Decision making is a choice made between two or

more alternatives.
It is choosing the best alternative to reach the
predetermined objective.
Thus decision making is a process of identifying and
selecting a course of action to solve specific
problem.
» Decisions made in the nursing service can be
categorized depending upon the following criteria:
» How much time the manager spends in making
decision
» What proportion of the organization must be
involved in making decision
» The organization function/ the nursing/midwifery
functions on which they focus
» On the basis of these there are three classifications:
» 1. Ends -Means
» 2. Administrative-Operational
» 3. Programmed-Non-programmed
1. End-Means:
Ends:
» deals with the determination of desired individual
or organizational results to be achieved

Means:
» decisions deal with strategic or operational
programmes, activities that will accomplish desired
results. These usually occur during managerial
planning processes, strategy and objective
formulation processes
2. Administrative-Operational
Administrative:
» made by senior management, which have
significant impact throughout the organization.
Usually this type of decision is concerned with
policy, resource allocation and utilization.
Operational:
» are generally made by mid level and first line
managers and address day to day operational
activities of a particular organization.
3. Programmed – Non-programmed.
Programmed:
» These are repetitive and routine in nature. Since
they can be programmed, procedures, rules and
often manuals are formulated to cover those
situations.
None programmed:
» unique and non- routine
» Opportunity/threat
» Crisis
» Deviation
» Improvement
» Relying on tradition: taking the same decisions that
had been undertaken when similar problem arouse
in the past
» May appeal to authority and make decisions based
on suggestions from an expert/a higher level
management
» Priori reasoning: based on assumption
» Logical decision making: is a rational, intelligent
and systematic approach to decision making
1. Investigating the situation
• Define the problem
• Identify the problem objective
• Diagnose the cause
2. Develop alternatives
3. Evaluate alternatives
4. Implement and follow up
1. Decision makers attribute
• Knowledge, experience, and judgment
• Perception and personality
• Values and philosophy
2. The Situation
• Urgency of solution and time pressures
• Magnitude and importance
• Structure and uncertainty and risk
• Cost benefit
3. Environmental Constraints
• External & Interna
The activities of the problem solver, the nature of
the situation and the environmental constraints
influence how decision is done; resource spent in
performing it, and the quality of the ultimate
decision. However, these influences are not
mutually exclusive. Managers should recognize
these attributes and be sensitive to the factors that
affect decision-making, change their method as
appropriate, modify and mitigate detrimental
influences when possible, and cope with those that
cannot be changed. In this way, they will improve
the quality of decision-making.
» Convergent thinking: the problem is divided into
smaller and smaller pieces to find a more
manageable perspective.
» Divergent thinking: One's view of the problem is
expanded. The problem is considered in different
ways
» Brain storming: under favorable circumstances a
group working together can identify more ideas
than an individual or the group of individuals
working separately. It is a technique managers
can use to create a free flow of ideas
» There is always some uncertainty in making
decisions. However, management analysts have
developed tools that provide some order and
direction in obtaining and using information or that
are helpful in selecting who should be involved in
making the decision. Because there are so many
decision aids, this topic presents selected
technology that would be most helpful to
beginning- or middle-level managers, including
decision grids, pay-off tables, decision trees,
consequence tables, logic models, and program
evaluation and review technique (PERT).
» It is important to remember, though, that any decision-
making tool always results in the need for the person to
make a final decision and that all such tools are subject
to human error. Beinhocker, Davis, and Mendonca (2009,
p. 58) agree, suggesting that while “data, computing
power, and mathematical models have transformed
many realms of management from art to science,” that
the economic downturn experienced worldwide late in
the first decade of the 21st century, pointed out the folly
of the reliance by banks, insurance companies, and other
“on financial models that assumed economic rationality,
linearity, equilibrium, and bell-shaped
distributions.” Beinhocker et al. point out that while it
would be wrong to eliminate the use of such tools, they
caution managers to “look inside the black boxes that
advanced quantitative tools often represent” so that
they can better understand their functioning,
assumptions, and limitations
» The decision aids known as payoff tables have a cost-
profit-volume relationship and are very helpful when
some quantitative information is available, such as an
item’s cost or predicted use. To use payoff tables, one
must determine probabilities and use historical data,
such as a hospital census or a report on the number of
operating procedures performed. To illustrate, a payoff
table might be appropriately used in determining how
many participants it would take to make an in-service
program break even in terms of costs.
» If the instructor for the class costs $400, the in-service
director would need to charge each of the 20 participants
$20 for the class, but for 40 participants, the class would
cost only $10 each. The in-service director would use
attendance data from past classes and the number of
nurses potentially available to attend to determine
probable class size and thus how much to charge for the
class. Payoff tables do not guarantee that a correct
decision will be made, but they assist in visualizing data.
» A decision grid (aka Pugh method/grid analysis or the
multi-attribute utility theory) allows one to visually
examine the alternatives and compare each against the
same criteria. Although any criteria may be selected, the
same criteria are used to analyze each alternative. When
many alternatives have been generated or a group or
committee is collaborating on the decision, these grids
are particularly helpful to the process. This tool, for
instance, would be useful when changing the method of
managing care on a unit or when selecting a candidate
to hire from a large interview pool. The unit manager or
the committee would evaluate all of the alternatives
available using a decision grid. In this manner, every
alternative is evaluated using the same criteria. It is
possible to weight some of the criteria more heavily
than others if some are more important. To do this, it is
usually necessary to assign a number value to each
criterion. The result would be a numeric value for each
alternative considered.
» Because decisions are often tied to the outcome of
other events, management analysts have
developed decision trees.
» The decision tree are graphic decision making tools
used to evaluate decisions containing a series of steps.
» Consequence tables demonstrate how various
alternatives create different consequences.
» A consequence table lists the objectives for solving a
problem down one side of a table and rates how each
alternative would meet the desired objective.
» For example, consider this problem: “The number of
patient falls has exceeded the benchmark rate for two
consecutive quarters.” After a period of analysis, the
following alternatives were selected as solutions:
» 1. Provide a new educational program to instruct
staff on how to prevent falls.
» 2. Implement a night check to ensure that
patients have side rails up and beds in low position.
» 3. Implement a policy requiring soft restraints
orders on all confused patients.
» The decision maker then lists each alternative
opposite the objectives for solving the problem,
which for this problem might be (a) reduces the
number of falls, (b) meets regulatory standards, (c) is
cost-effective, and (d) fits present policy guidelines.
The decision maker(s) then ranks each desired
objective and examines each of the alternatives
through a standardized key, which allows a fair
comparison between alternatives and assists in
eliminating undesirable choices. It is important to
examine long-term effects of each alternative as well
as how the decision will affect others
» Logic models are schematics or pictures of how
programs are intended to operate. The schematic
typically includes resources, processes, and desired
outcomes and depicts exactly what the relationships
are between the three components. Scheirer (2009)
says that logic models can be used to better
understand and specify project elements in project
planning; for monitoring and improving project
implementation in project management; for
communicating and building consensus; for
demonstrating assumptions in line of reasoning; for
suggesting measures needed for project evaluation;
and for improving communications.
» Program Evaluation & Review Technique is a popular
tool to determine the timing of decisions. Developed by
the Booz-Allen- Hamilton organization and the U.S. Navy
in connection with the Polaris missile program, PERT is
essentially a flowchart that predicts when events and
activities must take place if a final event is to occur.
Figure 1.5 shows a PERT chart for developing a new
outpatient treatment room for oncology procedures.
The number of weeks to complete tasks is listed in
optimistic time, most likely time, and pessimistic time.
The critical path shows something that must occur in the
sequence before one may proceed. PERT is especially
helpful when a group of people is working on a project.
The flowchart keeps everyone up-to-date, and problems
are easily identified when they first occur. Flowcharts are
popular, and many people use them in their personal
lives.
» Is the problem easy to deal with?
Tip: avoid being bogged down in trivial details.
Effective managers reserve decision making techniques
for problems that require them.

» Might the problem resolve itself?

Tip: prioritize and rank problems in order of
importance
» Is it my decision?
Tip: the closer to the origin of the problem the
decision is the better. Before deciding ask the following
questions:
• Does the issue affect other departments?
• Will it have a major impact on the superior's area of
responsibility?
• Does it need further information from higher level?
• Does it involve serious breach of my department’s
budget?
• Is this problem outside my area of responsibility or
authority?
If the answer to any of these questions is 'YES' pass it to
your superior.
» 1. Easy recall: the more easily can recall the event, the
more frequently they believe it occur
» 2. Easy search: not to put effort to seek information
from the appropriate sources
» 3. Misconception of chance: Most people do not
understand the nature of random events
» 4. Confirmation gap
» 5. Relaxed avoidance: the manager decides not to
decide or act after noting that the consequences of
inaction will not be serious
» 6. Defensive avoidance: Faced with a problem and
unable to find a good solution based on past
experience, this manager seeks a way out. He/she
may let someone else make decisions. This resigned
posture may prevent consideration of more viable
alternatives.
» 7. Panic: the manager feels pressurized not only by
the problem but also time
» 1. Setting priority

» 2. Acquiring relevant information

» 3. Proceeding methodically and carefully