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School of Business, Liberty University Faizan Malik Literature Review: Final Assignment Author Note: Faizan Malik I have no known conflict of interest to disclose. Correspondence concerning this article should be addressed to Faizan Malik: Fmalik@Liberty.edu

Abstract Effective decision making and business strategies are critical aspects of organizational success and sustainability. This literature review explores various approaches to decision making and business strategies while also examining the role healthcare administration plays within healthcare settings. The impact of both internal and external environments are highlighted, with an emphasis on agility and flexibility. The findings included in this literature review offer insights for organizations seeking to optimize decision-making and business strategies in various industries.

Introduction Decision making and strategy formulation and execution are vital components of business, often determining which organizations garner the most success. However, each component are compiled of various approaches: individual vs group decision making and traditional approaches vs new development in businesses strategies. How an organization approaches decision making, and strategy formulation is often dictated by both their internal and external environments, with the ability to adapt to changes carrying equal significance. This literature review with review the process of individual and group decision making, including the impacts they play on business decision making. It will then explore the traditional approaches business strategy development and execution while highlighting new trends that have emerged. Finally, the literature review examines the role of healthcare administration in the context of decision making and strategy development and execution. Individual and Group Decision Process impact on Business Decision-Making Effective decision-making is a crucial aspect of business operations, often distinguishing organizations who are successful and those who fall into obsoletion. The decision-making process itself then becomes a key factor in success or failure, as businesses will needed to distinguish their approach to utilize individuals or groups for making business decisions. Some may opt to utilize a combination of the two based on the specific decision needed, where individual decision-making can be utilized for policy issues such a department manager and group decision-making can be utilized to determine how an organization handles future acquisitions such as a board of directors (Mukherjee et al., 2016). In order to distinguish which approach better suits an organization’s needs, it is vital to understand the process of each and how they can benefit or impede business operations.

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Individual Decision Process and Impact The individual decision process in business typically involves a systemic approach in which information is gathered and alternative solutions are discussed but the final decision rests with a single individual. Although dependent on the business type, industry and particular decision needed, the individual decision process often begins with the individual, or potentially the organization, recognizing the need for a decision to be made. Often the result of a problem, opportunity, or specific goal, organizations must first identify the potential problem that is impacting their business through methodologies such as performance analysis and environmental scanning (Phadermrod et al., 2019). Performance analysis, which utilizes data on the current performance of the business, provides insight into organizational needs and can subsequently impact any business decisions. However, performance analysis is not limited to an organization’s internal environment, but rather can extend externally and be utilized to gauge customer response to offered products and services. Referred to as importance-performance analysis, this technique assesses customer satisfaction in relation to an organization’s offerings and can identify products that need improvement (Abalo et al., 2007). Environmental scanning, however, primarily focuses on a business’s external environment by assessing factors such as market trends and competitor standings. Collectively, performance analysis and environmental scanning encompass SWOT analysis, which individual decision makers can implement to gather the necessary information once the need for a decision is recognized, and can be utilized by any individual or organization, regardless of industry, to gather the necessary information needed to make an individual business decision. By assessing the strengths, weakness, opportunities, and threats of both the internal and external environment, individual decision makers are provided a more comprehensive view of the problem and allows for capitalization of existing strength or opportunities while mitigating

potential impacts of weaknesses and threats (Benzaghta et al., 2021). In conducting SWOT analysis, individual decision makers are likely to come across alternatives for their original decision, as new information can provide insight into potential risks and consequences associated with a particular decision. By expanding their perspective, individual decision makers are better suited to understand the risks and benefits associated with any decision and can also act as a form of reinforcement by ensuring all possible outcomes have been assessed. Yazdani et al. (2019) describes a multi-attribute decision making approach, in which individual decision makers compile a defined number of alternatives with associated objectives and rank their options based on how they could potentially satisfy the identified problem or goal (Yazdani, 2019). Once all possible alternatives have been analyzed, the final step is for the individual decision-maker to make and implement their final decision, and assess the outcomes. While the process for individual decision-making can be similar across organizations and industries, the potential benefits and impact on business decision making has significant correlation with the individual decision-maker. Arguably the greatest benefit of individual decision-making is the speed in which decisions can be made, as there is no requirement for consensus or approval from other stakeholders. This allows the business to become more agile and adapt to changes more easily, which can distinguish the business amongst its competition. As explained by Reeves and Deimler (2012), in fast paced markets, businesses need to accelerate the speed in which decisions are made by making the process lighter, as the speed of organizational adaptation acts a function of the cycle time of decision making (Reeves & Deimler, 2012). Individual decision making also creates a clear sense of accountability within an organization, as the responsibilities and subsequent consequences are soley with the individual. Take for example Satya Nadella, CEO of Microsoft, who recognized the need for a shift in the organizational

culture and instituted polices that fostered a more inclusive environment (Ibarra et al., 2018). Although benefits exist with an individual decision-maker approach, when decision making is the responsibility of the sole individual, the business essentially becomes at mercy of the decision-making style of the individual regardless if meets the needs of the larger organization. Bubić and Erceg (2018) describe the optimizing and satisficing decision-making styles, in which optimizing calls for collecting as much data as possible to find the optimal choice and satisficing settles for a less than ideal solution when presented with limited information (Bubić & Erceg, 2018). If the individual prefers a satisficing decision style, but the problem or business requires a more optimizing approach, the ramifications could be detrimental. Organizations that utilize individual decision-making also carry the risk of bias within any decision is significantly increased. Cognitive biases, which can exist with individual decision making, carry the risk of inaccurate or suboptimal decision-making. Gain-loss bias, for example and as described by Montibeller and Winterfeldt (2018), occurs when individual decision-makers tend to be more risk-averse when the business is facing gains and more risk-seeking when faced with loss (Montibeller & Winterfeldt, 2018). This suboptimal form of risk management prioritizes short- term financial gains over the long-term business strategic objectives and exposes the organization to unnecessary risk. Individual decision-making is also dependent on existing context, such as the individual’s knowledge and expertise in the field and their values and ethics. Take for example, Elizabeth Holmes of Theranos, a health technology company that claimed to have developed a device capable of performing multiple lab tests from a small sample of blood. Ms. Holmes made the decision to mislead investors, partners, and other various stakeholders about the accuracy of the machine, causing failure of the business and her to face significant legal consequences (Lackner & Plebani, 2018). Organizations must understand the benefits and

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risks of relying on the judgement of an individual, as their success is intrinsically connected to the nuances of the individual. Group Decision Process and Impact The group decision making process is similar to the individual process, in that the organization must first identify that a decision is needed. When utilizing a group decision- making approach, organizations often rely on diverse individuals with various areas of expertise as issues requiring decisions do not originate from a single source. Zhang et al. (2019) explain that the overarching goal of group decision-making is to solve unstructured problems that require experts who partake in broad and thorough discussion before reaching a collective agreement (Zhang et al., 2019). With the varying personas that exists with decision-making groups, a consensus that an issue warrants a decision is needed before moving on to the next phase of the process. Just as in individual decision-making, the group decision making process calls for gathering supportive information and proposing alternative solutions. In gathering data, group members collectively retrieve supportive information, oftentimes relying on their industry knowledge to guide their research. Osiro et al. (2018) argue that for group decision making to provide value, a wide range of information needs to be gathered which includes internal data, external data, expert opinions, and group discussions (Osior et al., 2018). After the decision- making group has gathered the required information, similar to the individual approach, they must formulate several alternative decisions and assess the potential outcomes of each. This process, which can be more complex than individual decision making due to the dynamics that exists when working with multiple individuals, oftentimes requires effective collaboration and communication amongst group members through the means of brainstorming sessions and debates. Effective communication means that all group members are heard, any conflicts are

managed, and a consensus is reached amongst the members. Given the diversity that exists in the modern workforce, the process often requires navigating diverse opinions while maintaining a collaborative environment. Proper communication channels amongst individuals within a decision-making group provide the benefit of pooling information and resources, checking of errors and rejecting fault suggestions, and exerting positive influences over the decisional preferences of others (Hirokawa, 1990). Once the group has identified alternative options, the decision-making process becomes more difficult as the group must then collectively formulate the criteria for assessing each option, such organizational goals and values, cost-effectiveness, and impact on customer satisfaction. The group decision-making approach can carry the additional complexity of aligning with strategic objectives, as they may vary amongst group members if the group consists of personas from different departments or areas within the business. While some members may focus on short-term success, others may factor longer-term sustainability when making decisions for the business. To mitigate such issues, Mitton and Patten (2004) recommend an evidence-based prioritization system in which evidence is used to support the significance of an issue and or decision, as it allows for more well-informed decisions based on data (Mitton & Patten, 2004). Once all options have been assessed, the group decision- making process calls for group members to reach a consensus on a decision, which signifies a shared agreement and commitment to the selected option. The process requires that disagreements or concerns are addressed or, at minimum, can be mitigated and often require some degree of negotiation or accommodation. If a consensus cannot be reached, facilitation and/or mediation may be required to make a decision. Dong et al. (2020) suggests two approaches to facilitating consensus amongst a group: leader-based preference adjustment in which leaders adjust their preferences to obtain higher consensus and trust relationships

improvement in which relationships based on trust are formulated to reach consensus (Dong et al., 2020). Once a consensus has been reach, the organization can move forward with implementing the decision the group selected. As with individual decision making, the group decision making process carries its own benefits of drawbacks in regard to their impact on business decision making. As mentioned, the dynamic of having multiple individuals contribute to a decision is the key differentiator between group and individual decision making. Where in individual decision making, the sole individual can identify the problem and address it, group decision making allows for any member of that group to distinguish an issue as requiring a decision. This allows for a more substantial view of potential issues that may arise for the business, as each individual within the group can contribute their skills and areas of expertise. As explained by Bonner at al. (2002), the key benefit to the group decision-making approach is the availability of expertise of the individual group members, as it has been illustrated that a group’s ability to recognize the expertise of its members can be correlated to organizational success (Bonner et al., 2002). When businesses construct their decision-making groups with members from varying backgrounds, they are likely to encompass decisions that represent the larger organization when compared to organizations who utilize the individual decision-making approach. Take for example Zappos, an online clothing and shoe retailer, who utilizes a concept known as holacracy in which traditional hierarchies are replaced with autonomous teams which have decision-making authority (Kumar & Mukherjee, 2018). This approach has fostered a culture that embraces faster decision making, a greater sense of empowerment amongst employees, and greater adaptability for the business. Group decision making also allows for greater acceptance of and commitment to the decision that was made, as the process requires collaboration and active involvement of group members.

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The shared responsibility amongst group members is then extended to the remainder of the organization, such as the group members’ respective departments. Van Riel et al. (2005) explains that the alignment of of employee with organizational strategies and decisions is gaining significance and can be vital for the success of businesses, as research indicates that organizations with employees that support the business objectives are more likely to make decisions that aligned with these objectives (Van Riel et al., 2005). Group-decision making, however, can promote adverse effects on the business decision process. The same dynamics of the group decision making approach that allows for a more encompassing view of potential issues can also lead issues amongst group members. As mentioned, objectives are often not- shared amongst departments and, when in a decision-making group, it is natural for members to have biases that are in their interest. These biases can influence their perspectives and preferences, as well as what information they seek to gather during the decision-making process. Take for example Kodak, a photography and imaginative company that attempted to transition to digital technology. The executive team at Kodak preferred the film-based technology that provided success for the organizations which made it difficult for the business to fully adopt digital technology which resulted in missed business opportunities (Lucas et al., 2009). This over-confidence bias is not uncommon, even in group decision-making approaches. Enslin (2022) highlights the impact of overconfidence bias for businesses and managerial group- decision making, citing evidence that overconfidence bias may be a contributing factor to the over-entry of entrepreneurs into markets despite the high rate of failure (Enslin, 2022). Group decision making also generally involves a lengthier and more time-consuming process, as it requires group consensus and other variables such as voting or approval. Varying perspectives and objectives also lead to disagreement, as discussed earlier, and can result in further time

investment. Although mediation avenues exist, these approaches also can contribute to additional in the group decision making process. Lai et al. (2002) describes the Delphi method, in which group decisions are reached via surveying a panel of experts, which requires participant coordination, multiple iterations, and extensive documentation – all of which delay the final decision being made (Lai, 2002). In the context of business decision making, delayed decisions can have significant and detrimental impact of business performance. Take for example Boeing, a designer and manufacturer of aircraft, satellites, etc., and their 737 MAX model which sustained two large scale crashes between 2018 and 2019. In response to the crashes, through a group decision-making approach, Boeing sought to understand the root cause the crashes, a process involving numerous stakeholders including the Federal Aviation Administration (FAA). Although this was done to ensure customer safety, the delay in decision making resulted in significant impact to Boeing’s reputation and financial performance, estimated to exceed $18 billion (Herkert et al., 2020). Literature indicates that neither individual or group decision making is preferred in business setting, rather a combination of the two and dependent on decision type needed can yield optimal results. Latest Developments In Strategy Development and Execution Gamble et al. (2021) describe business strategy as a series of managerial actions that are utilized to outperform their competitors with the ultimate goal of sustained success and growth (Gamble et al, 2021). The process for developing such business strategies is often complex and can define how an organization operates, both in day-to-day activities as well as in a long-term view. While some methods of business strategy and development are tried and true, new developments are emerging and can help business differentiate themselves within their respective industries. This section will review existing approaches to strategy development and execution,

as well a review of the latest developments and offer suggestions for additional research into new potential approaches. Traditional Approaches to Strategy Development and Execution The proper business strategy has always been a key driver in the success of an organization, as it provides the business a roadmap for achieving their goals and objectives, dictates business operations, and helps the business gain a competitive advantage. The process often begins with defining the organization’s mission, vision, and values, collectively referred to as the strategic vision, and acts as a foundation for the business to develop and execute various business strategies. Establishing the organizations’ mission, vision, and values provides both internal and external stakeholders clarity and direction, as it defines why the business exists and how they want to conduct business. For internal stakeholders such as employees, Lee et al. (2018) provides that the proper mission, vision, and values for an organization provide employees with direction, an understanding of long-term goals, and provides a sense of purpose, and as such, it becomes “essential that managers steer their organization in a long-term, strategic, and team-oriented direction” (Lee et al., 2018). Bartkus and Glassman (2018) suggest an organization’s strategic vision can be seen as an indication of the business’s external stakeholder management, as they can illustrate that an organization values their employees and customers over profits and revenue streams and acts to build stronger commitments to the brand (Bartkus & Glassman, 2018). After the strategic vision has been formulated, organizations should look to set business objections which “ convert the strategic vision into specific performance targets [and] reflect management’s aspirations for company performance in light of the industry’s prevailing economic and competitive conditions and the company’s internal capabilities (Gamble et al., 2021). In addition to providing clarity around organizational goals, business objectives can

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provide further insight into performance through the means of measurable data and a quantitative view of areas such as employee productivity. Ugoani (2020) echoes this sentiment, stating that understanding how employees are performing is vital to understanding and measuring productivity and that “after an employee has been selected for a job, trained to do it, and worked on it for a period of time, his or her performance should be reviewed” (Ugoani, 2020). Once measurable business objectives are established, an organization can then craft a strategy that align with the strategic vision of the business and assist with achieving goals. It is important to distinguish the differences that exist between corporate and business strategy, where corporate strategy focuses internally such as growth and profitability while business strategy primarily focuses on competing within the respective industry. While both strategies must align with the organization’s strategic vision and can impact business operations, business strategy allows for formulation of strategies that enhance competitive advantage. This is reiterated by Abdulwase et al. (2020), who explain that the most vital business strategies help the business succeed in individual markets and begin with the with the organization developing “a strategy at the business division level in analyzing the competitive market by gathering the necessary information about competitors in the market, and people must be at a high level of competence to meet the needs of customers in the best way possible (Abdulwase et al.,2020), The final steps in the traditional approach to business strategy development and execution involve implanting and executing the decided strategy, evaluating performance, and then making adjustments as needed (Gamble et al., 2021). Effectively implementing and executing a business strategy is multifaceted and involves effectively communicating the strategy to all stakeholders and allocating funding and resources to ensure completion. Ali et al. (2021) demonstrate that effective communication in the context of implementing and executing a business strategy includes communication to

both internal and external stakeholders and can lead to numerous benefits for the business including increased profit and growth (Ali et al., 2021). Resource allocation, although traditionally viewed as a function of human resources, can also solidify the execution of a business strategy, often presenting in an iterative manner through a series of managerial decisions based on organizational structure and culture, vision of leadership, and the competitive environment (Noda & Bower, 1996). The purpose of measurable objective is to provide organizations the tools to evaluate performance, both at the employee and business levels and assist with identifying areas that require improvement. This allows the organization to adjust their business strategies as need to address changes in the market, evolving customer demands, and their own internal capabilities. As referenced earlier, the ability for an organization to be agile often corresponds to their competitive advantage as allows them to quickly address internal and/or external changes that impact the organization. This is echoed by Shan et al. (2019), who states businesses must develop new technologies or product to meet the changing needs of their customers and noting that conflicts between businesses strategies and new technologies may create a barrier for success, making flexibility a vital component of business strategy (Shan et al., 2019). While additional action is likely needed for most organizations to develop and implement business strategies, continuous monitoring, evaluation, and adjustment can have a significantly larger impact on organizational success. Latest Developments in Strategy Development and Execution While the traditional approach to business strategy development and execution is effective, organizations that venture from the status quo are often met with great success. One of the most prevalent developments across most industries is digital transformation, specifically how data and analytics can be used to formulate more effective business strategies and how

technology can streamline business operations. The analysis of internal data, such as that provided by measurable objectives and through tools such as key performance indicators (KPIs), give business additional insight into how employees operate, how the business can improve, and how to align business strategies with organizational goals. Medne and Lapina (2019) highlight the value of KPIs specifically, stating that they have a direct correlation with organizational and business success “because well‐defined and weighted KPIs can help realize strategic plans” (Medne & Lapina, 2019). Analyzing internal data and metrics also allows organizations to identify problem areas within the business such as bottlenecks and ineffective workflows. Such problem areas can impede business operations by reducing productivity and efficiency, resulting in adverse effects such as increased operating costs and customer dissatisfaction. Hartleb et al. (2021) notes that such bottles can also limit the flow of customers and typical occur when a business process is operating at or beyond its capacity, adding that such impediments to business operations can carry their own measurable data through parameters such as buyers' probability and buyers' concentration (Hartleb et al., 2021). The development of data and metrics in formulating and implementing business strategies has also caused businesses to adopt a more a customer-centered approach. This involves consumer data and insights and agile responsiveness as discussed, but also entails, but also involves businesses having a better understanding of their customers through tools such as customer journey mapping. By providing insight into the end-to- end experience of the consumers, customer journey mapping involves identifying pain points experienced by the customer, understanding their needs vs expectations, and various forms of customer engagement. Micheaux and Bosio (2019) explain the process of costumer journey mapping involves diving the customer experience into “moments of truth,” from “the moment when the customer chooses a product in store and the moment when the customer tries the

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product at home” (Micheaux & Bosio, 2019). When done effectively, customer journey mapping can provide organization the benefit of a more defined business direction, improved competitive advantage, and long-term success. While embracing digital transformation is essential for most businesses, doing so carries its own set of risks that must be assessed by the organization. The costs and required resources associated with the digital transformation can result in financial constraints for the organization. Take for example Predix, an industrial internet platform produced by General Electric (GE). The business heavily invested in the development and promotion of Predix, but failed to anticipate the associated costs with technological challenges of the platform which resulted in an estimated $7 billion loss for GE (Steiber et al., 2021). A focus on agility and adaptation has also emerged as a development in business strategy development and execution, as it is often a key attribute of successful businesses. Truly agile organizations have the benefit of rapid responses to market changes, such as updating their offerings and other opportunities that can increase their competitive advantage. This development also encompasses an organization’s ability to innovate and provide consumers with continually evolving products or services. This is especially prevalent in emerging markets, as reported by Anning-Dorson (2018), where organizations continually seek advantages that put them ahead of competition, enhance organizational production, and increase revenue – all of which can done through an emphasis on internal strengths and innovation (Anning-Dorson, 2018). A trend that resulted from the increased value on innovation is the formulation of partnerships and ecosystems amongst organizations in varying industries. By partnering with organizations that cater to other target markets, businesses are provided the benefit of increased resources, experiences, and technologies that can provide an avenue to expand into additional markets. An example of a business partnership that benefited both organizations is that of Apple and Nike, with products

such as the Nike+ iPod Sports Kit and Apple Watch Nike+. A study performed by Oh (2019) found that this partnership resulted in a positive response from customers, who were willing to pay premium prices for shoes that incorporate Apple technology (Oh, 2019). By combining expertise and technologies, Apple and Nike essentially created an ecosystem of products that combined technology and fashion, generating a greater perception of value amongst customers, and further enhancing the already strong competitiveness of both organizations. Another development in business strategy development and execution involves a greater emphasis on risk management, with organizations recognizing the need to be proactive in addressing issues that can impact business operations. This development is multifaceted and involves identifying potential risk, assessing their impact, continually monitoring for threats, and creating an organizational culture that promotes risk awareness and accountability. The concept of enterprise risk management (ERM) is often utilized to identify potential risk and mitigate their impacts through a holistic view. Lechner and Gatzert (2018) review the prevalence of ERM in recent years, noting the approach is gaining popularity due to the complexity of modern risk, the emergence of more advanced risk identification technologies, the recent financial crisis, and other various factors (Lechner and Gatzert, 2018). While the focus of the latest developments in business strategy development and execution focuses on the positive impacts, it remains equally important the potential determinants that can emerge with changes existing approaches. Beginning with change management, changes to existing policies and methodologies can be disruptive for business operations and are often met with some degree of resistance, be it internal or external. While advancements in AI technology are seen as potentially groundbreaking and revolutionary, they also carry the potential to impact employees across multiple industries. With the continued economic downturn that resulted from the Covid-19 pandemic, businesses

continue to experience supply chain issues that have resulted in significant global inflation. With businesses looking to cut costs, many organizations are implementing business strategies that include replacing the existing workforce with AI technology or automated processes, resulting in growing concerns for job security. A study performed by Kong et al. (2021) highlight such concerns for front-desk hotel employees, who historically have a high rate of job burn out which is only compounded by concerns of AI replacing their positions making “feel emotionally exhausted” (Kong et al., 2021). The concerns over advancements in AI technology extend to customers as well, which makes it imperative that such developments continue to address ethical considerations and other governance. As AI technology advances, a segment of consumers having growing concerns over privacy and security. Mazurek and Małagocka (2019) discuss privacy concerns on consumer in the context of e-commerce, nothing that despite “privacy has become increasingly important in the daily lives of both individuals and businesses” data is being collected at an unprecedented rate as the result of advancements in AI technology and raises concerns of consumers to protect their personal data (Mazurek & Małagocka, 2019). Regardless if new developments in business strategy development and formulation provide greater benefit or risk, an organization’s flexibility and ability to remain agile during changing conditions will dictate its success or failure, as disruptions to market trends and other changing variables will continue to impact business operations in all industries. Future Areas of Research As new developments in business strategy development and execution emerge, successful businesses have already begun research and development into advancements that differentiate them amongst competition. Despite a digital transformation already underway, the emergence of artificial intelligence (AI), should be seen as the next development is business strategy

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development and execution. Further research into emerging AI technologies can enhance the customer experience, improve business operations, and provide new opportunities that add to the success of the business. Ameen et al. (2021) provide examples of AI being used today by organizations to enhance the customer experience by personalizing services, recommending products based on past purchases, and offering chatbots and virtual assistance to assist customers (Ameen et al., 2021). With such technology essentially in its infancy, research should extend into how AI can be utilized internally by organizations in regard to the development and execution of business strategies. This includes the use of AI to conduct more comprehensive market analysis, as a means to increase organizational competitiveness. Huang and Rust (2021) provide a multi- stage frame for market analysis that encompasses existing technology which involves “mechanical AI for automating repetitive marketing functions and activities, thinking AI for processing data to arrive at decisions, and feeling AI for analyzing interactions and human emotions” (Huang and Rust, 2021). Finally, research into the ethical implications of AI technology in relation business strategy development and execution should be assessed, as concerns exist for both businesses and their consumers. Such research should focus on how businesses adopt AI technologies into their business operations and frameworks while continuing develop business strategies based on ethics, specifically centered around the degree of AI self- learning and potential impact on the exiting workforce (Brendel et al., 2021). Healthcare Administration influence on Business Strategy Development and Execution Leadership in healthcare settings play a pivotal role in the development and execution of business strategies, as those in such roles are responsible for the business side of medicine. From small rural clinics to large-scale teaching hospitals, most medical entities produce revenue to some degree and, as such, require business strategies that improve areas such as financial

performance and operational efficiencies. Healthcare administrators also must ensure that business strategies adhere to laws and regulations that govern medicine, along with the patient’s care and experience as well. Regardless if traditional methods or new approaches are utilized, healthcare administrators and their business strategies can influence the entirety of the healthcare system, be it on a local or national level. Group vs Individual Decision Making in Healthcare Administration Decision making for healthcare administration is often complex given the variations that exist within healthcare, medical professionals, and their patients. The most common approach for the decision-making process in healthcare settings utilizes the group decision-making model, with teams consisting of medical professionals, business executives, and other various roles. This diverse group can then make decisions based on their varying expertise and perspectives, as discussed earlier, which results in a holistic approach to healthcare delivery. Li and Wei (2020) highlight the benefit of multi-criteria group decision-making given success in areas such as pricing of various medical technologies and services (Li & Wi, 2020). In this process, healthcare administrators and the various other members of the decision-making group consider multiple criteria when making decisions, such as cost-effectiveness and patient outcomes, as this approach allows for more comprehensive decision making. While individual decision-making is a rarity in healthcare, especially in the United States, such instances do exist globally and carry risks that extend to patient care. Limited perspective or medical knowledge, biases, and lack of accountability all impose additional risks on patients and can impact outcomes. One of the most prevalent examples of impact to patients as of individual decision making in healthcare is that of Dr. Andrew Wakefield, who published a study which incorrectly correlated the measle, mumps, and rubella vaccine with autism in children. The ramifications of Dr. Wakefield’s study are still

felt today. A survey conducted by Gallup News asked participants if they believe vaccinations cause autism in children, with 6% of participants responding yes and a resounding 48% responding unsure despite there being no factual correlation between vaccines and autism (Joslyn & Sylvester, 2019). With the caveat of patient care and outcomes being the responsibility of healthcare administrators as well, it is likely that the practice of group-decision making within healthcare will remain prevalent. Traditional Approaches to Healthcare Strategy Development and Execution As within most businesses, healthcare administration often begin the process of formulating businesses strategies by developing a strategic vision for their respective medical entity, which establishes the overall direction and purpose. Weston (2020) provides that most healthcare organizations have a strategic vision that includes a mission in vision, which acts to motivate healthcare professionals to a common goal “to deliver high quality, affordable, compassionate care to patients and improve the health of our community” while allow the business to grow and remain profitable (Weston, 2020). Healthcare administrators, however, have a unique responsibility to incorporate patient care and safety into their strategic vision, as this is the foundation on which the healthcare system exists. A study performed by Belohlav et al. (2010) explored core values that exist in hospital settings, which commonly highlighted factors such as quality of patient-centered care and superior customer service (Belohlav et al., 2010). The study also emphasized that healthcare administrators’ focus should centered around activities that coincide with their current capabilities, as this will allow for effective resource allocation and increased performance by staff, noting “As a hospital increases it’s level of performance excellence, it will ultimately be able to achieve all of the core values” (Belohlav et al., 2010). Once a strategic vision is established, healthcare administrators should then look to establish and

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define measurable objectives for both their staff and the medical entity as a whole. The objectives may vary based on factors such as types of care offered, location, and various federal regulation, but at the crux, healthcare objectives should center around financial stability and quality of patient care. Carini et al. (2020) makes note that measuring of healthcare provider’s performance is fairly common across the world in hospital settings, highlighting the Performance Assessment Tool for quality improvement in Hospitals (PATH) developed by the World Health Organization (WHO) with the goal of identifying indicators for hospital performance. Defining measurable objectives for performance also provides healthcare administrators with the benefits of performance benchmarking, identifying variations in care amongst providers, and reducing patient errors. Once objectives have been defined, healthcare administrators must then develop strategies that allow the business to reach their goals. Meeting organizational goals is often directly correlated to financial performance through various federal programs and initiatives, including the The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which “updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care” through programs sucg as Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) (Centers for Medicare & Medicaid Services, 2016). Healthcare administration can then implement the various strategies, which also entails evaluating performance and adjusting their approach as needed. A study performed by Abernethy and Brownell (1999) found that hospitals and other healthcare settings typically adjust their strategies through two approaches: introducing new services and programs that meet the demands of their patients and expanding existing programs (Abernethy and Brownel, 1999). With the complexity that exists in healthcare settings, healthcare administrators must formulate

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and execute business strategies that not only enhance business performance but also maintains patient safety. New Developments in Healthcare Strategy Development and Execution As with most industries, healthcare administrators are overseeing the digital transformation for the healthcare sector and the associated consequences. One of the main areas of focus for healthcare administrators is that of Electronic Health Record (EHR) software, which were mandated by the American Recovery and Reinvestment Act in 2009. The goals of EHR implementation were to improve patient care, streamline workflows for healthcare professionals, and increase patient engagement through the use of patient portals. However, despite the proposed benefits, EHR have introduced new issues for healthcare administrators. Such issues are often centered around the cost and implementation of EHR systems, which often impede workflows and can impact patient care. While larger, financially sound healthcare settings such as teaching hospitals have benefited greatly from EHR implementation, smaller settings such as those more rural areas are essentially facing a digital divide from EHR use as a result of poor short-term return on investments (Thakkar & Davis, 2006). The costs associated with EHRs extends beyond the initial implementation, as such software often incurs costs associated with maintenance and support. A study by Menachemi and Collum (2011) found that the cost associated with EHR maintenance costs averaged $8,412 per provider per year, a number that has most certainly increased in the 12 years since the study was conducted (Menachemi & Collum, 2011). Artificial intelligence technologies have also begun to be introduced into healthcare settings as well, which result in the same concerns for healthcare administrators. Kooli and Muftah (2022) highlighted the ethical concerns of AI technology within in healthcare, admitting the technology will revolutionize healthcare but present with ethical concerns regarding patient

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safety (Kooli & Muftah, 2022). Take for example IBM Watson for oncology, an AI tool designed to assist oncologists with making treatment decisions for cancer patients. Concerns have been raised over systems accuracy, transparency, and potential for bias. Compliance and Regulations Healthcare administration must also include considerations of compliance and regulations, issued at both the federal and state levels, when formulating business strategies. Policies such as HIPAA and HITECH aim to protect patient safety and privacy, and can result in significant legal and financial ramifications if guidelines are not followed. One of the most significant aspect of such healthcare regulations is the protection of patient data, specifically protecting their protected health information (PHI). Floyd et al. (2016) highlights the data breach of Community Health Systems in 2014, in which “4.5 million records were stolen which caused various types of financial repercussions which have been estimated at upwards of 150 million dollars” (Floyd et al., 2014). As such, healthcare administrators must make decisions and formulate business strategies that promote protection and security of PHI. As stated by Pradeep et al. (2022), “Medical records are the most critical personal records and useful knowledge in e- healthcare networks. Maintaining protection for this information system is very necessary to maintain discretion” (Pradeep et al., 2022). These strategies are primarily focused on the infrastructure and security of IT systems, which can act as a barrier to protect PHI and other sensitive data. This includes implementing security measures such as encryption, firewalls, performance audits and assessments, and addressing any potential vulnerabilities. Zhang and Lin (2018) highlight the benefits of cloud-based health records, which allow for PHI amongst healthcare providers while also addressing concerns of patient privacy and security (Zhang & Lin, 2018).

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Conclusion While both individual and group decisions share a similar process, they each present each with unique benefits and risks. Organizations must first determine which approach best suits their needs, as doing so yield the best outcomes. However, regardless of approach, the ability to be agile and have flexibility in decision making, as well utilizing both approaches depending on the issue will result in the most success. Similarly, the traditional approach to developing and executing business strategies is tried and tested, but provides limited resources for organizations to differentiate themselves from competition. While new developments may produce success for the business, associated risks such as those that present with artificial intelligence technologies should be explored. Healthcare administrators in particular have a unique responsibility in that, their decision making, and strategy development and execution not only impact the business of their healthcare facilities, but also must adhere to regulations as they govern patient safety and outcomes.

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