1. Making Decisions and Solving Problems

2. Learning Outcomes 1. Terms 2. Describe differences between decision making and problem solving. 3. Identify decision making models and theories. 4. Discuss the problem solving process. 5. Time Management

3. Decision Making Decisions are a means to an end. Used to achieve a goal. It will minimally disrupt operations. Help to achieve priorities. Is consistent with values, Is acceptable to those involved. Consider pros, cons, risks.

4. Planning Set goals Decide on a course of action. Develop rules and procedures. Forecasting the future of the organization

5. Use Critical Thinking Exam the data Use reason to make informed decisions Think “outside the box” Use for problem solving and decision making Uses reasoning Examinees questions and problems Weighs, clarifies and evaluate evidence Good chart on p. 87 in Finkelamn comparing critical think, decision making and problem solving.

6. Decision Making Purposeful and goal-directed effort using a systematic approach to choose from available options. Identification & selection of alternative resolutions. Essential skill for nursing practice, leadership, and management. Requires critical thinking- a high level cognitive process. Intellectually disciplined process of conceptualizing, applying, analyzing or evaluating information. (Paul, 1995) Improves with practice.

7. Decision Styles Systematic – form decisions logically with structured approach. Intuitive – trial-and-error,, the ‘gut” approach. Team decision making – “two heads are better than one”. Plan-Do-Study-Act Cycle

8. Problem Solving Also requires critical thinking. Includes a decision making step. Focused on resolving an immediate problem. Problem: “deviation” between expectations and actual performance. Creativity is essential for optimal problem solving.

9. Problem Solving Solving problems can enhance a positive work environment: More motivated staff Better attitudes about work Improved ability to think critically To create a solution between the gap of “what is” and “what should be.”

10. Clinical reasoning – the ability to reason as a clinical situation changes, and considering all those involved, such as the patient and family. Clinical Judgment – determine if published research is applicable to a specific patient or situation.

13. Phases of Decision Making 1. Defining objectives – identifying the “problem” 2. Collect all the data necessary 3. Generating options 4. Identifying advantages/disadvantages 5. Ranking options 6. Selecting an option 7. Implementing decision 8. Evaluation

14. Decision Model Theories Normative or Prescriptive information is objective routine decisions involved options known and predicable (Agency policies) Descriptive/Behavioral information is subjective non routine and unstructured decisions Solutions unknown or unpredictable Good for group decisions

15. Decision Model Theories Satisficing solution selected minimally meets objective. conservative method. Used when time is an issue. Optimizing solution selected maximally meets objective. decision is most “ideal” solution. typically results in a better decision. More time consuming.

16. Decision Making Styles Similar to Leadership Styles: Autocratic: decisions are independent of others input or participation “decide and announce”. rapid used in emergencies. encourages dependency in workers. can result in dissatisfied employees, high turnover, low creativity & motivation.

17. Decision Making Styles Democratic/Participative: decisions involve other personnel in the process. leads to increase work performance, productivity, and satisfaction. longer process. may decrease efficiency. Laissez-Faire: “hands-off”: manager stays out of most decisions. works well with dedicated employees. may be counter-productive when clear direction needed.

18. Factors Affecting Decision Making Internal FactorsExternal Factors Decision maker’s: emotional state physical state personal philosophy biases, values knowledge experience environmental conditions time available for decision availability of resources

19. Group Decision Making Two Criteria: Decision is of high quality- achieves the goals, objectives, & outcomes. Those responsible for implementing must accept the decision. “Two heads are better than one, five heads are even better.”

20. Group Decision Making Can result in more ideas & higher quality decisions, Workers involved- more productive, satisfied, & committed to solution, Involve multi-disciplinary teams when decisions effect different disciplines,

21. Group Decision Making More effective if members are: Actively involved Cohesive Use effective communication Understand the group process Generates more ideas

22. Decision Making Strategies Brainstorming Large number of potential solutions Enhanced creativity Interactive, share ideas Avoid “killer phrases” Nominal Group Technique All members can participate Write ideas without talking Take turns sharing ideas- no comments from group Discussion allowed after all ideas presented Each member ranks ideas Highest rank is final decision

23. Decision Making Strategies Focus Group Explore issues & generate information. Face to face meeting w/ facilitator. Ideas discussed; advantages/disadvantages. Delphi Techniques Collect data/opinions from experts. Operated in “rounds”, from varied locations. Opinions summarized, analyzed & rerouted to panel members. Consensus achieved after a number of rounds.

24. Decision Making Tools Decision Grid Compares alternatives visually (Yoder & Wisep.106) SWOT Analysis Strengths, Weaknesses, Opportunities, Threats

25. Learning Activity A unit manager must decide between 3 different infusion pumps. The Alpha-1 pump costs $2000 and can administer continuous and intermittent infusions. It has a 5 year warranty. The Beta-X costs $2800 and can administer both continuous and intermittent infusions plus patient controlled medications. It also has a 5 year warranty. The Gamma-300 costs only $1400 and can infuse fluids both intermittently and continuously. It’s warranty is only 1 year. What pump should the manager choose?

26. Problem Solving Trigger for action Before attempting a solution ask: Is it important? Do I want to do something about it? Am I qualified? Do I have authority? Do I have knowledge, time, resources? Can I delegate it? What are benefits of finding a solution?

27. Problem Solving Process

28. Data Collection Covered in Research

29. “One of the tests of leadership is the ability to recognize a problem before it becomes an emergency.” Arnold Glasgow

30. Time Management Good time management: 1. facilities productivity 2. decreases work-related stress 3. ensures quality of care 4. ensure appropriate prioritization of patient care Poor time management: 1. impairs productivity 2. feeling of being overwhelmed and stressed 3. creates dissatisfaction with care provided

31. Time Management Involves….. Organizing care to meet the patients’ needs. What must be done now? What must be done by a specific time? What must be done by the end of the shift – daily wound care, dressing change, discharge teaching? What can be delegated?

32. Time Savers and Time Wasters Hand out