HCA 574 Decision Making In Healthcare Reading 1 The Basics O

Hca 574decision Making In Healthcarereading 1the Basics Of Dm Process

HCA 574 Decision Making in Healthcare Reading #1 The Basics of DM Processes Module 1: October 18-28, 2018 Important Questions How are decisions made in HC organizations? What are the useful DM models? Which DM model should I apply? How can the DM process be managed? How do consumers (patients) bear the burden of choice? What is the influence of technology, culture, and ethics on DM? How do different viewpoints on DM such as those of patients, providers or health executives consider important issues such as cost, quality and access in the DM process? How are Decisions Made in HC Organizations? DECISION MAKING--Defined as: The process of choosing a course of action for dealing with a problem or an opportunity. Or The process through which alternatives are selected and then managed through implementation to achieve healthcare objectives. What is your definition of DM? Why? How are Decisions Made? STEPS IN SYSTEMATIC DM Recognize and define the problem or opportunity. Identify and analyze alternative courses of action, and estimate their effects on the problem or opportunity. Choose a preferred course of action. Implement the preferred course of action. Evaluate the results and follow up as necessary. How are Decisions Made? The systematic decision-making process may not be followed where substantial change occurs and many new technologies prevail. New decision techniques may yield superior performance in certain situations. Ethical consequences of decision making must be considered. All applicable in health care? Why, Why Not? So DM is Important … To come to a decision, a series of events take place Resources: Have to be in place Processes: Have to be determined DM: Has to be executed Strategy: Has to be in place Implementation: Can it work in all situations? Returns: What are patient/organizational benefits? DM has to be part of strategic position for healthcare organizations How are Decisions Made? DECISION ENVIRONMENTS INCLUDE: Certain environments. Risk environments. Uncertain environments. What’s the most dominant environment in health care? Why? How are Decisions Made? CERTAIN ENVIRONMENTS Exist when information is sufficient to predict the results of each alternative in advance of implementation. Certainty is the ideal problem solving and decision making environment. Examples in health care?? Whose perspective should take precedence in this environment? Why? How are Decisions Made? RISK ENVIRONMENTS Exist when decision makers lack complete certainty regarding the outcomes of various courses of action, but they can assign probabilities of occurrence. Probabilities can be assigned through objective statistical procedures or personal intuition. Give two examples in health care. Whose perspective should take precedence in this environment? Why? How are Decisions Made? UNCERTAIN EVIRONMENTS Exist when there is so little information that one cannot even assign probabilities to various alternatives and possible outcomes. Uncertainty forces decision makers to rely on individual and group creativity to succeed in problem solving. Examples in health care?? Whose perspective should take precedence in this environment? Why? Uncertain Environments …2 Also characterized by rapidly changing: External conditions. Information technology requirements. Personnel influencing problem and choice definitions. These rapid changes are also called organized anarchy. How are Decisions Made? TYPES OF DECISIONS Planned Decisions Involve routine problems that arise regularly and can be addressed through standard responses. Non-planned Decisions. Involve abnormal problems that require solutions specifically tailored to the situation at hand Decision Making Models Classical Decision Theory (CDT) Views the decision maker as acting in a world of complete certainty. Behavioral Decision Theory (BDT) Accepts a world with bounded rationality and views the decision maker as acting only in terms of what he/she perceives about a given situation. CDT vs. BDT CDT The classical decision maker: Faces a clearly defined problem. Knows all possible action alternatives and their consequences. Chooses the optimum alternative. Is often used as a model of how managers should make decisions. CDT vs. BDT …2 BDT Recognizes that human beings operate with: Cognitive limitations. Bounded rationality. The behavioral decision maker: Faces a problem that is not clearly defined. Has limited knowledge of possible action alternatives and their consequences. Chooses a satisfactory alternative. CDT vs. BDT …3 CDT May not fit well in a chaotic world. Can be used toward the bottom of many firms, even most high-tech firms. BDT Fits with a chaotic world of uncertain conditions and limited information. Encourages satisficing decision making. Decision Making Models The Garbage Can Model (GCM) A model of decision making that views problems, solutions, participants, and choice situations as mixed together in the “garbage can†of the organization. In stable settings, behavioral decision theory may be more appropriate. In dynamic settings, the garbage model may be more appropriate. Decision Making Models Implications of GCM Choice making and implementation may be done by different individuals. Because of interpretation, there is a risk that the actual implementation does not exactly match the choice. Many problems go unsolved. Think of an example in the US HC System which may represent a problem that has never been solved due to poor DM/poor choices. Decision Making Models: A.D.P.I.E. The Assessment, Diagnosis, Planning, Implementation Evaluation (ADPIE) Model Assessment Evaluate Diagnose Planning Implementation On-going Assessment On-going Diagnosis On-going Planning On-going Implementation On-going Evaluation This model was developed as an on-going evaluation tool. The strategic plan is an ongoing living process. As soon as the organization initiates the assessment process and, therefore, determines the needs of the organization (diagnosis), it is time to move on to the planning phase where the stakeholders determine (plan) the strategies to meet the needs of fixing or addressing the problems within the organization (diagnosis). After this phase is completed, it is time to put into action the plans (implement) determined by the organization’s stakeholders. It is then imperative to see if the organization has met the goals of the plans and programs that were implemented (evaluate). Upon finishing the evaluation and discovering the success and failures of the implemented plans, (take note already a new organization is emerging), it is time to begin assessing the new organization with its new strengths and weaknesses that are a net result of implementing the initial ADPIE process. To do this effectively, it is necessary to initiate the ADPIE process again. At the end of this next ADPIE process, the result will again be a new organization with its new strengths and weaknesses that are a net result of implementing the second ADPIE process. ADPIE then starts again, and so on and so on…. This process is ongoing through out the life of the organization. This helps to prevent inertia, stagnation, and non-growth which is inherent in many organizations who have not put in place an on-going evaluation processes to use as a metric for the on-going outcomes measurements needed for the on-going success of the organization. ADPIE …2 Ongoing DM/Evaluation tool Phase by phase through A.D.P.I.E State the cycle after completing the initial ADPIE Ongoing throughout the life of HC organization Shared Decision Making Model SDM MODEL Collaborative model—providers & patients/family Applies the SHARE Approach (AHRQ) Applies clinical evidence Applies the principle of patient centeredness What are the likely challenges in SDM? Where/What is the place/role of health executive in SDM? E.T.H.I.C.A.L. Model Applied in Ethical DM Examine the ethical dilemma Thoroughly comprehend the possible alternatives Hypothesize ethical arguments Investigate, compare, and evaluate the arguments for each alternative Choose the alternative you would recommend Act on your chosen alternative Look at the ethical dilemma and examine the outcomes while reflecting on the ethical decision Use to arrive at rational and justifiable decisions Intuitive DM Model How the Intuitive Model Works Consciously recalling gained knowledge Based on formal/informal education and experience Inexperienced: Take time to make decisions—step by step from assessment to implementation Experienced: “Leap†from information gathering to implementation. Good idea? DM Realities Decision makers face complex choice processes. DM information may not be available Bounded rationality and cognitive limitations affect the way DM parties define problems, identify alternatives, and choose preferred solutions Most DM goes beyond step-by-step rational choice Most DM falls between the highly rational and the highly chaotic Decisions must be made under risk and uncertainty DM realities …2 Decisions must be made to solve non-routine issues Decisions must be made under time pressures Decisions must be made under information limitations Decisions should be ethical So what’s your pick as the best DM Model in health care environment? Why? How to Manage a DM Process CHOOSING PROBLEMS TO ADDRESS Ask and answer the following questions: Is the problem easy to deal with? Might the problem resolve itself? Is this my decision to make? Is this a solvable problem within the context of the organization? Apply to a specific health care problem How to Manage a DM Process …2 Reasons for DM failure Decision makers tend to copy others’ choices and apply them in their situation Decision makers tend to emphasize problems and solutions rather than successful implementation Decision makers use participation too infrequently How to Manage a DM Process …3 WHO SHOULD PARTICIPATE IN DM? Authoritative Decisions. Made by authority without involving other parties and by using information on hand Consultative Decisions Made by one individual after seeking input from others Group Decisions Made by all affected/concerned parties collectively Influence of Culture, Technology and Ethics on DM Information technology and DM Cultural factors and DM US culture stresses decisiveness, speed, and the individual selection of alternatives. Other cultures place less emphasis on individual choice than on developing implementations that work. Ethical issues and DM Ethical dilemmas: ethical/legal/right/beneficial decisions? Watch the movie “John Q†Discuss the importance of cultural, technological and ethical factors in DM processes. Use views from your group perspective * 1. AOI [5] Before the Truth in Lending Act, auto dealers used to use a trick called add on interest. Suppose you bought a $30,000 car and financed it over 5 years at 6% interest. To calculate your payment, they’d take $30,000x5yearsx.06=$9,000. Your monthly payment would be ($30,000+$9,000)/12x5years = $650 per month. Write a spreadsheet that allows the user to enter the amount borrowed, the life of loan in years and the annual interest rate. The spreadsheet calculates the add-on interest payment, what the payment should be if calculated correctly, and the effective annual interest rate on the loan if the add-on interest payment is used. 2. WEEK [5] For any loan, loan length (up to 30 years) and interest rate, the spreadsheet calculates monthly payment in the ordinary fashion. Then, the borrower makes ½ a monthly payment every two weeks. (Assume bi-weekly compounding at a rate of r/26). Write a spreadsheet that determines how long it takes to pay off the loan in years.

Paper For Above instruction

Decision making in healthcare is a complex and multifaceted process influenced by various models, environments, and ethical considerations. Effective decision making (DM) is integral to achieving optimal patient outcomes, ensuring healthcare quality, and managing resources efficiently. This essay explores the fundamentals of decision-making processes in healthcare organizations, the models that inform these processes, environmental influences, and ethical considerations, emphasizing their relevance in contemporary healthcare settings.

Understanding Decision Making in Healthcare

Decision making in healthcare organizations involves selecting a course of action among alternatives to address clinical, operational, or strategic issues. As defined, it is the process of choosing actions to resolve problems or capitalize on opportunities, ultimately aimed at improving health outcomes (Ham, 2013). The steps typically include recognizing problems, analyzing alternatives, making choices, implementing actions, and evaluating outcomes. These steps form the basis of systematic decision processes that can vary depending on the context, urgency, and complexity of the issue at hand (Birkland, 2010).

Models of Decision Making

Several models underpin decision-making in healthcare. Classical Decision Theory (CDT) assumes a rational actor operating in environments of certainty, where all options and consequences are known. However, healthcare rarely fits this ideal, leading to the adoption of Behavioral Decision Theory (BDT), which recognizes human limitations like bounded rationality and cognitive biases (Simon, 1972). BDT suggests that decision makers often satisfice rather than optimize, especially under conditions of uncertainty and complexity prevalent in healthcare (Kasthuri et al., 2016).

The Garbage Can Model (GCM) offers a perspective suited to highly dynamic and chaotic healthcare environments. It posits that decisions emerge from a confluence of problems, solutions, and participants unrelated to each other, highlighting the importance of timing and context over rational deliberation (Cohen, March, & Olsen, 1972). Furthermore, the ADPIE model—Assessment, Diagnosis, Planning, Implementation, Evaluation—is an iterative, ongoing process facilitating continuous quality improvement in healthcare organizations (George et al., 2014).

Decision Environments and Their Implications

The decision environment is crucial in guiding the appropriate model application. In environments of certainty, decisions are straightforward with predictable outcomes. Conversely, risk environments involve probabilistic assessments, such as predicting patient responses to treatments or assessing outcomes of policy changes. Uncertain environments, characterized by rapid technological changes and limited information, often require innovative and creative decision approaches, like those emphasized by BDT and the Garbage Can Model (McKenna & Wallington, 2017). Recognizing these environments helps healthcare leaders tailor decision strategies effectively.

Types of Decisions and Decision Models

Decisions are categorized into planned, routine problems addressed through standard protocols, and non-planned, complex, and unpredictable issues necessitating individualized solutions (Evans & Lindsay, 2017). In healthcare, routine decisions include administering standard treatments, whereas non-routine decisions may involve crisis interventions or strategic restructuring (Naylor & Kurtzman, 2014). The choice of decision model—classical or behavioral—depends on the environment, urgency, and the nature of the problem (Klein & Rubin, 2016).

Integrated Decision-Making Models and Their Applications

In practice, healthcare organizations often utilize integrated decision models like ADPIE, which promotes continuous assessment and refinement of strategies. The shared decision-making (SDM) model emphasizes patient involvement, applying evidence-based practices while respecting patient values and preferences (Elwyn et al., 2012). Ethical models, like the E.T.H.I.C.A.L. framework, direct clinicians to examine dilemmas thoroughly, hypothesize, investigate, and reflect, ensuring ethically sound decisions (Beauchamp & Childress, 2013).

Intuitive decision-making, based on experience and tacit knowledge, complements analytical approaches, especially under time constraints or uncertainty (Kahneman & Tversky, 2011). Managers may rely on intuition during crises, but it requires experience and awareness of biases to be effective (Klein, 2013).

Influence of Culture, Technology, and Ethics

Healthcare decision-making does not occur in a vacuum; it is heavily influenced by cultural values, technological advancements, and ethical considerations. The U.S. culture, which values decisiveness and individual choice, shapes how decisions are approached, emphasizing speed and autonomy (Hofstede, 2001). Oppositely, other cultures may prioritize consensus and systemic interventions over individual initiative (Triandis, 2001).

Technology plays a pivotal role by providing data analytics, electronic health records, and decision support systems, thereby augmenting real-time decision capacity. However, these technological tools also raise ethical concerns related to privacy, data security, and equitable access (Greenhalgh et al., 2017). Ethical dimensions, particularly in dilemmas involving resource allocation, end-of-life care, and informed consent, necessitate careful, principled decision-making frameworks (Beauchamp & Childress, 2013).

Challenges in Shared Decision Making

Shared Decision Making (SDM) fosters patient engagement and collaboration between providers and patients. While beneficial, SDM faces challenges including time constraints, varying health literacy levels, and cultural differences (Elwyn et al., 2012). Health executives can facilitate effective SDM by promoting education, integrating decision aids, and fostering organizational cultures that value patient-centered care (Joosten et al., 2018).

Conclusion

In summary, decision-making in healthcare encompasses diverse models and environments that influence outcomes significantly. Rational models such as CDT serve well in predictable contexts, while behavioral and garbage can models adapt to chaotic, complex situations. The ongoing ADPIE process exemplifies continuous quality improvement, aligning decision-making with strategic organizational goals. Ethical, cultural, and technological considerations further complicate the decision landscape but are indispensable for delivering equitable, patient-centered, and effective care. Hence, healthcare leaders must adeptly select and adapt decision models to suit specific circumstances, fostering ethical, informed, and responsive decisions that enhance health systems' efficiency and effectiveness.

References

• Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics (7th ed.). Oxford University Press.
• Birkland, T. A. (2010). An Introduction to the Policy Process: Theories, Concepts, and Models. Routledge.
• Cohen, M. D., March, J. G., & Olsen, J. P. (1972). A Garbage Can Model of Organizational Choice. Administrative Science Quarterly, 17(1), 1-25.
• Elwyn, G., Frosch, D., Thomson, R., et al. (2012). Shared Decision Making: A Model for Clinical Practice. Journal of General Internal Medicine, 27(10), 1361-1367.
• George, J. B., et al. (2014). Nursing Management and Theories. F.A. Davis Company.
• Greenhalgh, T., Wherton, J., Papoutsi, C., et al. (2017). Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to The Scale-up, Spread, and Sustainability of Health and Care Technologies. Journal of Medical Internet Research, 19(11), e367.
• Ham, W. (2013). Decision-Making and Healthcare: A Systematic Approach. Healthcare Management Review, 25, 69-75.
• Hofstede, G. (2001). Culture's Consequences: Comparing Values, Behaviors, Institutions and Organizations across Nations. Sage Publications.
• Kahneman, D., & Tversky, A. (2011). Prospect Theory: An Analysis of