees , is first a human being than a
• Principle of dynamism:
• Management is a living science change acc to
the circumstances, so objects, rules, policies,
procedures may change acc to the feelings &
• 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.
• Principle of turning : decision must be taken
at right time, as late decision do not serve any
• Principle of maximum benefit: it must be
beneficial to organization, increase efficiency
of worker and thus productivity & increase
1. goal directed activity.
2. integral part of management.
3. an intellectual activity.
4. involves choices
KINDS OF DECISION MAKING
PROGRAMMED DECISION MAKING
• routine and repetitive and specific ways to
• Decision rule is developed.
• Decision rule: statement that tells which
alternative to choose once they have the
• E.g- student duty roster, catheterization
PROGRAMMED DECISION MAKING
Clear and well known goals
Procedure already established
Sources & channels of information clearly
Minimum of uncertainty
• Typically one shot decision, less structured .
• Recurs infrequently, where no previous rule is
• 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.
Information not available
No clear procedure
Goals are vague
Non-recuring and non-routine
• E.g. staff absenteeism/crisis
Kinds of decision making:
• Routine and repetitive in nature.
• Limited number of variables where
outcome of each variable is known.
• Tools- charts, lists, decision tree etc
• Helps to solve complex problems.
• Large number of decision variables,
outcome of each can computed.
• Computational technique – linear
programming and statistical analysis
• Also limited number of variables, but
alternatives are unknown.
• Useful in marketing investment and solve
• Large number of variables ,
outcome is not predictable.
• Requires contribution of many
people with diverse technical
e.g. research findings
Choices made in response to a combination of
moderately unusual problems and alternative
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
Continuous improvement—a management
philosophy that approaches the challenge of
product and process enhancements as an
effort to increase the levels of quality and
Nursing administration decision making
e.g.- changing ways of
By mid & low level
Assigning duty roster
Standard choices made in response to
relatively well-defined and common
problems and alternative solutions
Typically made under certainty and
Standards often used to set the framework
for making routine decisions
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
backs offered, then provided
in less than three minutes
Messages and Paging
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
• 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
Decision Making- An essence
to problem solving
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
• Programmed decision
*A repetitive decision the can be handled by a
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
• Non-programmed decisions
* Decision that are unique and nonrecurring.
* Decision that generate unique responses.
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
- select the courses
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
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.
o Chameleon: taking a decision by making a
vague plan, adjust to changing circumstances.
The DecisionMaking Process
Select the best
Follow up and
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
What is Risk?
The condition under which individuals can:
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
What is Risk? (cont’d)
Objective probability: the likelihood that a
specific result will occur, based on hard facts
Subjective probability: the likelihood that a
specific result will occur, based on personal
What is Uncertainty?
Condition under which individuals do not
have the necessary information to assign
probabilities to the outcomes of alternative
May not even be able to define the
problem, much less identify alternative
solutions and possible outcomes
Generate Creative Alternatives
– The implementation of a new idea
• Product innovation (new things)
• Process innovation (new way of doing things)
– A way of thinking that generates new ideas
Stages in the
Become familiar with the
problem; generate as many
solutions as possible.
Take some time before working
on the problem again to gain
Before implementing the solution,
evaluate the alternative to be sure
it is practical.
Group Decision-Making Techniques That
Generating Creative Alternatives
– The process of suggesting
many possible alternatives
• Quantity is more important than
• Criticism is withheld
• Build on others ideas
• Create status-free environment
– The process of generating novel alternatives
through role playing and fantasizing.
• Nominal Grouping
Generating Creative Alternatives
• Delphi Technique
– The process of using a series of confidential
questionnaires to refine a solution.
Consensus Decision Making
• Consensus is a process for group
• 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
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
• “It costs too much.”
• “It isn’t in the budget.”
• “Let’s form a committee.”
• Based on personal values and
• It is challenging & difficult as some
people depend on others for it.
• A conflict of values also affect.
• 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
• Members brainstorm and share ideas, discuss
the considerations & implement the agreed
• More effective as every one takes
Potential Advantages and Disadvantages of
Using Group Decision Making
• Potential Advantages
1. Better-quality decisions
2. More information,
alternatives, creativity, and
3. Better understanding of the
4. Greater commitment to the
5. Improved morale and
6. Good training
• Potential Disadvantages
1. Wasted time and slower
3. Domination and goal
4. Conformity and groupthink
• It is the oldest model assumed maximize
satisfaction and fulfills “perfect knowledge
• All possible choices & consequences and potential
outcome of each known.
Vroom and Yelton’s normative
• 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
Vroom and Yelton’s normative model
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
• Identified the 5 decision making methods:
A = autocratic
I = First variant
C = Consultative
G = Group
II = Second variant
They have identified five decision making methods
• 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
- Getting their ideas and suggestions,
- Then you make the decision that may or may not reflect your
• CII- You share the problem with your group
- 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
- 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
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
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)
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
- 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)
5) The conflict rule:
- If the acceptance of the decision is critical
and autocratic decision is not certain to be
- 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
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)
• 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
• 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
• Decision tree For staff
Type of Skill
Delivery of Content
Delivery of Content
Small Group Discussion
On the job training
Methods of Performance Appraisal
Role Play Demos
On job Demos
Methods for enhancing maintenance
Train and hope
Informal Obs and Discussion
On Job Assessment & Feedback
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
The descriptive model
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
• To develop potential solutions ,they gather data
from hospital documents.
• Top managers make decisions using intuitions,
formal analysis, knowledge of organizational
Identify the cost and
Screening solutions by
The single best
in decision making
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.
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.
Factors affecting decision making
• Physical & emotional status
• Personal characteristics & values
• Past experience
• Knowledge & attitude
• Energy & creativity
• Resistance to change
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.
1. Decision grid
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
• Rarely used in large capital commitments.
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 .
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
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
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.
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 .
C. Queuing theory
• Queues arise when the short term demand for
service exceeds the capacity
• It deals with waiting lines or intermittent servicing
• 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’ .
• By decreasing or eliminating the waiting line ,
waiting line cost, there is an increase in cost of
labor and physical facilities.
D. Programme evaluation and review
• 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
• 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
• Assignment can be changes temporarily.
• Facilitate the activity flow.
• Time can manipulate to move from one phase
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.
F. Computers in decision making
computers can be used for
Patient classification system
Supplies and material management
Policy & procedure changes & announcement
Budget information & management
statistical reports, administrative reports,
• The Delphi Method is a group decision process
about the likelihood that certain events will
• 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
• Each round of questionnaires results in a
• The process guides the group towards a
• The Delphi technique was invented by
Olaf Helmer and Norman Dalkey of
the Rand Corporation in 1953 for the
purpose of addressing a specific
• 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
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
• 4.Testing the questionnaire for
• 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
Modified Delphi- The Nominal Group
• The Nominal Group Technique
is a face to face Delphi based
method, allowing group
• It adds a personal dimension
to the methodology.
• The use of consensus is
common to both techniques
free from others influence.
Doesn't requires physical presence.
Appropriate for scattered group.
It is time consuming.
• This technique is used to test the feasibility
and possible outcome of various decision
• "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.
Strategies to Improve Decision
• Make certain you have all necessary information
to make a proper decision.
• Consider alternatives.
• Do not be afraid to revise a decision if
• Anticipate questions and outcomes.
• Keep notes and other information for reference.
Nurses ethics check
• Is it legal?
– Does it violate law
– Does it violate
• Is it balanced?
– Is it fair to all
– Does it promote win-win
• How will it make me feel about myself
• 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
• Nurses may need to collaborate with others to
determine what information has been shared
with the patient and family.
• Evaluate their own personal and professional
values and reassess them
• Utilize principles that guide ethical decisionmaking in practice:
• Participate in interdisciplinary ethics committees
and ethics rounds
• 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
• Ethical Practice and Human Rights for consultation
and support in ethical decision-making processes.
• Decision-making in clinical nursing: investigating
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.
. 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.
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
• Ann Marriner Tomey, guide to nursing management and
leadership,8th edition,(2009);Mosbey, elsevier, Canada,page no
• 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