AFAMS Leadership Lesson. Objectives Describe various problem-solving models: Individual versus group decision-making, and managerial decision-making styles

AFAMS Leadership Lesson

Objectives

Describe various problem-solving models: Individual versus group decision-making, and managerial decision-making styles.

Analyze issues and set appropriate priorities

Identify and analyze problems, including writing a problem statement and applying critical thinking to a situation.

Identify leadership actions to ensure the decisions are effectively implemented

Evaluate results and take corrective action if necessary

Generate and evaluate alternative solutions to a problem.

Module Outline

I. Decision Making and Problem Solving

II. Problem Identification and Analysis

III. Implementation of the Decision

The Pervasiveness of Decision Making

Almost everything a leader does involves decision making:What should be our goals and objectives for next

year? How should resources be allocated? Who should be promoted? What gets included in the agenda for the next

committee or staff meeting? What should be done regarding a patient safety

concern or medical error?

Thus, medical leaders must have the skills and tools to assist them in making these and many other decisions.

Types of Decisions

Programmable decisions: Repetitive decisions that often use

predetermined guidelines. Usually made by front-line managers and staff. Examples are: determining eligibility for care,

scheduling appointments, and ordering of supplies

Nonprogrammable decisions: Decisions for which there are no easy, ready-

made solutions. Examples are deciding on whether to start or

expand a service or what actions to take in response to recent patient complaints.

Problem-Solving Model

Problem solving is a process by which leaders analyze situations and make decisions that cause organizational results to be more like those desired.


Identifying and Analyzing the Problem

Generating Alternatives

Making a Decision

Implementing the Decision

Evaluating the Decision


This step includes recognizing that a problem or opportunity exits, formulating a problem statement, and analyzing the causes of the problem.

Critical thinking is required for identifying current problems.

Identifying and Analyzing the

Problem




Making a Decision




This step involves the identification of all possible solutions to the problem.

Frequently used tools are group brainstorming, and discussion among those involved in the situation.





Making a Decision




In this step a decision is made on what course of action to take.

Frequently used tools for decision making are the decision matrix, motivating, and guided or facilitated discussions.

Making a Decision




Making a Decision




This step requires the leader to develop the implementation plan, communicate the decision, and obtain commitment (“buy-in”) of the decision.

Frequently used tools in implementation are the pilot study, an action plan, and the responsibility matrix.





Making a Decision




This step consists of a continual review of the effectiveness of the decision.

Frequently used tools in this step are: the OODA (Observe, Orient, Decide, and Action) Loop, in-progress reviews, and the control chart.Evaluating the

Decision

Individual vs. Group Decisions

The very first decision that you must make as a manager is to decide whether or not to involve others in a decision.

Four situational factors are most critical in making this determination: Availability of information Complexity of the problem Time constraints Level of commitment (“buy-in”) of staff to

implement the decision

Individual vs. Group Decisions

Leaders can make individual decisions (without input or involvement from the group) when these conditions exist:Time is criticalThe problem is relatively simple to solveRelevant information is readily available to the

managerThe decision will likely be accepted by those

who will carry out the implementation

Individual vs. Group DecisionsGroup involvement is appropriate when:

There is sufficient time for consultation/discussion

The problem is complexInformation or perspective is needed from

othersGroup commitment is needed to implement the

decision

Decision-Making Styles I

1. The manager solves the problem or makes the decision alone When to Use: If the leader has all the

information or time is critical Caution: Manager may not know what

information is critical; also the decision may not be accepted by the group

Decision-Making Styles II

2. The manager obtains information from subordinates/group and then makes the decision When to use: If information is needed from

others, the problem is relatively simple to address, and the solution is likely to be accepted by group

Caution: Could be viewed as manipulative if overused

Decision-Making Styles III

3. The manager shares the problem with, and gets ideas/suggestions from, selected individuals within the department/group, and then makes the decisionWhen to use: If you need others to fully

understand the basis of a relatively complex problem so they can offer better ideas/suggestions

Caution: Some group members could feel “left out” and strongly resist the decision

Decision-Making Styles IV4. The manager shares the problem with the

entire group, obtains their ideas and suggestions, and then makes a decision. The decision may not reflect the general consensus of the groupWhen to use: Same as in #3, but also to obtain

more commitment to the decision as the entire group was consulted; also used when the manager wants to retain the right to override any solution developed by a group

Caution: Could be viewed as manipulative, particularly if ideas or suggestions were often not adopted

Decision-Making Styles V5. The manager shares the problem with the

group and together they make a decisionThe manager is willing to accept and

implement any decision madeWhen to use: If you need a high level of

support and commitment from the group to implement the decision per the maxim, “people will support what they help create”

Caution: Should never be used if there is a chance you will veto or change the decision of the group

Problem Solving Pitfalls I 1. Working on problems that are too general, too

large, or not well-defined

2. Jumping to a solution before really analyzing the problem

3. Failing to involve critical decision markers or employees affected by the problem when identifying the problem and solutions

4. Tackling problems that are beyond the control or influence of the individual or team/group

Problem Solving Pitfalls II 5. Applying “pet” solutions rather than

seeking a creative solution

6. Failing to develop good reasons for choosing a solution

7. Failing to adequately plan the implementation and evaluation of the chosen solution

Barriers to Decision Making I

Errors made by managers who make poor decisions:Not allocating enough time for decision making, particularly

for group deliberations and the reaching of consensus

Not using tools (brainstorming, cause-effect diagrams, etc.) to assist with the problem-solving process

Not willing to make a decision, being risk adverse, and continually desiring more information before making a decision (“the paralysis of analysis”)

Not listening to subordinates/staff (e.g., “Please don’t confuse me with facts, my mind is made up!”)

Barriers to Decision Making II

Not waiting to offer ideas or solutions (offering your ideas on a solution early during a discussion often inhibits subordinates from offering their ideas or suggestions)

Engaging in “defensive avoidance” by denying that a problem exists, exaggerating the advantage of the chosen alternative, or trying to get someone else to make a decision

Not being aware of the phenomenon of “group think” – Where officers are deterred from offering their own individual opinions

Problem Identification and Analysis

The first phase of problem solving consists of three steps1. Recognizing that a problem or gap exists2. Formulating a problem statement3. Analyzing the problem, including its root

causes

These 3 steps will be described in the following slides

Conditions that Require Problem Solving

1. Crisis / Immediate problem The areas we most often associate with “problem

solving”

2. Deviation Gap in performance from what is expected

3. Improvement Enhancement of systems and processes, often done to

improve quality of patient care, or to reduce costs

4. Opportunity / Threat Strategic areas to address to take advantage of a

market opportunity or to counter a threat from a competitor

The Problem Statement

A good problem statement has four components: 1. An invitational stem (e.g., “In what ways

can…”)

2. An ownership component (e.g., “we”)

3. An action component (e.g., “reduce patient waiting time in the ER”)

4. A goal component (e.g., “by at least 20 per cent within 30 days”)

Problem Statement: Key Questions

Has evidence for the problem been gathered through a rigorous needs assessment?

Have those affected by the problem been involved in generating data about the problem and agreed on the problem statement?

Has the problem been defined too narrowly?

Has the problem statement been challenged by all stakeholders?

If the problem involves methods and/or resources, has it been linked to key result areas at the appropriate level?

Problem Analysis: Key Questions I

What are all of the relevant facts that describe the background of the current situation surrounding this decision?

What do we all need to understand?

What assumptions are we operating under?

Which of these assumptions are still valid?

What constraints, boundaries, or political realities should we take into account?

Problem Analysis: Key Questions II

When does the problem manifest itself?

What are the trends over time?

Who might be affected by the problem?

What is the urgency or priority in solving the problem?

Why is the problem occurring?

Tools for Problem Analysis I

Asking “why” to determine root causes is the most important question during problem analysis.

It should be asked repeatedly to ensure that the true, underlying causes are identified.

Tools for Problem Analysis IIFish-bone diagram (cause-effect analysis)

Purpose: Used to gather together all possible causes of a problem with the ultimate goal to uncover the root cause(s)

Key steps: Start with the problem statement

Determine the major categories in which problems may exist, e.g., Manpower, Materials, Machines, Methods, Management; these would be the major bones of the fish-bone diagram

Brainstorm and identify the possible sub-causes to the possible main causes (sub-branches to the fish-bone)

Example of Fish-Bone Diagram

Communication

Admitting that staff is unaware bed is

clean

Unit clerk unaware of discharge or transfer

Patient Waits for

Bed

Physician Procedures

Physician did not write order

Admissions Quota

Timing

Hospital Procedures

Too Many Transfers

Inappropriate Admitting Procedures

Discharged patient did not

leave

Called Housekeeping too

Late

Tools for Problem Analysis III

Root-cause analysis (RCA)Purpose:

Used to identify the basic or causal factor(s) that underlie problems or variations in performance

Most often used to in response to a sentinel event

Key Steps:Identification of underlying process and systems

problemsAnalysis that asks “Why?”; then when answered,

“Why?” again, and so onInquiry to all areas appropriate to an event or

problem, including supervision and training of staff, equipment and technology, and communication among healthcare providers

Tools for Problem Analysis IV

Critical thinkingUsed to systematically view a problem,

including:All of its ramificationsPattern(s) of occurrenceRelationships to other issuesBroader context within the organization,

including how the problem is affected by or affects other entities, systems, or processes

Tools for Problem Analysis VCritical thinking

Key Skills Required:Analysis to identify relationships among problems

Inference to form hypothesis on what is happening and to draw reasonable conclusions subject to further research/study

Self-regulation to test one’s own assumptions regarding the problem and how it should be resolved

Characteristics of Critical Thinkers I

Inquisitiveness on a wide range of issues

Remaining well informed

Alertness to opportunities

Trust in the process of reasoned inquiry

Open-mindedness regarding divergent views/opinions

Characteristics of Critical Thinkers II

Flexibility in considering alternatives

Honesty in facing one’s own biases, prejudices, stereotypes, or egocentric tendencies

Prudence in suspending, making, or altering judgments

Willingness to reconsider and revise one’s own views

Tools for Generating Alternatives I

Group BrainstormingUsed when a high degree of creativity is

needed, when a group is stuck in current thinking or approaches, and/or when there is a need to get more individuals involved or energized

Key Steps Nonjudgmental, spontaneous “whatever

comes to mind” listing of ideas on a flip chart

Review the list of ideas, asking for clarity and discarding duplicate comments

Tools for Generating Alternatives II

Brainwriting (“6-5-3” Method)“Levels the playing field,” particularly if some

group members are introverted or otherwise hesitant to speak up due to a perceived status difference or the presence of supervisor(s)

Key Steps:Six or more people each have five minutes to

write down three or more ideas on a piece of paper

Each person passes his/her sheet to the next person who has five more minutes to add three or more ideas (hence, the “6-5-3” Method)

Tools for Generating Alternatives IIINominal Group Technique (NGT)

As above, NGT “levels the playing field”; also, NGT allows everyone to see ideas as they are displayed, thus facilitating the consideration of each idea

Key StepsIndividual, silent generation of ideasSharing/posting of these ideas in a round-

robin

Tools for Decision Making I

Multivoting Used to set priorities for a large number of

alternatives

Key Steps:Individuals are given a number of votes (usually

25% of the total number of alternatives)Each person can then place their votes on the

alternatives they feel are bestThe votes are totaled to identify the high priority

alternativesGuided discussions are used to come to

consensus on a decision/solution

Tools for Decision Making II

Guided/facilitated discussions, using ground rules for decision making Used to ensure participation and input from all

members of a group or team and to obtain consensus on a decision

Key Steps:Setting ground rules for decision making and

group consensus (see next section)Using facilitation practices of questioning,

summarizing, checking, etc.

Tools for Decision Making III

Decision Matrix Provides a high degree of rigor to the

comparison of alternatives

Key Steps:Identification of decision criteria Listing of alternativesComparison of alternatives against all criteria

Decision Criteria IDecision Criteria

The keys to effective decision making are the clear delineation of all decision criteria and the evaluation of all alternatives against these criteria.

Some common decision criteria are:1. Effectiveness in solving the problem2. Feasibility of implementation3. Cost of implementation4. Financial benefits, e.g., cost-effectiveness5. Non-quantitative advantages, e.g., public

image6. Political acceptance7. Timeliness (implementation in a reasonable

time frame)

Decision Making Ground Rules

Decision-making ground rules or guidelines should be established for groups to ensure that all issues are fully discussed and consensus is reached.

Managers should be aware of the phenomenon known as “group think”.

Group think occurs whenever the desire for harmony and a quick decision overrides the needs for critical evaluation of a problem.

How to Avoid Group Think I

1. Assign the role of critical evaluation to each group member

2. Have the leader avoid seeming partial to one course of action

3. Create subgroups and have each work on the same problem

4. Have group members discuss issues with outsiders and report back

How to Avoid Group Think II5. Invite outside experts to observe and react to

group processes

6. Assign someone to be a “devil’s advocate” at each meeting

7. Write alternative scenarios for the intentions of competing groups

8. Hold “second chance” meetings after consensus is apparently achieved

Ground Rules for Decision Making Free, open discussion with issues and ideas candidly

put “on the table” for debate and consideration

Non-attribution of comments

Review/clarification of what was said and subsequent distribution of an executive summary after each meeting

Consensus is being able to live with the outcome of any decision after having full opportunity to provide input

Use of an iterative process whereby members obtain input from their own service/stakeholders. This input is then fed back to the working group for further consideration.

Guidelines for Group Consensus I

Do not argue blindly, consider others’ reactions to your points

Do not change your mind simply to reach agreement (avoid group think)

Do not avoid conflict by voting, coin tossing, and bargaining

Try to get every group member involved in the decision-making process

Guidelines for Group Consensus II

Allow disagreements to surface so information and opinions can be deliberated

Do not focus on winning versus losing, seek alternatives that are acceptable to all (“win-win” situations)

Discuss assumptions and listen carefully to the perspectives of others

Leader Responsibilities

Leadership is the most important factor in the successful implementation of any decision.

The leader must:Plan for the implementationCommunicate the decisionObtain commitment (“buy-in”)Follow up to ensure that the decision was

implemented as planned.

Tools for Implementation Planning I

Action Plan Purpose: Delineates exactly what needs to be

done to implement a decision The action plan identifies:

What needs to be accomplishedWho is responsible for that task When the task must be completed How well (metric to measure success)

Tools for Implementation Planning II

Responsibility Matrix Displays the action plan in a matrixThe responsibility matrix goes one step further

by identifying those who support the primary owner of the task and those with whom the task needs to be coordinated

Development of a matrix that lists all members of the group/team and all tasks that need to be accomplished

Assignment of responsibilities to each task along with target dates for completion of the task

Tools for Implementation Planning III

Pilot Tests a solution prior to full implementation

Implements a solution in one specific area

Uses results to make changes as necessary prior to full scale implementation

Obtaining Ongoing Support from Organization I

MediaThe manager should use multiple media

sources (e.g., newsletters, bulletin boards, etc.) to announce and generally explain certain decisions.

This should create awareness that a change will soon be seen in the HCMO, department, or unit.

Obtaining Ongoing Support from Organization IIStaff Meetings

The leader would discuss: Overview of the decision (change being implemented)

Why the decision was made, and how it will address future needs of the organization

How the solution benefits both the organization and the staff (e.g., “what’s in it for them”)

How the decision will be implemented, including the timetable and what will be done if problems are encountered

Everyone’s role in making the implementation a success

Obtaining Ongoing Support from Organization III

Support from Opinion LeadersOpinion leaders are those whom the staff respects

or frequently interacts with due to their expertise, knowledge, or personality.

Before a decision is actually implemented, the leader should:Seek out opinion leaders in the organization. Ask for their supportAddress any concerns that they haveSolicit their input on how to effectively

implement the decision, particularly in overcoming any possible resistance

Obtaining Ongoing Support from Organization IV

Managing by Walking AroundGet a first-hand view of how the decision is

being implemented

Asking for input from the staff on how the implementation is progressing and what can improve the process

Reinforcement and Rewards

Reinforcement and RewardsFollow up on each item of the action plan,

providing gentle reminders of responsibilities and due dates

Put in place new policies and procedures that “cement” the implementation of the decision

Show appreciation and recognize those who have successfully implemented the decision

Publicize success via newsletters, e-mail, etc.

Share lessons learned, particularly with other units who will later implement the decision

Evaluating the Decision:Feedback Loop

1. Observe Fact-finding (examining the current situation and the

changed reality)

2. Orient Assessment of one’s position vis-à-vis the changed

situation

3. Decide Rapid decision for a new course of action due to new

circumstances

4. ActionImplementation of a new course of action without

delay

Evaluating the Decision:In Progress Review I

Reviews should be held once every month to review how the decision is being implemented and the results thereof, particularly to identify if changes are needed.

Evaluating the Decision:In Progress Review II

Review of ResultsThis consists of evaluating changes or trends as

compared with previous months, internal benchmarks or targets, and external benchmarks, if available.

Reports from Responsible Individuals This consists of a review of reports and/or

discussions with those responsible for each major implementation task.

It is particularly important to determine the current status of the implementation and to identify any barriers currently being encountered.

AFAMS Leadership Lesson

Documents

AFAMS Leadership Lesson. Objectives Describe various problem-solving models: Individual versus group decision-making, and managerial decision-making styles