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

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

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

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.

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.

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)

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

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.

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.

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.

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.

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.

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.

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

Decision Making Methods

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

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

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

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

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

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

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

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

Thank you for listening Any Question ! A Thank you for listening