Decision making occurs in all organizations. The decision-making process begins with identifying a question, problem, or area needing improvement, or an operational issue. Problems, issues, questions, and operational challenges come to leaders and managers from many different people both within and outside the health organization (Pablo, 1996). To make the important decision that was given to us in the case study, I would use the garbage can model and its subsets to help me come to a conclusion. This decision involves a lot of people so the choice that will be made will affect all parties involved.
In this paper I will discuss how I would tackle this problem with the various tools of decision making through the readings that we have had. The Garbage Can Model How can the garbage can model help in this situation? The garbage can model was invented to expand the understanding of the organization. It addresses the problem that is going on at that time and accepts confusion as a reality. In the garbage can model loose coupling is required in an organization to understand decision making. The garbage can model has also been introduced as a possible method to understand how an organization learns (Tsang, 1997).
In the case study the CEO is faced with a myriad of issues like for instance trying to keep the physicians, and adequate staff at the hospital not only that if they were to leave they have threatened to go to their rivals hospitals across the city. The CEO also has to deal with a possible DECISION MAKING IN HEALTHCARE ORGANIZATION 3 lawsuit because the nurse who possibly has HIV has been asked to leave the operating room to work somewhere else. Would this not spark a fire?
Could asking the nurse to leave no matter how they tried to butter the deal up still seem like covert discrimination? So the hospital is about to be hit by a media freight train if they cannot get this under control. The garbage can model allows for the CEO to handle these problems accordingly. “Garbage can decisions can occur in any organization but are more likely to be found in ‘organized anarchies’ where decisions are made under ambiguity and fluid involvement of participants. ” Garbage can models are attempts at finding logic and order in the mist of decision-making chaos.
Garbage, defined as sets of problems, solutions, energy, and participants, is dumped into a can as they are produced (streams of “garbage” in time) and when the can is full, a decision is made and removed from the scenario (Takahashi, 2002). The garbage can model depicts the chaotic nature of decision making. Temporal Order Temporal order is a component of the garbage can model. Temporal order replaces sequential order. Time is spatial in that a multitude of issues, problems, information flows, and sensing mechanisms can bombard decision makers in short or long time blocks.
How problems and information to resolve the problems arrives in time has relatively equal priority as the evaluation of their importance. Arrival time and sequence in the current context influences decision makers’ attention to the situation. “The process is thoroughly and generally sensitive to load. An increase in the number of problems, relative to the energy available to work on them, makes problems less likely to be solved, decision makers more likely to shift from one arena to another more frequently, and choices longer to make and less likely to resolve problems”
DECISION MAKING IN HEALTHCARE ORGANIZATION 4 (March, 1996). Individuals in the decision-making process, directly and indirectly, are interconnected and influence the context of the decision at hand. The amount of time that the CEO has to make his decision is limited he has to try to make an informed decision about a very sensitive issue that involves a lot of individuals. His decision also will take an effect on peoples family members that use the hospitals services. If he keeps the man will they still want to use the hospital? Or will they go to the cross cities rival hospital?
The CEOs problems increased when the media got involved. The CEO has to find a way to balance his time so no one issue become bigger than the other because if he does this something will be forgotten in the process. To combat these issues the CEO will have to be attentive. Attention demands influence decision making. Time and energy must be allocated to understand, evaluate, and formulate a problem, then synthesize relevant information, evaluate options, and finally choose an alternative to counter or terminate the problem. Individuals focus on some things and do not attend to others in the same space of time.
Corporate actions, outcomes, and responsiveness are the results of dynamic organizational processes, not heuristics of individual choice (Swanson 1996). Time and energy combine to form “attention. ” Attention is a dynamic concept that is highly dependent on load (that is the number of decisions that need to be made). Information to Media The information that is conveyed to the media is an important tool in this case study. The way that we receive news has dramatically changed in recent years with the addition of social DECISION MAKING IN HEALTHCARE ORGANIZATION 5 etworking sites. These sites allow us to get information much more quickly, and the way a decision is made and perceived can be misconstrued. Information richness is defined as the ability of information to change understanding within a time interval. The longer the time interval to exchange understanding, the less rich the information. Consequently, the less time required the more rich the information is to the communicators (sender and receiver). The media (such as email, the telephone, or face-to-face conversation) that carries information to intended audiences also has a richness associated with it.
A continuum of media richness has been established based on the medium’s capacity for immediate feedback, the number of cues and channels utilized personalization, and language variety. In decreasing media richness, the continuum of richness consists of: “1) face-to-face, 2) telephone, 3) personal documents such as letters, memos, and emails, 4) impersonal written documents, and 5) numeric documents. ” The richer the media, the better equivocality can be reduced; media low in richness is best used when communicating messages that are understood well and possess standard information (Draft, 1986).
Simply put, face-to-face interaction works best and bulletin board flyers work the worst in transferring meaning. Leaders and managers must consider what media with which to communicate to ensure the highest probability to transfer meaning to their intended audience. So as CEO he need to make sure that he communicate well with the media saying exactly what he means at all times. My final decision would be to not remove the nurse from the operating room because if he is singled out a lawsuit would ensue and it would be hard to say that he was not removed because it is suspected that he has HIV.
He cannot be asked if he has it or not because of HIPPA DECISION MAKING IN HEALTHCARE ORGANIZATION 6 laws prohibit this. As long as everyone followed hospitals protocols such as use of blunt tip sutures as approved by the surgeon, a hands free neutral zone large enough where sharps can be placed and not easily tipped over and the use of double gloves in the operating room if would be okay for everyone to work there. If these procedures were taken lightly whoever did not follow would be reprimanded because there is little room for error in this type of setting.
It has already been said that you treat everyone as if they are infected not just certain people. DECISION MAKING IN HEALTHCARE ORGANIZATION 7 References Daft RL, Lengel RH. Organizational information requirements, media richness, and structural design. Manage Sci. 1986;22(5):554–571. March JG, Weisinger-Baylon R. Ambiguity and Command: Organizational Perspectives on Military Decision Making. Marshfield, MA: Pitman Publishing; 1986. Pablo AL, Sitkin SB.
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