PADMASHREE INSTITUTE OF NURSING. M.Sc.

NUrsing II years (2009-2011 batch)

DECISION MAKING

Definition:

Decision making can be regarded as the mental processes (cognitive process) resulting in the
selection of a course of action among several alternatives. Decision making is the process of
selecting one course of action from alternatives.

Stages of Decision making:

Developed by B. Aubrey Fisher, there are four stages that should be involved in all group
decision making. These stages, or sometimes called phases, are important for the decision-
making process to begin
 Orientation stage- This phase is where members meet for the first time and start to get to
know each other.
 Conflict stage- Once group members become familiar with each other, disputes, little
fights and arguments occur. Group members eventually work it out.
 Emergence stage- The group begins to clear up ambigiuity in opinions is talked about.
 Reinforcement stage- Members finally make a decision, while justifying themselves that
it was the right decision.

Principles of decision making:

1. Purpose-Driven. People need a reason to participate in the process.

2. Inclusive, Not Exclusive. All parties with a significant interest in the issues should be
involved in the collaborative process.
3. Educational. The process relies on mutual education of all participants.
4. Voluntary. The parties who are affected or interested participate voluntarily.
5. Self-Designed. All parties have an equal opportunity to participate in designing the
collaborative process. The process must be explainable and designed to meet the
circumstances and needs of the situation.
6. Flexible. Flexibility should be designed into the process to accommodate changing
issues, data needs, political environment, and programmatic constraints such as ptime and
meeting arrangements.
7. Egalitarian. All parties have equal access to relevant information and the opportunity to
participate effectively throughout the process.
8. Respectful. Acceptance of the diverse values, interests, and knowledge of the parties
involved in the collaborative process is essential.
9. Accountable. The participants are accountable both to their constituencies and to the
processthat they have agreed to establish.
10. Time Limited. Realistic deadlines are necessary throughout the process.
11. Achievable. Commitments made to achieve the agreement(s) and effective monitoring
are essential.

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

MITHUN
PADMASHREE INSTITUTE OF NURSING. M.Sc. NUrsing II years (2009-2011 batch)

STEPS IN DECISION MAKING:

The decision making task can be divided into 7 steps which are stated in order of
sequence are as

1. Establishing goal and objectives

2. Making the diagnosis
3. Analyzing the problem
4. Searching alternative solution
5. Selecting the best possible solution
6. Putting the decision into effect
7. Following up the decision
1. Establishing goal and objectives: goal and objectives can be set prior to beginning the
general process. They will answer the question, what do we want the outcome or
results of this decision to be? When new products or services are the outcome, goals
and objectives are established first and problems or decision are then forecast.
2. Making the diagnosis: the 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 problem will start from this incorrect appraisal of the situation. The
diagnosis should not be merely based on one or more visible symptoms but it should
be diagnosed after the whole situation.
3. Analyzing the problem: The problem should be analysed 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. A thorough information search include knowledge of organizational
policy, prior personal experience or training or the experience of others. From the
information gathered, the facts should be identified and separated so as to provide the
solid foundation for making sound decision.
4. Searching alternative solution: after analysing the problem, attempts are made to find
alternative solutions to the problems comparing the potential solutions to the desired
outcome to available resources. Establishing goals with measurable objectives helps
to focus the search the alternatives. This search for alternatives forces the manager to
see things from many view points and to study cases from their proper perspectives.
When comparing potential alternatives, one should certainly consider the cost, time
required and available, and the capabilities of those who will be involved in
implementating a decision.

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

MITHUN
PADMASHREE INSTITUTE OF NURSING. M.Sc. NUrsing II years (2009-2011 batch)

5. Selecting best possible solution: the selection of one best course of action, out of
several alternatives developed, requires an ability to draw distinction between
tangible and intangible factors as well as facts and guesses. Four criteria suggested by
Drucker for choosing the best possible solution are as
 Proportion of risk to the expected gain
 Relevance between the economy of effort and the possibility of
results
 The time consideration that meet the needs of the situation
 The limitation of resources
6. Putting the decision into effect: even the best decision may become inoperative due to
the opposition of employees. The decision can only be made effective through the
action of the people. To overcome the resistance or opposition in the employees,
managers must make necessary preparations for putting the decision into effect. Three
important things related to preparation of this are
 Communication of decision
 Securing employees acceptance
 Timing of decision
7. Follow up the decision for evaluation: inspite of all efforts, the decision taken may
not be accurate mainly because of two reasons:
 Some amount of guesswork becomes inevitable in almost every decision.
Because of the cost and time involved in analyzing the problem.
 Wrong decision also arise from the limited capacity of the manager itself

The 9 step decision making model is proposed by David Welsh in his book 'Decisions,
Decisions'.
The 9 step decision making model
Step 1 - Identify your objective

What is it you wish to achieve?

Step 2 - Do a preliminary survey of your options

Besides the most obvious choices available to you, what other kinds of options can you think of?
Step 3 - Identify the implicated values
What values are at stake here? If it's an easy or unimportant decision you may not necessarily do
this step. But if the decision has a major impact on your wealth, your health or self-respect, then
it's useful to be aware of it.

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

MITHUN
PADMASHREE INSTITUTE OF NURSING. M.Sc. NUrsing II years (2009-2011 batch)

Step 4 - Assess the importance of the decision

The importance of the decision will determine how much you invest in it in terms of time, energy
and money. The importance is determined by examining the implicated values.
You may also have to consider the context here as well, a different situation or environment can
mean that a decision that is often not very important can become very significant.

Step 5 - Budget your time and energy

Having identified the main alternatives and the values, now decide on which time and energy to
spend making the decision itself. More important decisions are given more time and energy. He
suggests that busy people and nervous wrecks made worse decisions than other people.

Step 6 - Choose a decision making strategy

This step of the 9 step decision making model involves making another decision. The time and
energy you plan to devote will affect the strategy you choose.

And because the strategy you choose may profoundly affect your decision it's important to
choose an appropriate one.

Step 7 - Identify your options

When you examine your options in more detail you may discover other options with different
implicated values. He points out that occasionally you may have to go back to step three to five
and make revisions.

Step 8 - Evaluate your options

This is where you compare the options available to you. Again he suggests that seeking advice
from an expert is often easier than making the decision on your own.

Step 9 - Make your choice - on time, on budget

When you're finished doing the evaluation (only as much as it requires!), you make your choice.
He notes that people may still have difficulty at this stage because they fear the consequences of
making a bad decision.

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

MITHUN
PADMASHREE INSTITUTE OF NURSING. M.Sc. NUrsing II years (2009-2011 batch)

Techniques and Tools of Decision Making

A. Judgmental technique
B. Operational research technique
C. Delphi technique
D. decision tree

A. Judgemental technique:

This is the oldest technique of decision making and is subjective in nature. As it is based
on past experiences or intuition about future, it is frequently used for making routine decisions. It
is cheap and can be quickly done. But it is hazardous as there is chance of taking a wrong
decision. So this technique is rarely used in large capital comminments.

C. Operational research technique:

It is the analysis of decision problem using scientific method to provide manager the need
quantitative information in making decision.
Steps of operational research are
 Construction of a mathematical model that pin points the important
factors in the situation.
 Definition of criteria to be used for comparing the relative merits of
various possible courses of action
 Procuring empirical estimates of the numerical parameters in the model
that specify the particular situation to which it is applied.
 Carrying out through the mathematical process of finding and series of
action which will give optimum solution
c. Delphi technique: The Delphi method is a systematic, interactive forecasting method which relies
on a panel of experts. The experts answer questionnaires in two or more rounds. After each round, a
facilitator provides an anonymous summary of the experts’ forecasts from the previous round as well as
the reasons they provided for their judgments. Thus, experts are encouraged to revise their earlier
answers in light of the replies of other members of their panel. It is believed that during this process the
range of the answers will decrease and the group will converge towards the "correct" answer. Finally,
the process is stopped after a pre-defined stop criterion.

Advantage is that it is free from another’s influence and does not require physical presence which
makes it appropriate for scattered group and limitation is that it is time consuming.

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

MITHUN
PADMASHREE INSTITUTE OF NURSING. M.Sc. NUrsing II years (2009-2011 batch)

D. Decision trees: A decision tree is a graphic method that can help the supervisor in visualizing
the alternative available, outcomes, risks and information for a specific needs for a specific
problem over a period of time. It helps her to see the possible directions that action may take
from each decision point and to evaluate the consequences of a series of decisions. The process
begins with a primary decision having atleast two alternatives. Then the predicted outcome for
each decision is considered, and the need for further decisions is contemplated.

Types of Decision Making

Main types
There are many types of decision making and these can be easily categorised into the following
4 groups:

 Rational
 Intuitive
 Recognition primed decision making
 The ultimate decision making model

Rational

Rational decision making is the commonest of the types of decision making that is taught
and learned when people consider that they want to improve their decision making. These
are logical, sequential models where the emphasis is on listing many potential options and then
working out which is the best. Often the pros and cons of each option are also listed and scored
in order of importance.

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

MITHUN
PADMASHREE INSTITUTE OF NURSING. M.Sc. NUrsing II years (2009-2011 batch)

Intuitive

The second of the types of decision making are the intuitive models. The idea here is that
there may be absolutely no reason or logic to the decision making process. Instead, there is an
inner knowing, or intuition, or some kind of sense of what the right
thing to do is.

Recognition primed...
Gather information from our environment in relation to the decision we want to make. Pick an
option that work. We rehearse it mentally and if we still think it will work, we go ahead. If it does not
work mentally, choose another option .If that seems to work, go with that one. Also points out
that as get more experience, recognise more patterns, and make better choices more quickly.

The ultimate...

Firstly, before you even make a decision, you establish how and who you want to be.
You obviously want to be in a good state so that you can make good decisions. But you also
want to be true to yourself, and that means knowing who 'yourself' is.

(ACCORDING TO Ken Shah & Prof. Param J. Shah)

Irreversible
This are those type of decisions, which, if made once cannot be unmade. Whatever is
decided would than have its repercussions for a long time to come. It commits one irrevocably
when there is no other satisfactory option to the chosen course. A manager should never use it as
an all-or-nothing instant escape from general indecision.

Reversible
This are the decisions that can be changed completely, either before, during or after the
agreed action begins. Such types of decisions allows one to acknowledge a mistake early in the
process rather than perpetuate it. It can be effectively used for changing circumstances where
reversal is necessary.

Experimental
This types of decisions are not final until the first results appear and prove themselves to
be satisfactory. It requires positive feedback before one can decide on a course of action. It is
useful and effective when correct move is unclear but there is a clearity regarding general
direction of action.

Trial and Error

In this type of decisions, knowledge is derived out of past mistakes. A certain course of
action is selected and is tried out, if the results are positive, the action is carried further, if the

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

MITHUN
PADMASHREE INSTITUTE OF NURSING. M.Sc. NUrsing II years (2009-2011 batch)

results appear negative, another course is adopted and so on and so forth a trial is made and an
error is occurred. Till the night combination this continues. It allows the manager to adopt and
adjust plans continuously before the full and final commitment. It uses both, the positive and
negative feedback before selecting one particular course of action.

MadeinStages
Here the decisions are made in steps until the whole action is completed. It allows close
monitoring of risks as one accumulates the evidence of out- comes and obstacles at every stage.
It permits feedback and further discussion before the next stage of the decision is made.

Cautious
It allows time for contingencies and problems that may crop up later at the time of
implementation. The decision-makers hedge their best of efforts to adopt the night course. It
helps to limit the risks that are inherent to decision- making. Although this may also limit the
final gains. It allows one to scale down those projects which look too risky in the first instance.

Conditional
Such types of decisions can be altered if certain foreseen circumstances arise. It is an
‗either or‘ kind of decision with all options kept open. It prepares one to react if the competition
makes a new move or if the game plan changes radically. It enables one to react quickly to the
ever changing circumstances of competitive markets.

Delayed
Such decisions are put on hold till the decision–makers feel that the time is right. A go-
ahead is given only when required elements are in place. It prevents one from making a decision
at the wrong time or before all the facts are known. It may, at times result into forgoing of
opportunities in the market that needs fast action.

THEORIES OF DECISION MAKING

1. Marginal theory

This theory stress on profit maximization .this theory focused on increases profit from the
decision. It related to health care cost and patient outcome

2. Psychological theory

The trust of this theory is on the maximization of customer satisfaction (patient). The
manager acts as a administrative man rather than economic man

3. Mathematic theory

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

MITHUN
PADMASHREE INSTITUTE OF NURSING. M.Sc. NUrsing II years (2009-2011 batch)

This theory is based on the use of models. This is also known as operational research
theory. The techniques generally used include linear programming. Theory of probability
stimulation models etc

4. Classical decision theory

 Views the decision maker as acting world of complete certain

 Classical decision making faces a clearly defined problem. Knows all possible action
alternative and their consequences
 Choose the optimum alternative

5. Behavioural decision theory

 Accepts a world with bounded rationality and views the decision maker as acting
only in terms of what he/she perceive about a given situation
 The behaviour decision maker faces a problem that is not clearly defined . has limited
knowledge of possible action alternatives and their consequences

6. Statistical decision theory

Several statistical tools and methods are available to organize evidence, evaluate risks,
and aid in decision making. The risks of Type I and type II errors can be quantified
(estimated probability, cost, expected value, etc.) and rational decision making is improved

MODELS OF DECISION MAKING

 Vroan and yelton‟s normative model

The Vroom-Yetton- model is a decision making tree that enables a leader to examine a situation
and determine which style or level of involvement to engage. This model identifies five styles
along a continuum ranging from autocratic to consultative to group-based. Two are autocratic
(A1 and A2), two are consultative (C1 and C2) and one is Group based (G2).
A1: Leader takes known information and then decides alone.
A2: Leader gets information from followers, and then decides alone.
C1: Leader shares problem with followers individually, listens to ideas and then decides alone.
C2: Leader shares problems with followers as a group, listens to ideas and then decides alone.
G2: Leader shares problems with followers as a group and then seeks and accepts consensus
agreement.
 Bounded rationality model: is the notion that in decision making, rationality of
individuals is limited by the information they have, the cognitive limitations of their

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

MITHUN
PADMASHREE INSTITUTE OF NURSING. M.Sc. NUrsing II years (2009-2011 batch)

minds, and the finite amount of time they have to make decisions. The process of
bounded rationality involve 3 mechanism they are as

SEQUENTIAL ATTENTION TO ALTERNATIVE: here person examine possible

solutions of a problem systematically i.e. if first solution fails to work it is discarded and
next solution is considered till he gets acceptable solution

HEURISTICS: it is a rule which guides the search for alternative into areas that have a
high probability for yielding solution. Here the decision makers look for obvious solution
or previous solution that worked in similar situation

SATISFYING: Here the decision maker is looked as a satisfier where an alternative is

satisfactory if there exist a set of criteria that describes minimally satisfactory alternative,
alternative in question meets or exceeds all these criteria.

Factors Affecting the Decision-Making Process

Experience and knowledge

Experience and knowledge are two of the major factors affecting decision making.
Decision making within practice disciplines, such as nursing, involves more than the application
of theoretical knowledge. A deep understanding of the situation is required if treatment
approaches are to address the experience of illness as it relates to a particular patient. This
understanding evolves from knowledge and experience. Experience increases the cognitive
resources available for interpretation of data, resulting in more accurate decision making.

Creative thinking

Problem solving involves organisation of new and previously learned information to form
new responses to novel situations. The promotion of creative thinking through education calls for
teachers to endorse the creative thinkers' self-worth, listen to them, challenge learners to develop
new ideas and to question their taken-for-granted ideas, demonstrate critical thinking ability,
encourage breadth of reading, invite learners to talk about what they think and feel, and to adopt
a conversational approach

Self Concept

Perceptions of being less intelligent, less educated and less competent result in
relinquished authority to those perceived as being better. Those with an internal locus of control
believe in their ability to influence results, whereas, those possessing an external locus of control
believe that events are contingent upon the actions of others. Locus of control refers to the extent
to which a person believes they can control events and outcomes

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

MITHUN
PADMASHREE INSTITUTE OF NURSING. M.Sc. NUrsing II years (2009-2011 batch)

Interpersonal Conflict

The stressors involved with interpersonal conflict constitute another barrier to decision
making. Clinical decision making is a social activity involving health care team members and the
patient. The social context in which the clinician functions impacts upon decision making

Inadequate Staffing

That it is stressful to work when staffing levels are inadequate for the tasks required
would be disputed by few. Most nurses have frequently encountered circumstances when
experienced staff are replaced with novices. This situation places stress on staff of all levels and
influence the decision

SOME COMMON MISTAKES THAT DECISION MAKERS SHOULD BE AWARE OF

INCLUDE:

 Only hearing and seeing what we want. Each individual has their own unique set of
preferences or biases which blinker them to certain information. The best way to deal
with this problem is to identify your preferences and biases whilst attempting to be open
to the information around you.
 Placing too great a reliance on the information you receive from others. Often we rely on
certain individuals to provide support and guidance. This may be a suitable course of
action in many cases. However, if the individual is not closely involved in the problem
situation they may not have the necessary information or knowledge to help make the
decision.
 Placing too little emphasis on the information you receive from others. This issue can
easily occur in a team situation. In many cases the team members are the people who are
most closely involved in a problem situation and they often have the most pertinent
information in relation to the problem. The best way to deal with this issue is to ensure
that team members are involved in the decision making process.
 Ignoring your intuition. On many occasions we are actually aware at a subconscious level
of the correct course of action. Unfortunately, we often tend to ignore our intuition.

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

MITHUN