nursing Management ad Administration decision making

1. DECISION MAKING
PRESENTED BY:
Ms. Haranjan Kaur
M Sc. (N),2nd year
Critical Care Nursing
CON, DMC&Hospital
GUIDED BY:
Mrs. Sandeep Saini
Prof. CHN, CON, DMC& Hospital

2. DEFINITION
• Decision making is a complex, cognitive process
often defined as choosing a particular course of
action. - Webster’s
• Decision making is a necessary component of
leadership, power, influence, authority and
delegations. -John 1993

3. DEFINITION (contd..)
• Decision making as a systematic, sequential
process of choosing among alternatives & putting
the choice to action. -Lancaster & Lancaster
• Decision making is a conscious, intellectual activity
involving judgement, evaluation and selection
from among several alternatives.
. -Claude

4. DEFINITION (contd..)
• Problem solving- Problem solving is a part of
decision making. A systematic process that
focuses on analyzing a difficult situation,
problem solving always includes a decision
making step.

5. DIFFERENCE BETWEEN PROBLEM
SOLVING & DECISION MAKING
• Decision making can occur without the full
analysis required in problem solving.
• Problem solving attempts to identify the root
problem in situations, much time & energy is
spent on identifying the real problem.
• Decision making, on the other hand, is usually
triggered by a problem but is often handled in
a manner that does not eliminate the
problem.

6. TYPES OF DECISION…
Mechanistic decision
Analytical Decision
Judgmental Decision
Adaptive Decision

7. Mechanistic Decision
• routine & repetitive in nature.
• usually occurs in situation involving a limited
number of decisions variables where the
outcome of each alternative is known.
• solves problems by habitual responses.
• useful in daily routine & scheduled activities.
• Tools used for these kinds of decisions are
charts, list, decision tree etc.

8. Analytical Decision
• This decision helps to solve complex
problems.
• It involves a problem with a large number of
decision variables, where the outcome of each
decision alternative can be computed.

9. Judgmental Decision
• It involves a problem with a limited number of
decision variables, but the outcomes of
decision alternatives are unknown.
• It is useful in marketing, investment & to solve
personal problems.

10. Adaptive Decisions
• It involve a problem with a large number of
decision variables, where outcomes are not
predictable.
• Such ill structured problems require
contribution of many people with diverse
technical background. Eg. Research finding.

11. Nursing Administration Decision Making
a. Non routine decision: made by directors of
nursing. The outcome of the problem will be
unpredictable. Eg. Changing ways of organizing
for the delivery of nursing care.
b. Routine Decision: made by mid level and low
level managers the outcome will be predictable.
Eg. Assigning the duty roster, assign the security
laws.

12. Decisions: Categories
• Routine Decisions: Involve no extraordinary judgement,
analysis and authority, since they are dealing with less
important problems. Routine decisions demand power to
select the shortest path, within the given means and ends.
• Strategic Decisions: Aim at determining or changing the
means and ends of the enterprise. They require a thorough
study, analysis and reflective thinking on the part of
administrators.
 Strategic decisions : taken by top managers,
 Routine decisions: by lower level managers.

13. Decision Strategies
A strategy is an artful or clever plan for applying techniques to
achieve any goal. Before selecting any method of decision
making, manager should adopt a decision strategy:
 Optimizing: in this, an individual analyses a problem,
determines desired outcomes, identifies possible solutions,
predicts the consequences of each action, and selects the
course that yields the greatest amount of preferred
outcomes.

14. Decision Strategies Cont……
 Satisfying: it is in this approach, whereby an
individual chooses a problem solutions, and
then select best of remaining options.

15. Decision Strategies Cont……
 Mixed Scanning: making a decision that
satisfies to remove least promising solutions,
then select best of remaining options.
 Opportunistic: making a decision for the
solution chosen by problem identifier.
 Do nothing: Taking decision after waiting the
storm to pass.
 Eliminate Critical Limiting Factors: by
removing most powerful obstacle to success.

16. Decision Strategies Cont……
 Maxima: an optimistic approach in which the
individual chooses that action alternative that will
provide the maximum output.
 Mini regret: an approach designed to minimize the
surprise resulting from any action decision by selecting
the action alternative that will provide a result midway
between the most desired & the least desired
outcomes.

17. Decision Strategies Cont……
 Precautionary: By choosing action that will maximize gain
or minimize loss regardless of opponent's actions. It is
useful when the manager engages in a zero sum conflict
with another.
 Evolutionary: individual has to make series of small
changes leading towards goal. It is based on the
assumption that subordinates can better adjust to a series
of small changes than a quantum leap.

18. Decision Strategies Cont……
 Chameleon: Taking a decision by making a
vague plan, adjusted to changing circumstances.
It consists of framing management decisions in
general terms, so that they can be interpreted
differently at different times.

19. Basis/Aids for Decision Making
Experience
Authority
Facts
Intuition
Research and analysis
Experimentation

20. Factors affecting Decision
Making
Internal factors
• Decision makers physical and
emotional status
• Personal characteristics and
values
• Past experience and interest
• Knowledge and attitude
• Self awareness and courage
• Energy and creativity
• Resistance to change
• Sensitivity and flexibility
External factors
• Cultural env.
• Philosphical env.
• Social background
• Time
• Poor communication
• Cooperation
• Coordination

21. Steps in Decision Making
1. Making
the
diagnosis
2. Analysing
the
problem
3.Searching
alternative
solutions
4. Selecting
best
possible
solution
5. Putting
the decision
into effect
6. Following
up the
decision

22. 1. Making the diagnosis
• First step is to determine what the real problem
is?.
• If the problem is not ascertained correctly at the
beginning, money and effort spent on the
decision making will be a waste. The original
situation will not come under control. But new
problems will start from this incorrect appraisal
of the situation.

23. 2. Analysing the problem
• Done to find out adequate background
information and data relating to the situation.
• This analysis may provide the manager with some
revealing circumstances that will help him to gain
an insight into the problem.
• The whole approach should be based around the
important factors. Only pertinent and closely
connected factors are selected, as dictated by the
principle of the limiting or strategic factor.

24. 3.Searching alternative solutions

25. 4. Selecting best possible solution
• Select one of the best course of action among the
several alternatives developed;
• requires an ability to draw distinctions between
tangible and intangible factors as well as facts
and guesses.
• Instead of picking the best solution managers
have to really on a course of action that is
satisfactory enough under the existing
circumstances and limitations.

26. 5. Putting the decision into effect
• Decisions can be made effective through the
action of other people.
• In order to overcome the opposing on the part
of employee’s managers can make 3
important preparations.
a. Communication of decisions
b. Securing employee acceptance
c. The timing of decisions

27. 6. Following up the decision
• As a safe guard against the incorrect decisions
managers are required to maintain a system of
follow up care of the decisions, so as to
modify the at the earliest.

28. Decision making authorities
Individual
Group
Committees

29. MODELS OF DECISION MAKING
• Descriptive model
• Econological model or economic man
• Bounded rationality model or administrative man
• The normative model
• The decision tree model
• Simplicity favorite model or view of Games man
• The strategic model
• Optimizing model
• Satisfying model

30. Descriptive model
Simon developed the descriptive model based
on the assumption that the decision maker is
a rational person looking for acceptable
solutions based on known information.

31. STEPS IN DESCRIPTIVE MODEL INCLUDE….
1.Establish
acceptable goal.
2.Define subjective
perceptions of the
problem
3.Identify acceptable
alternatives
4.Evaluate each
alternative
5.Select alternative
6.Implement
decision.
7.Follow up

32. ECONOLOGICAL MODEL
It is an ideal view of ‘economic man’, in which
the manager is faced with a problem weights
the economic aspects of all possible courses of
action & chooses the action that is giving
greatest net gain or the least loss.

33. ECONOLOGICAL MODEL Cont…..
Discover Symptoms
Set goals or develop criterion
define problem
Develop alternatives
Determine Select alternatives
all outcomes
act or implement
decision

34. BOUNDED RATIONALITY MODEL
It is the pragmatic view of ‘Administrative man’. In this the
people seek a king of bounded or limited rationality in
decisions. It has 3 mechanisms as given below:
1) Sequential attention to alternatives: here, persons
examine possible solution of a problem sequentially, i.e. if
first solution fails to work it is discarded & next solution is
considered till he gets acceptable solutions & discontinued
after acceptable ones.

35. BOUNDED RATIONALITY MODEL
cont………..
2) Heuristics: A heuristic is a rule which guides the search for
alternatives into areas that have a high probability for
yielding satisfactory solutions.
Accordingly, the decision makers use heuristics to reduce
large problems to manageable proportions, so that the
decision can be made rapidly.
They look for obvious solutions or previous solutions that
worked in similar situations.

36. BOUNDED RATIONALITY MODEL
cont………..
3) Satisfy: This model sees decision maker in a
satisficer. Where an alternative is satisfactory if:
a) There exists a set of criteria that describes
minimally satisfactory alternatives
b) The alternative in question meets or exceeds
all these criteria.

37. Normative Model
• At least 200 years old. It is assumed to
maximize satisfaction and fulfills the “perfect
knowledge assumption” that” in any given
situation calling for a decision, all possible
choices and the consequences and potential
outcome of each are known.”

38. 7 steps of Normative Model
Define and
analyze the
problem
Identify all
available
alternatives
Evaluate
the pros
and cons of
each
alternative
Rank the
alternatives
Select the
alternative
that
maximizes
satisfaction
Implement Follow up

39. Decision Tree
Decision point 1
A1
A2
A3
A4
Alternatives
Chance events Probable consequences

40. Tools of Decision Making
• Judgemental technique
• Operational research technique
• Delphi technique
• Decision tree

41. Advantages of Decision Making
It is Characterized by order and direction that enables managers to
determine where they are.
Provide framework data gathering which is relevant to the decision.
Allows application of previous knowledge and experience that minimize
errors and improve quality of patient care and work of an organization.
Increase manager’s confidence and ability in making decisions.

42. Pitfalls of decision making
• Inadequate fact finding
• Time constraints
• Poor communication
• Failing to systematically
follow the steps of the decision making process

43. Improving Decision Making
• Educating people so they know how to make decision
• Securing support of top management for decision
making at the lowest possible level
• Establishing decision making check points with
appropriate time limits
• Keeping informed of progress by ensuring access to
first hand information
• Using statistical analysis when possible to pinpoint
problems for solution
• Staying open to use of new ideas or technologies in
analyzing problems& identifying alternatives.

44. Strategies in decision making & policy
development
• Decentralization to the unit level
• Committee systems- Opportunity is provided
for nurse participation on inter-departmental,
interdisciplinary & institution-wide
committees with knowledge that collectively
made decisions are more apt to be collectively
implemented & supported.

45. Strategies in decision making & policy
development (contd…)
• Governance systems- The theory of participative
management could be operationalized as
management by committees instead of by nurse
managers.
• Each committee has coordination responsibilities
for specific management tasks. This system
requires voluntary support & respect for the
clinical management role of peers & places
control of nursing practice in the hands of
professional nurses.

46. Individual variations in decision
making
• Values & decision making-Individual decisions
are based on each person’s value system.
Values also determine which problems in
one’s personal or professional life will be
addressed or ignored.

47. Individual variations in decision
making(contd…)
• Life experiences & decision making-Each
person brings to the decision making task
past experiences that include education &
decision making experience.The more mature
the person & the broader his or her
background,the more alternatives they can
identify.

48. Individual variations in decision
making(contd..)
• Individual preference & decision making-
Physical, economic & emotional risks & time &
energy expenditures are types of personal risk
& costs involved indecision making.
• Individual ways of thinking & decision
making- Evaluating information & alternatives
to arrive at a decision is a thinking skill.
Individuals think differently. The way one
thinks has much to do with individual problem
solving & decision making

49. Decision making in Nursing
As heath care becomes increasingly customer oriented, nurses are
responding by establishing close patient care advocated
relationships. Sound decision making is the foundation needed to
advance professional practice. The decision maker must:
a) Assess the situation
b) Plan the process
c) Implement the decision
d) Evaluate the outcome of the decision

50. Summary & conclusion….
• Decision making & problem solving occur
concurrently with all major functions of nursing
management. While problem solving is not the
exact equivalent of decision making, it employs a
similar thinking process. Decision making is
different from problem solving in that the
objective does not have to pertain to a problem.
It can be an objective that relates to change, to
progress, to research,& to implementation of any
operational or management plan .

51. THANK
YOU…..