ch. 1

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Atlanta Technical College *

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LEADERSHIP

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Management

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Apr 3, 2024

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Leadership Ch.1 Notes Decision Making, Problem Solving, Critical Thinking, Clinical Reasoning, and Elastic Thinking Decision making is a complex, cognitive process often defined as choosing a particular course of action. Problem solving is part of decision making and is a systematic process that focuses on analyzing difficult situations. Critical thinking aka reflective thinking is related to evaluation and has a broader scope than decision making and problem solving.  disciplined thinking that is clear, rational, open minded, and informed by evidence clinical reasoning uses both knowledge and experience to make decisions at the point of care. Elastic thinking, a type of creative thinking, differs from step-by-step analytical or linear thinking models in that it arises from what scientists call “bottom-up” processes Mlodinow notes the way an issue is framed has a influence on the way it is solved Vicarious Learning to Increase Problem-Solving and Decision- Making Skills structured, social problem-solving training can improve cognitive problem- solving, critical-thinking, and decision-making skills. Case studies, simulation, and problem-based learning (PBL) are some of the strategies that have been developed to vicariously improve problem solving and decision making. simulation provides learners opportunities for problem solving that have little or no risk to patients or to organizational performance. The desired outcome for teaching and learning decision making and critical thinking in management is an interaction between learners and others that results in the ability to critically examine management and leadership issues using a formal decision-making process improves both the quality and consistency of decision making. The Marquis–Huston Model for Teaching Critical Thinking has 4 sections. The first is a didactic theory component, such as the material that is presented in

each chapter; the second consists of a formalized approach to problem solving and decision making. The third involves some form of a group process, which can be accomplished through large and small groups and classroom discussion. The last sphere entails the material being made real for the learner so that the learning is internalized. Experiential learning provides mock experiences that have tremendous value in applying leadership and management theory. Theoretical Approaches to Problem Solving and Decision Making Heuristics: discrete, often unconscious, processes people use to make decisions  use trial-and-error methods or a rule-of-thumb approach to problem solving rather than set rules.  They provide a more immediate solution to the decision at hand. This is particularly true for uncertain or emergent situations where knowledge, time, and resources are limited. A structured approach to problem solving and decision making increases clinical reasoning and is the best way to learn how to make quality decisions because it eliminates trial and error and focuses the learning on a proven process. traditional problem-solving model  Weaknesses: the amount of time needed for proper implementation and lack of an initial objective-setting step  Problem-solving process  Identify the problem.  Gather data to analyze the causes and consequences of the problem.  Explore alternative solutions.  Evaluate the alternatives.  Select the appropriate solution.  Implement the solution.  Evaluate the results. MANAGERIAL DECISION-MAKING MODEL  Determine the decision and the desired outcome (set objectives).  Research and identify options.  Compare and contrast these options and their consequences.  Make a decision.  Implement an action plan.  Evaluate results.

NURSING PROCESS  Assess  Diagnose  Plan  Implement  Evaluate Integrated Ethical Problem-Solving Model  developed by the National Association of Social Workers (2020  DETERMINE whether there is an ethical issue or/and dilemma.  IDENTIFY the key values and principles involved.  RANK the values or ethical principles which—in your professional judgment—are most relevant to the issue or dilemma.  DEVELOP an action plan that is consistent with the ethical priorities that have been determined as central to the dilemma.  IMPLEMENT your plan, utilizing the most appropriate practice skills and competencies.  REFLECT on the outcome of this ethical decision-making process. Intuitive Decision-Making Models recognition of familiar problems and the use of intuition to identify solutions is a focus of contemporary research on intuitive decision-making research Klein (2008) developed the recognition-primed decision (RPD) model for intuitive decision making in the mid-1980s to explain how people can make effective decisions under time pressure and uncertainty. the RPD model blends intuition and analysis, but pattern recognition and experience guide decision makers when time is limited, or systematic rational decision making is not possible. Critical Elements in Problem Solving and Decision Making CRITICAL ELEMENTS IN DECISION MAKING  Define objectives clearly.  Gather data carefully.  Take the time necessary.  Use an evidence-based approach.  Generate numerous alternatives.  Think logically.  Choose and act decisively.

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If a decision lacks a clear objective or if an objective is not consistent with the individual’s or organization’s stated philosophy, a poor-quality decision is likely. Confirmation bias refers to our tendency to search for and favor information that confirms our beliefs while simultaneously ignoring or devaluing information that contradicts our beliefs QUESTIONS TO EXAMINE IN DATA GATHERING  What is the setting?  What is the problem?  Where is it a problem?  When is it a problem?  Who is affected by the problem?  What is happening?  Why is it happening? What are the causes of the problem? Can the causes be prioritized?  What are the basic underlying issues? What are the areas of conflict?  What are the consequences of the problem? Which is the most serious? Facts can be misleading if they are presented in a seductive manner, if they are taken out of context, or if they are past-oriented. Typically, a PICO (patient or population, intervention, comparison, and outcome) format is used in evidence-based practice to guide the search for the current best evidence to address a problem STRATEGIES FOR THE NEW NURSE TO PROMOTE EVIDENCE-BASED BEST PRACTICE  Keep abreast of the evidence—subscribe to professional journals and read widely.  Use and encourage use of multiple sources of evidence.  Use evidence not only to support clinical interventions but also to support teaching strategies.  Find established sources of evidence in your specialty—do not reinvent the wheel.  Implement and evaluate nationally sanctioned clinical practice guidelines.  Question and challenge nursing traditions and promote a spirit of risk taking.  Dispel myths and traditions not supported by evidence.  Collaborate with other nurses locally and globally.  Interact with other disciplines to bring nursing evidence to the table.

Evidence-based decision making and evidence-based practice should be viewed as imperatives for all nurses today as well as for the profession in general. The greater the number of alternatives that can be generated, the greater the chance that the final decision will be sound. 4 common ways people illogically think  Overgeneralizing: This type of “crooked” thinking occurs when one believes that because A has a particular characteristic, every other A also has the same characteristic.  Affirming the consequences: In this type of illogical thinking, one decides that if B is good and one is currently doing A, then A must not be good  Arguing from analogy: This thinking applies a component that is present in two separate concepts and then states that because A is present in B, then A and B are alike in all respects.  Both-sidesing: Both-sidesing occurs when someone or something presents two sides as equally valid when one in fact is wrong Questions to consider when analyzing situations  What factors can you influence? How can you make the positive factors more important and minimize the negative factors?  What are the financial implications of each alternative? What are the political implications? Who else will be affected by the decision, and what support is available?  What are the weighting factors?  What is the best solution?  What are the means of evaluation?  What are the consequences of each alternative? Many individuals choose to delay acting because they lack the courage to face the consequences of their choices. Individual Variations in Decision Making Sex: Research suggests that sex may play a role in how individuals make decisions, although some debate continues as to whether these differences are more gender role based than biologic sex based. Values: No matter how objective the criteria, value judgments will always play a part in a person’s decision making, either consciously or subconsciously. Life Experience

Individual Preference Brain Hemisphere Dominance and Thinking Styles analytical, linear, left-brain thinkers process information differently from creative, intuitive, right-brain thinkers. Left-brain thinkers were supposed to be better at processing language, logic, and numbers, whereas right-brain thinkers excelled at nonverbal ideation and creativity. New evidence suggests the existence of left- or right-brain dominance may be an oversimplification. Overcoming Individual Vulnerability in Decision Making Values- Being confused and unclear about one’s values may affect decision- making ability Life Experience- use available resources, including current research and literature, to gain a fuller understanding of the issues involved. Second, involve other people, such as experienced colleagues, mentors, trusted friends, and experts, to act as sounding boards and advisors. Third, analyze decisions later to assess their success Individual Preference- involves self-awareness, honesty, and risk-taking. people also must be honest with themselves about their choices and their preferences for those choices  Those who can do the right but unpopular thing and who dare to stand alone will emerge as leaders. Individual Ways of Thinking- most organizations include both types of thinkers and proactively seek out a diverse group of thinkers when solving problems and making decisions. Decision Making in Organizations important for leaders and managers to also understand how the organization influences the decision-making process. Effect of Organizational Power Powerful people in organizations are more likely to have decisions made (by themselves or their subordinates) that are congruent with their own preferences and values

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The ability of the powerful to influence individual decision making in an organization often requires adopting a private personality and an organizational personality. Rational and Administrative Decision Making Simon (1965) delineated two types of management decision makers: the “economic man” and the “administrative man.” Economic- Decisions are made in a rational manner; All possible alternatives are considered; Decision maker has complete knowledge of the problem or decision situation; A rational system of ordering preference of alternatives is used; Decisions are selected that maximize utility. Administrative- Decisions made are “good enough”; Because consequences of alternatives occur in the future, they are impossible to predict accurately; Complete knowledge is not possible, so knowledge is always fragmented; Some alternatives are considered, but not all possible ones; Final choice is “satisficing” rather than maximizing. Most management decisions are made by using the “administrative man” model of decision making. Decision-Making Tools Decision Grids- A decision grid allows one to visually examine the alternatives and compare each against the same criteria; would be useful when changing the method of managing care on a unit or when selecting a candidate to hire from a large interview pool. Payoff Tables- have a cost–profit–volume relationship Decision Trees- FIGURE 1.4. Consequence Tables- demonstrate how various alternatives create different consequences. A consequence table lists the objectives for solving a problem down one side of a table and rates how each alternative would meet the desired objective. Logic Models- schematics or pictures of how programs are intended to operate. The schematic typically includes resources, processes, and desired outcomes and depicts exactly what the relationships are between the three components. Program Evaluation and Review Technique(PERT)- popular tool to determine the timing of decisions; a flowchart that predicts when events and activities must take place if a final event is to occur.

 Pitfalls in Using Decision-Making Tools: Many of the pitfalls associated with management decision-making tools can be reduced by choosing the correct decision-making style and involving others when appropriate. Integrating Leadership Roles and Management Functions in Decision Making -The successful decision maker possesses courage, energy, and creativity and is aware of the need for sensitivity in decision making. Leaders recognize the appropriate people to include in decision making and to use a suitable theoretical model for the decision situation. The integrated leader-manager understands the significance that sex and gender, personal values, life experience, preferences, willingness to take risks, brain hemisphere dominance, and thinking styles have on selected alternatives in making the decision. KEY CONCEPTS!  Successful decision makers are self-aware, courageous, sensitive, energetic, and creative.  The rational approach to problem solving begins with a fixed goal and ends with an evaluation process.  Naturalistic decision making blends intuition and analysis, but pattern recognition and experience guide decision makers when time is limited or systematic rational decision making is not possible.  Evidence-based nursing practice integrates the best evidence available to achieve desirable outcomes.  Typically, a PICO format is used in evidence-based practice to guide the search for the current best evidence to address a problem.  The successful decision maker understands the significance that sex and gender; personal, individual values; life experience; preferences; willingness to take risks; brain hemisphere dominance; and predominant thinking style have on alternative identification and selection.  Left- and right-brain dominance may be an oversimplification in terms of how individuals think.  The critical thinker is aware of areas of vulnerability that hinder successful decision making and makes efforts to avoid the pitfalls of faulty logic when gathering data.  The act of making and evaluating decisions increases the expertise of the decision maker.

 There are many models for improving decision making. Using a systematic decision-making or problem-solving model reduces heuristic trial-and-error or rule-of-thumb methods and increases the probability that appropriate decisions will be made.  Two major considerations in organizational decision making are how power affects decision making and whether management decision making needs to be only “satisficing.”  Management science has produced many tools to help decision makers make better and more objective decisions, but all are subject to human error, and many do not adequately consider the human element.

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