1. NUR 425 Decision Making in Clinical Practice
Lecture 3
Decision-Making
Techniques & Methods

2. Main objectives:
Describe the fundamentals of decision making techniques, necessary to balance decisions.
Differentiate among the key decision-making techniques.
Explain the different decision making methods and differentiate among the situations necessitate each of the methods.
Apply from the techniques and methods on the recommended clinical situations/case studies

3. Techniques for better decision-making
Nominal Group Think
Delphi Technique
Stepladder Technique
Pareto Analysis
Grid Analysis

4. Techniques for better decision-making
NOMINAL GROUP THINK
The NGT is designed to help all team members participate and express opinions while still building team consensus
The nominal group technique is a structured decision making process in which group members are required to compose a comprehensive list of their ideas or proposed alternatives in writing
NGT is designed to help with group decision making by ensuring that all members participate fully.

5. Techniques for better decision-making
NOMINAL GROUP THINK
NGT follows these steps:
7-10 individuals are brought together to participate in a structured exercise that includes the following steps:
Team members are presented with a problem, challenge or issue
Individual team members silently and independently write down their ideas about how to tackle the problem.
Each team member (one at a time, in round-robin fashion) presents an idea to the group.
Individuals silently and independently vote on each idea.

6. Techniques for better decision-making
2. DELPHI TECHNIQUE
Another technique which capitalises group's resources, while avoiding several possible disadvantages of relying on group decision-making processes
This approach, called the Delphi Technique, is similar to NGT in several respects, but also differs significantly in that the decision-makers never actually meet.
Its greatest advantage is that it avoids many of the biases and obstacles associated with interacting groups (that is, groups where the members meet face-to-face)

7. Techniques for better decision-making
2. DELPHI TECHNIQUE
DELPHI follows these steps:
Select a group of individuals who possess expertise in a given problem area
Survey the experts for their opinions via a mailed questionnaire.
Analyze the experts' responses.
Mail the summarised results of the survey to the experts and request that they respond once again to a questionnaire.
If one expert's opinion sharply differs from the rest, he or she may be asked to provide a rationale.
process is repeated several times, the experts usually achieve a consensus

8. Techniques for better decision-making
3. STEPLADDER TECHNIQUE
A problem-solving structure recently proposed as a solution to the problem of unequal participation in groups
The technique is intended to improve group decision-making by structuring the entry of group members into a core group.
encourages all members to contribute on an individual level before being influenced by anyone else
This results in a wider variety of ideas, it prevents people from "hiding" within the group, and it helps people avoid being "stepped on" or overpowered by stronger, louder group members.

9. Techniques for better decision-making
STEPLADDER TECHNIQUE
Step 1: Before getting together as a group, present the task or problem to all members. Give everyone sufficient time to think about what needs to be done
Step 2: Form a core group of two members. Have them discuss the problem.
Step 3: Add a third group member to the core group. The third member presents ideas to the first two members BEFORE hearing the ideas that have already been discussed.

10. Techniques for better decision-making
STEPLADDER TECHNIQUE
Step 4: Repeat the same process by adding a fourth member, and so on, to the group. Allow time for discussion after each additional member has presented his or her ideas.
Step 5: Reach a final decision only after all members have been brought in and presented their ideas.

11. Techniques for better decision-making
4. PARETO ANALYSIS - Choosing the Most Important Changes to Make
Pareto analysis is a formal technique for finding the changes that will give the biggest benefits. It is useful where many possible courses of action are competing for your attention.

12. Techniques for better decision-making
PARETO ANALYSIS
How to Use the Tool:
write out a list of the changes you would make
score the items or groups. The scoring method you use depends on the sort of problem you are trying to solve.
The first change to tackle is the one that has the highest score. This one will give you the biggest benefit if you solve it.

13. Techniques for better decision-making
GRID ANALYSIS
Also known as Decision Matrix Analysis
Making a decision by weighing up different factors
A useful technique to use for making a decision. It's particularly powerful where you have a number of good alternatives to choose from, and many different factors to take into account.

14. Techniques for better decision-making
5. GRID ANALYSIS
Factors:
Cost
Board
Storage
Comfort
Fun
Look
Total
Weights:
Sports Car 1 3
SUV/4x4 2
Family Car
Station Wagon
Factors:
Cost
Board
Storage
Comfort
Fun
Look
Total
Weights: 4 5 1 2 3
Sports Car 9 12 27
SUV/4x4 15 28
Family Car 8 10 6 25
Station Wagon 36

15. Decision Making Methods

16. Decision-making methods
Decision made by Authority
Decision by Expert
Decision by Averaging Individual’s Opinion
Decision made by authority after group discussion
Decision by Minority
Decision by Majority vote
Decision by Consensus

17. Decision-Making Methods
METHOD 1 – DECISION MADE BY AUTHORITY
(without group decision)
Process:
The designated leader makes all decisions without consulting group members
STRENGTHS
WEAKNESSES
Takes minimal time to make
decision
No group Interaction
Familiarity - commonly used in
organizations
Team may not understand the decision or be unable to implement it
High on assertiveness scale
Low on cooperation scale

18. Decision-Making Methods
METHOD 2 – DECISION BY EXPERT
Process:
Select the expert from group, let the expert consider the issues, and let the expert make decision
STRENGTHS
WEAKNESSES
Useful when one person on the
team has the overwhelming
expertise
Unclear how to determine who the
expert is (team members may have different opinions)
No group interaction
May become popularity issue or
power issue

19. Decision-Making Methods
METHOD 3 – DECISION BY AVERAGING INDIVIDUAL’S OPINION
Process:
Separately ask each team member his/her opinion and average the results.
STRENGTHS
WEAKNESSES
Extreme opinions cancelled out
No group interaction, members are
not truly involved in the decision
Error typically cancelled out
Opinions of least and most
knowledgeable members may cancel
Group members consulted
Commitment to decision may not be
strong
Useful when it is difficult to get the
team together to talk
May damage future team
effectiveness
Urgent decisions can be made

20. Decision-Making Methods
METHOD 4 – DECISION MADE BY AUTHORITY AFTER GROUP DISCUSSION
Process:
The team creates ideas and has discussions, but the designated leader makes the final decision. The designated leader calls a meeting, presents the issue, listens to discussion from the team, and announces her/his decision.
STRENGTHS
WEAKNESSES
Team used more than methods 1–3
Team is not part of decision
Listening to the team increases the
accuracy of the decision
Team may compete for the leader’s
attention
Commitment from the team to the decision may not be strong

21. Decision-Making Methods
METHOD 5 – DECISION BY MINORITY
Process:
A minority of the team, two or more members who constitute less than 50% of the team, make the team’s decision
STRENGTHS
WEAKNESSES
Method often used by executive
committees
Still may not have commitment
from team to decision
Method can be used by temporary
May not have full team commitment to decision
Useful for large number of
decisions and limited time
Some team perspective and
discussion

22. Decision-Making Methods
METHOD 6 – DECISION BY MAJORITY VOTE
Process:
This is the most commonly used method in the United States (not synonymous with best method). Discuss the decision until 51% or more of the team members make the decision.
STRENGTHS
WEAKNESSES
Useful when there is insufficient time
to make decision by consensus
Full group interaction is not obtained
Useful when the complete team-
member commitment is unnecessary
for implementing a decision
Team is viewed as the “winners and the losers”; reduces the quality of decision
Minority opinion not discussed and
may not be valued
May have unresolved and
unaddressed conflict

23. Decision-Making Methods
METHOD 7 – DECISION BY CONSENSUS
Process:
Collective decision arrived at through an effective and fair communication process (all team members spoke and listened, and all were valued).
STRENGTHS
WEAKNESSES
Most effective method of team
decision making
Takes more time than methods 1–6
All team members express their
thoughts and feelings
Team members “feel understood”
Active listening used

24. Thank you for listening
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