The decision-making process is often regarded as a core of the effective organizational performance and effective management. In the healthcare sector, all employees are viewed as decision-makers. They are not cogs in a machine. The traditional hierarchical organization does not operate effectively in a world characterized by constant dynamic change. Investing all power in the hands of top management implies that top management has the solutions to all problems. In a static world, top management may indeed know most of the solutions. In a turbulent world, though, no one grasps more than a small fraction of the answers. In spite of the popularity of the decision-making process, many critics admit that “the ideal decision-making process is unrealistic” because economic, social, and political changes affected modern society and an organization.
Salaman (2001) underlines that the ideal decision-making is unrealistic because change leads to uncertainty, and there is less uncertainty in the short run than in the long run. He uses examples of business failures to portray ineffective decision-making processes based on decision-making norms rather than careful analysis of the situation. Salaman (2001) states that: “central to decision-making is the notion of rationality. Rationality refers to the quality of thinking and decision-making” (p. 2). Organizations can be pretty sure that whatever long-term guesses they make will be wrong. Unfortunately, most worthwhile achievements are carried out in the long run and consequently require a long-term outlook. A simple landscaping project requires a five- to ten-year time horizon. An urban renewal project may require a ten- to twenty-year outlook. For example, account executives are concerned with making a sale. Once a healthcare project contract is signed, they turn their attention to other opportunities. If they made promises to the customer that project staff cannot fulfill, they are not held accountable. In this case, “a decision can be ‘formally’ rational in that it was dressed up in the language of calculations, but by other measures irrational, or questionable” (Salaman 2001, p. 3). In this case, the ideal decision-making is impossible and unrealistic.
Also, ideal decision-making is impossible because of substantive rationality. Following Weber: “[decision-making] conveys only one element common to all the possible empirical situations” (Salaman 2001, p. 3). The departure often leads to painful changes in the project requirements, which are in turn important contributors to time and cost overruns. In this situation, long-term considerations are sacrificed to short-term exigencies. The corporate culture must extol the virtues of a long-term outlook. It must cast a cold eye on all undertakings that focus narrowly on short-term results. It must also convey the attitude that short-term setbacks are tolerable when they lead ultimately to long-term gains (Chase & Jacobs 2005). The best way to let people know the importance of this outlook to the organization is to create incentive systems that reward long-term behavior and to develop organizational structures that make it difficult to be a short-termer. A customer-focused culture requires a new attitude toward customers. They should not be seen as irritants that get in the way of doing the job.
Salaman (2001) identifies four main relational concepts of decision-making: quasi-resolution of conflicts, uncertainty avoidance, problematic search, organizational learning (p. 64). Explaining each of these concepts, Salaman underlines that ideal decision-making is impossible because an organization is influenced by internal and external environmental it cannot predict or control. For instance, in healthcare, rank-and-file employees are often better informed than their “superiors” in such circumstances since they have firsthand knowledge of a rapidly evolving situation. By the time managers in the rarefied heights of the hierarchy receive information on what is happening, circumstances have changed.
When change is rapid, it is tempting to adopt a short-term view of life. Healthcare is influenced by social and cultural changes which require diverse professional and communication skills, new technologies, and methods of treatment. In many situations, it is impossible to follow a standardized approach based on different cultural factors and social changes (Chase & Jacobs 2005.. Their confusion about the technical requirements of the project should not be viewed as a sign of obtuseness. Their inability to define what they want and need should not be interpreted as the fickleness. Instead of being seen as antagonists, they should be viewed as partners in the project. In the final analysis, they are the experts on their needs and requirements. Following Salaman (2001): search, like decision-making, is problem-directed” (p. 68). The medical staff and the patients work together to reveal these needs and requirements and to develop a deliverable to satisfy them. The point is, a cultural, knowledge, and communication gap often exists between customers and developers, and this gap makes it difficult for the project team to capture customer needs effectively and then convert them into requirements that lead to customer satisfaction (Chase & Jacobs 2005).
The ideal decision-making is unrealistic because: “it is far removed from the coolly logical appraisal and selection of alternatives” (Salaman 2001, p. 81). In such an environment, the job of healthcare staff is not to call the shots independently but to ensure that effective decisions are made. They can do this in a number of ways. For example, they can create an environment where they, their workforce, and customers can interact productively to arrive at decisions. Effective decision-making does not occur by accident (Pittengrew et al 2006). Rational decision-making is fundamentally a process of prioritizing options. The best options go to the top of the list, the worst to the bottom. In healthcare, patients consider a number of selection criteria, including price, performance, and even prestige.
In the absence of an explicit decision-making methodology such as the analytical hierarchy process, they intuitively assess the performance of the target on each of these criteria and then sum up the results. In view of the fact that decision-making entails prioritization, whatever decision-making tools we use should have a built-in capacity to rank the options. This is precisely what lies at the heart of the specific project selection techniques (Mullins, 1993). Benefit-cost analysis refers to the attempt to systematically weigh the benefits associated with an option against its costs. This can be done in a highly informal manner, as when we divide a page into two columns, labeling one “pros” and the other “cons.” It can be done more formally through the creation of sophisticated mathematical models of benefits and costs. A benefit-cost ratio is a quantitative tool, and as such it requires that the variables being analyzed be quantified. Most typically, benefits are measured in monetary terms. In this particular formulation, benefits are measured by estimating revenue in the simplest way possible (Mullins, 1993).
The ideal decision-making is unrealistic because all organizations are influenced by social and political changes. “Location within and dependence upon a certain cognitive and political context renders these ideas and assumptions natural and powerful” (Salaman 2001, p. 139). For example, key players may change (senior managers, technical team members, customers), and the new players will pursue an agenda that is different from that of their predecessors. Budgets change—money that was earmarked for project use might suddenly be withdrawn. Technology is continually changing—new technologies may be viewed as irresistible, and pressure to incorporate them into the deliverable may grow. The business environment experiences change—what was a compelling feature at the outset of the project is now regarded as a white elephant. People simply change their minds— at the outset of the project, the requirements they agreed to were abstractions written on paper, but when they see what they are actually getting, they may ask for additions or deletions. This information is crucial for future maintenance of the deliverable. It is also important to have in the event of legal disputes between customers and developers when one party maintains that the other did not meet its contractual obligations (Pittengrew et al 2006). Change control is needed on all projects. What makes it difficult on time-boxed projects is that owing to the hectic pace of work that is being carried out, it is tempting to bypass change control processes because they are regarded as bureaucratic impediments that retard progress.
In sum, ideal decision-making is an unrealistic process because modern organizations are influenced by internal and external environments, political, ideological, and technical changes. Decision-making is based on rationality and the choice between alternatives. Too often, when key personnel does not understand the original rationale of a project, they redefine this rationale to suit their outlook, and this leads to problems of continuity. the ideal decision-making is unrealistic because change influences companies from the very beginning till the end of projects, and it is impossible to use experience and a standardized approach in all circumstances. A predictable reality is that as a project is being carried out, changes to the authorized requirements will occur.
Bibliography
Chase R.B., Jacobs R.F. 2005, Operations Management for Competitive Advantage, Hill/Irwin; 10 edn.
Mullins, L.J. 1993, Management and Organizational Behavior. PITMAN publishing. 3d edn.
Pittengrew, A. M., Thomas, H. Whittington, R. 2006, Handbook of Strategy and Management. Sage Publications.
Salaman, G. 2001, Making for Business: A Reader. Sage Publications Ltd.