Managerial problem Managerial problem &decision making&decision making

((Choosing the best and Choosing the best and appropriate alternative from appropriate alternative from

many alternatives which solve many alternatives which solve problem)problem)

Types of decisionsTypes of decisions

Ends-Means Decisions: "Ends" (i.e., Ends-Means Decisions: "Ends" (i.e., objectives) answer the question "what objectives) answer the question "what is to be achieved"? . "Means" is to be achieved"? . "Means" decisions (operational programs) decisions (operational programs) answer the question "how the answer the question "how the objectives will be achieved?objectives will be achieved?

Administrative-operational Administrative-operational decisions: "Administrative" (or decisions: "Administrative" (or policy) decisions are those made by policy) decisions are those made by senior managers. In contrast, senior managers. In contrast, "operational" decisions are generally "operational" decisions are generally made by mid-level and first – line made by mid-level and first – line managers about day-to day activities managers about day-to day activities of a unit.of a unit.

Programmable – nonprogrammable Programmable – nonprogrammable decisions: Programmable decisions decisions: Programmable decisions are repetitive and routine. Rules and are repetitive and routine. Rules and manuals are used as guide to such manuals are used as guide to such decisions. Nonprogrammable decisions. Nonprogrammable decisions are unique and non-routine decisions are unique and non-routine decisions which cannot be decisions which cannot be programmed. Such decisions occur programmed. Such decisions occur infrequently.infrequently.

Factors influencing problem – solving Factors influencing problem – solving

and decision makingand decision making

problem solver attributeproblem solver attribute

1. Knowledge, experience and 1. Knowledge, experience and judgment. The more the knowledge judgment. The more the knowledge and experience the better, the and experience the better, the decision. This coupled with decision. This coupled with judgment, which solve rational judgment, which solve rational thinking, may lead to very sound thinking, may lead to very sound decision which solve most problems. decision which solve most problems.

Manager perception and personalityManager perception and personality

Those who have narrow perspective Those who have narrow perspective (tunnel vision) will probably make lower (tunnel vision) will probably make lower quality decision than managers with broad quality decision than managers with broad perspective. Personality traits such as perspective. Personality traits such as nervousness, aggressiveness, instability, nervousness, aggressiveness, instability, self – assurance, self- confidence, self – assurance, self- confidence, preference for risk & change….etc., will preference for risk & change….etc., will influence the way a manger solves influence the way a manger solves problems and quality of his decisions.problems and quality of his decisions.

Values, ethics and moralsValues, ethics and morals

Managers who believe " the end Managers who believe " the end justifies the means" will stop at justifies the means" will stop at nothing to fulfill their objective, even nothing to fulfill their objective, even unethical means. The opposite is unethical means. The opposite is true of those with high morals and true of those with high morals and ethics.ethics.

The situationThe situation

1.Urgency of results, time pressure. 1.Urgency of results, time pressure.

Here decisions will be quick and less Here decisions will be quick and less sophisticated since immediate sophisticated since immediate decisions are required and cost of decisions are required and cost of delay is too great e.g. patients with delay is too great e.g. patients with medical crisis, an impending work medical crisis, an impending work stoppage ..etc.stoppage ..etc.

2. Magnitude and importance of the problem.2. Magnitude and importance of the problem.

The more important problems require The more important problems require greater attention and intensity of greater attention and intensity of evaluation than day to day operational evaluation than day to day operational decisions. Managers must be careful decisions. Managers must be careful that the cost of searching for an that the cost of searching for an alternative does not exceed its benefit alternative does not exceed its benefit except in humanitarian situation.except in humanitarian situation.

3. Structure, uncertainty, and risk.3. Structure, uncertainty, and risk.

Structure refers to the degree to which the Structure refers to the degree to which the situation is clear. The clearer and more precise situation is clear. The clearer and more precise problems hold less risk and therefore problems hold less risk and therefore outcomes can be more clearly predicted. outcomes can be more clearly predicted. Problem situations involving certainty imply Problem situations involving certainty imply that the manager has completed information that the manager has completed information and can predict the outcomes of alternatives and can predict the outcomes of alternatives considered. Incomplete information implies risk considered. Incomplete information implies risk because there is a high degree of uncertainty.because there is a high degree of uncertainty.

ContinueContinue..…..…

A second consideration involving A second consideration involving uncertainty is the distinction between uncertainty is the distinction between actions under the control of the decision actions under the control of the decision maker and what must be left to chance. maker and what must be left to chance. Every alternative outcome holds some Every alternative outcome holds some degree of uncertainty, however, the more degree of uncertainty, however, the more structured the problem and the more structured the problem and the more information available and the less the information available and the less the degree of uncertainty and chance degree of uncertainty and chance involvement the predictable will be the involvement the predictable will be the outcome.outcome.

3. Cost – benefit. Selection of alternatives will 3. Cost – benefit. Selection of alternatives will untimely depend to a great extent on untimely depend to a great extent on quantative cost – benefit and/ or qualitative quantative cost – benefit and/ or qualitative advantage- disadvantage criteria. Final advantage- disadvantage criteria. Final choices must not be too dependent on the choices must not be too dependent on the cost or quantative aspects at the price of the cost or quantative aspects at the price of the humanitarian aspect of the situation. Some humanitarian aspect of the situation. Some medical choices may not cost – beneficial medical choices may not cost – beneficial (i.e. kidney transplant) yet they are chosen (i.e. kidney transplant) yet they are chosen because of their humanitarian aspect.because of their humanitarian aspect.

The environment: (external and The environment: (external and internal)internal)

Problem solving may be classified asProblem solving may be classified as

prospective: if it is performed in prospective: if it is performed in anticipation (or prevention) of an events anticipation (or prevention) of an events that might cause organizational results that might cause organizational results to be inconsistent with those desired to be inconsistent with those desired ( prevent the occurrence of events that ( prevent the occurrence of events that might cause problems) prospective might cause problems) prospective problem solving requires the problem solving requires the performance of potential problem performance of potential problem analysisanalysis

Retrospective: when applied to Retrospective: when applied to deviations between actual and deviations between actual and desired results that have already desired results that have already occurred and existed for sometime.occurred and existed for sometime.

Concurrent: when the HSO is Concurrent: when the HSO is committed to a philosophy of committed to a philosophy of continuously improving quality and continuously improving quality and productivity through continuous productivity through continuous monitoring for early discovery and monitoring for early discovery and solution of problems.solution of problems.

Decision making ProcessDecision making Process

Phase 1 : Problem analysis (pre Phase 1 : Problem analysis (pre decision situation assessment steps). decision situation assessment steps). {step no. 1}{step no. 1}

Phase 2 : Decision making. {step no. Phase 2 : Decision making. {step no. 2&3}2&3}

Phase 3 : Implementation and Phase 3 : Implementation and evaluation ( post decision steps). evaluation ( post decision steps). {step no. 4&5}.{step no. 4&5}.

1-Identify the problem and analyze the situation: 1-Identify the problem and analyze the situation: What is wrong? Where is Improvement needed? What is wrong? Where is Improvement needed? When managers are concerned only with When managers are concerned only with infarction, they may be dealing with the effect infarction, they may be dealing with the effect

rather than the root cause of the problem, rather than the root cause of the problem, consequently, similar situations may continue.consequently, similar situations may continue.

Nurse managers can identify the problem by Nurse managers can identify the problem by analyzing the situation. The manager should have analyzing the situation. The manager should have a questioning attitude .a questioning attitude .

2- 2- Explore the alternativesExplore the alternatives: : There are usually There are usually a a

number of ways to solve a problem. When number of ways to solve a problem. When solving problem, the nurse manager should solving problem, the nurse manager should determine first whether the situation is determine first whether the situation is covered by policy. If it is not they must covered by policy. If it is not they must draw on their education and experiencedraw on their education and experience for for facts and concepts that will help them facts and concepts that will help them determine alternativesdetermine alternatives

3- Choose the most desirable alternative3- Choose the most desirable alternative

The number and quality of alternatives depend The number and quality of alternatives depend largely on the creativity and productivity of largely on the creativity and productivity of managers and their staff. Eagerness to reach managers and their staff. Eagerness to reach decision may lead to premature solutions. One decision may lead to premature solutions. One alternative is not clearly superior to all others. The alternative is not clearly superior to all others. The manager must try to balance such factors as manager must try to balance such factors as patient safety, staff acceptance, morale, public patient safety, staff acceptance, morale, public acceptance, cost, and risk of failure.acceptance, cost, and risk of failure.

4- Implement the decision4- Implement the decision

A decision that is not put into action is useless. The A decision that is not put into action is useless. The nurse manager will need to communicate the nurse manager will need to communicate the decision to appropriate staff associates in a decision to appropriate staff associates in a manner that does not arouse antagonism. The manner that does not arouse antagonism. The manager will need to control the environment. The manager will need to control the environment. The manager need to select the staff associate to manager need to select the staff associate to implement the decision and provide the direction implement the decision and provide the direction to initiate actionto initiate action

5- Evaluate the results5- Evaluate the results

Evaluative criteria may have to be Evaluative criteria may have to be developed. Audits, checklists, ratings, developed. Audits, checklists, ratings, and rankings can be used to review and rankings can be used to review and analyze the result.and analyze the result.

Creative decision makingCreative decision making

The creative process emphasizes The creative process emphasizes the uniqueness of the solution. the uniqueness of the solution. Creativity is a latent quality, activated Creativity is a latent quality, activated when a person becomes motivated by when a person becomes motivated by the need for self-expression or by the the need for self-expression or by the stimulation of a problem.stimulation of a problem.

1. Felt need1. Felt need::

When nurse manger confront with a When nurse manger confront with a problem, they start seeking a problem, they start seeking a solution.solution.

2. Preparation (work stage)2. Preparation (work stage)

from which creative ideas emerge. from which creative ideas emerge. Innovation is partially dependent in the Innovation is partially dependent in the number of the options considered. number of the options considered. Exploring relationship between potential Exploring relationship between potential solutions.. Extensive using the libraries for solutions.. Extensive using the libraries for data collection is useful; the creative data collection is useful; the creative person who take note on reading and person who take note on reading and develop the ideas then review it into new develop the ideas then review it into new answers.answers.

3. Incubation:3. Incubation: Is a period for pondering the situation. Is a period for pondering the situation.

Repetition of the same thoughts with no Repetition of the same thoughts with no new ideas or interpretation is a sign of new ideas or interpretation is a sign of fatigue and indicates that it is a good time to fatigue and indicates that it is a good time to start the incubation period. Switching ones start the incubation period. Switching ones attention provides a necessary respite, and attention provides a necessary respite, and yet the unconscious mind continuous to yet the unconscious mind continuous to deal with the problem. A time should be set deal with the problem. A time should be set to re examine the situation and review the to re examine the situation and review the data collected during the preparation phase.data collected during the preparation phase.

4. Illumination4. Illumination Discovery of the solution. It is Discovery of the solution. It is

recommended that the idea be recommended that the idea be written down so the details can be written down so the details can be preservedpreserved. .

5. Verification5. Verification: : It is a period of experimentation It is a period of experimentation

when the idea is improved throughwhen the idea is improved through

6-modification and refination.6-modification and refination. The advantage and disadvantage The advantage and disadvantage

must be weighed. successes and must be weighed. successes and constraints have to be evaluated, after constraints have to be evaluated, after that the manager can choose the most that the manager can choose the most desirable alternative.desirable alternative.

Creative nurse manager Creative nurse manager attributesattributes

1. Inner motivation.1. Inner motivation.

2. Mental ability.2. Mental ability.

3. Objectivity3. Objectivity

4.Tolerance for complexity4.Tolerance for complexity

5. Enjoyment for risk taking5. Enjoyment for risk taking

6.Ability to find problems6.Ability to find problems

Blocks to creativityBlocks to creativity 1. Negative attitudes1. Negative attitudes 2. Self censorship2. Self censorship 3. Lack of confidence3. Lack of confidence 4. Lack of effort4. Lack of effort 5. Habits5. Habits 6. Conformity6. Conformity 7.Reliance on authority7.Reliance on authority

Ethical positionsEthical positions

- Utilitarnism: Community oriented - Utilitarnism: Community oriented position that focuses on the position that focuses on the consequences and prefers the consequences and prefers the greatest amount of good and greatest amount of good and happiness for the most people. Or the happiness for the most people. Or the least amount of harm.least amount of harm.

- Egoism- Egoism : best for oneself without : best for oneself without regard for others.regard for others.

- Formalism- Formalism : Consider the nature : Consider the nature of the act and the related of the act and the related principles without thought to principles without thought to personal position on personal position on consequences of the action: be consequences of the action: be honesthonest

- Rules ethics- Rules ethics : Obedience to laws, : Obedience to laws, rules, professional codes, and rules, professional codes, and authority.authority.

- Fairness- Fairness : :Considers distribution of Considers distribution of benefits and liabilities from the benefits and liabilities from the viewpoint of the least advantaged viewpoint of the least advantaged population.population.

Decision-making toolsDecision-making tools

1. Probability theory: is a means of 1. Probability theory: is a means of predicting. It is a system of rules for predicting. It is a system of rules for analyzing a set of outcomes. analyzing a set of outcomes. Probability is the likely hood that an Probability is the likely hood that an event will occur, given all possible event will occur, given all possible outcome. It expressed as percent. outcome. It expressed as percent.

11-Gant chart: highly developed 11-Gant chart: highly developed schedules that allow one to visualize schedules that allow one to visualize multiple tasks that have to be done.multiple tasks that have to be done.

1V- Decision tree: is a graphic method 1V- Decision tree: is a graphic method that can help manager visualize the that can help manager visualize the alternatives available, outcomes risks, alternatives available, outcomes risks, and information needs for a specific and information needs for a specific problem over a period of time.problem over a period of time.

V- PERT Technique: recognizes that V- PERT Technique: recognizes that certain tasks must be completed and, certain tasks must be completed and, further, that subtasks must be completed further, that subtasks must be completed before others can be started.before others can be started.

T (e)=t(o)+4(tm) +t(p)/6T (e)=t(o)+4(tm) +t(p)/6 T o= Optimistic time.T o= Optimistic time. T m= the most likely time.T m= the most likely time. P m= the pessimistic time.P m= the pessimistic time. T e= the expected time.T e= the expected time.

ConsultationConsultation

It is a helping relationship. It is a It is a helping relationship. It is a process of interaction between the process of interaction between the consultant who has the specialized consultant who has the specialized knowledge and skills, and the consul knowledge and skills, and the consul tee, who asks for assistance with tee, who asks for assistance with problem solving.problem solving.

It has a beginning and an end is a It has a beginning and an end is a temporary, voluntary, educational temporary, voluntary, educational relationship. The consul tee identifies a relationship. The consul tee identifies a problem and seeks help from an expert. problem and seeks help from an expert. Usually the consultant not from the Usually the consultant not from the hierarchal structure of the hierarchal structure of the organization& The consultation organization& The consultation process Usually involve problem process Usually involve problem solvingsolving

The roles of the consultantThe roles of the consultant

Helping identifying problemHelping identifying problem Educating staff about related issuesEducating staff about related issues Identifying obstacles of problem solvingIdentifying obstacles of problem solving Offering advices how to solve problemOffering advices how to solve problem Acting as a change agentActing as a change agent Mediating conflictsMediating conflicts Developing interpersonal relationshipsDeveloping interpersonal relationships Performing tasks that organizational Performing tasks that organizational

members do not have the skill to performmembers do not have the skill to perform

The consultant typically collects and The consultant typically collects and

analyzes data, Recommends and analyzes data, Recommends and intervenes, and then terminate the intervenes, and then terminate the relationshiprelationship

Types of consultantsTypes of consultants

1. Internal consultant 1. Internal consultant

Knows the system, history, political Knows the system, history, political realities, norms, and language better realities, norms, and language better than an outside consultant and will than an outside consultant and will probably devote more time to the probably devote more time to the problem.problem.

I/C viewed as less costly. I/C viewed as less costly. Unfortunately Unfortunately

there are disadvantages to hiring there are disadvantages to hiring internal consultants.internal consultants.

They may be part of the problem,They may be part of the problem, Lack perspective to see the whole,Lack perspective to see the whole, Encounter resistance because of their Encounter resistance because of their

relationship with the hierarchy.relationship with the hierarchy.

2. External consultant:2. External consultant:

Has a more divers background, Has a more divers background, brings new ideas and a different brings new ideas and a different perspective to the situation, is perspective to the situation, is independent of the power structure, independent of the power structure, and consequently high powered .and consequently high powered .