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Judgment in Managerial Decision-Making Report

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Executive summary

Decision making is a complex process that is influenced by many factors that determine the quality of the outcome. My decision to take a patient out for a walk despite a physician’s refusal was influenced by bias, heuristics, and the framing effect. The physician’s report stated that even though the health of the patient was improving, he was not yet ready to start taking walks. He was not strong enough and his health status demanded more days for bed rest.

Selective use of information to confirm my belief and ineffective framing affected the quality of the decision. The decision can be analyzed using several theories, perspectives, and frameworks that include prospect theory, bounded rationality theory, and utilitarianism. A critical discussion of the decision reveals that heuristics, framing effect, and cognitive bias played key roles in influencing the outcome. Recommendations on how the decision could have been improved are provided and justified using concepts of prospect theory, framing effect, and heuristics. An effective decision-making process leads to good decisions. Through evaluation of the physician’s report, objective consideration of the situation, use of proper reference point, and risk aversion would have led to a better decision.

Introduction

Workers in the healthcare system make critical decisions that affect the health and wellbeing of patients. Decision-making primarily focuses on the possibility of attaining positive health outcomes that improve the health and safety of patients. As a unit assistant at King Hussein Hospital, I made several decisions that had significant implications on patients’ health. One of my responsibilities was to help patients under bed rest walk around the hospital precincts as a way of gaining strength and improving mobility.

Helping patients ambulate was only conducted under the recommendation and supervision of a nurse practitioner or a physician. However, I decided to help the patient get out of bed and take a brisk walk after placing several requests. The decision was influenced by the patient’s insistence, absence of the physician, my personal judgment regarding the importance of helping the patient, and ignorance of the dangers associated with defying a physician’s recommendations.

The decision had an adverse outcome because the health of the patient deteriorated significantly. The physician had barred the patient from getting out of bed because his legs were not strong enough to support the weight of his body. While out walking, the patient tripped and broke his right leg and fractured several ribs. The patient was in poor body condition and was very weak. The outcomes meant that he had to be hospitalized for a longer period of time because of the need for more attention and advanced nursing care.

Analysis of the decision

According to prospect theory, risky or uncertain situations compel people to make decisions based on the probability of gaining or losing (Fitzgerald, 2013). In uncertain situations, decision-makers usually ignore the overall significance of the outcome and focus on potential gains and losses (Shapira, 2002). Taking the patient out for a walk was against the recommendations of the physician who had assigned the patient to mandatory bed rest.

My decision-making ignored the possible dangers of defying the doctor’s orders and ignoring the unit’s rules. I focused on the value of the assistance to be offered to the patient and the satisfaction it would afford. The patient had insisted that he needed to get out of bed. The doctor’s report indicated that he was not in good health to enable him to walk around. I disagreed with the report because the patient looked healthy and strong. My judgment was clouded by his insistence, ignorance of the dangers of defying the physician’s orders, and the perceived joy the patient would get from my assistance.

Bounded rationality theory is a concept that suggests that decision-makers act under three main constraints namely limited information, inadequate time, and limited abilities to process information (Grune-Yanoff, 2007). My ignorance regarding the dangers of taking the patient out or a walk influenced my decision–making. The physician was aware of the patient’s poor health condition. He was very weak and his legs were not strong enough to support his body weight.

Lack of adequate information regarding the patient’s health condition and the dangers of taking a patient in poor health condition out for a walk informed my decision. I did not consult a nurse practitioner in my unit and relied solely on my poor judgment. It was against the rules of the unit for an assistant to make any critical decision without first contacting a nurse practitioner or a physician on duty.

On the other hand, I made the decision to help the patient because the physician was absent from the hospital that day and he would be out for several hours. I figured out that he would not know about the decision and the help offered would increase the patient’s wellbeing significantly. I disregarded the professional recommendation that barred the patient from getting out of bed because the procedure used to determine whether a patient was ready to start taking walks or not was long and ineffective. Adherence to the physician’s recommendations would have prevented the adverse outcomes that worsened the health of the patient.

The decision was also influenced by an attribution bias referred to as framing. The framing effect is a cognitive bias that affects decision-making depending on the way a choice is presented (Bazerman & Moore, 2008). My decision was influenced by risky choice framing. The choice to help the patient get out of bed despite the physician’s warnings appeared beneficial to the patient. Declining to help the patient was the right thing to do because it would have improved his health and avoided additional injuries.

On the other hand, helping the patient presented several risks to their health and wellbeing. According to risky choice framing, people prefer a certain option but chose the risky one (Ipurie, 2004). I chose the risky option because I thought it would be beneficial to the patient. My decision was also influenced by confirmation heuristics because the decision resulted from the selective evaluation of information.

Confirmation heuristic refers to the tendency to favor certain information during decision making because it confirms certain beliefs (Gurevich, Kliger, & Weiner, 2011). My decision was primarily made from the fact that the physician had observed great improvements in the patient’s health. Therefore, I concluded that he was getting stronger and was ready to start taking walks. I ignored the most important information and chose the one that confirmed my belief that the patient was healthy enough to start walking.

Utilitarianism is an ethical perspective that can be used to analyze the decision. The theory argues that the morality of an action is determined by its ability to maximize utility and increase pleasure (Icheku, 2011).

This theory influences decision making processes because its major tenet is that an action can be described as right or wrong based on the consequences of the outcome. Erroneous evaluation of the decision convinced me that taking the patient out for a walk would help him relax, practice, and release the stress that had accumulated from prolonged bed rest. The decision would have positive outcomes and was therefore in the best interests of the patient. Moreover, the walk would provide pleasure and increase his feelings of belonging and being cared for because the physician had rejected his request for taking short walks.

Critical discussion

My decision-making process was poor because it was influenced by confirmation heuristic and framing effect. Confirmation heuristic refers to the tendency to use information selectively in decision making. Information that confirms one’s beliefs is chosen and applied (Madjid, 2012). The doctor’s report regarding the patient contained detailed information that could have helped to make a rational decision.

However, I chose the information that confirmed my belief that the patient was healthy and strong enough to take a walk. This selective use of information presented a weakness that led to a poor decision. Confirmation heuristic affected my decision in two main ways. First, I chose information that supported my belief. Second, I ignored information that challenged my belief. The framing effect refers to a cognitive bias that affects decision making depending on whether a choice is presented as a positive or negative frame (Fitzgerald, 2013).

The choice to take the patient out for a walk was presented as a positive frame because it would provide pleasure, help him relax, and serve as practice for his feeble body. There were two options available and I chose the risky one. Taking the patient for a walk was very risky because of his poor body condition. However, I took the risky option because my decision making was influenced by risky choice framing.

The application of the principles of utilitarianism was important and helpful in making the decision. However, the influence of biases and heuristics weakened the process and the effectiveness of the theory’s application. It is impossible to determine the outcome of a decision (Icheku, 2011). The doctor’s report stated that the patient’s health was improving but he was not ready to be released from bed rest yet because he was not strong enough. My decision-making process ignored this critical information and gave in to the influence of heuristics and bias. In addition, ineffective framing weakened the process. At the moment of making the decision, the action of taking the patient for a walk was right.

However, it became wrong in hindsight because of the negative consequences of its outcome. The patient suffered injuries that worsened his health. Another weakness of the decision-making process was the influence of a bias known as the confirmation trap. Confirmation trap results from the tendency to make decisions by using information selectively (Madjid, 2012). The doctor’s report contained information that would have enabled me to make a good decision. This selectivity influenced me into choosing information that was confirmed by the belief that the patient was strong enough to walk.

Recommendations

In order to overcome the confirmation heuristic, I should have evaluated all the information contained in the doctor’s report regarding the health status of the patient. The recommendations were provided by a professional after carrying out thorough medical tests and assessments. On the other hand, I allowed emotions to influence the decision-making process. The patient was very insistent and claimed that prolonged bed rest was making him more stressed because he did not get an opportunity to meet other people and relax. I felt sorry for him and decided to grant his wish. Emotional interference and bias compelled me to defy the rules of the unit that bared any assistant from making any critical decision without the permission of a physician or a nurse practitioner.

One of the most important aspects of effective decision-making is the proper use of information. A common source of weakness in my decision-making process was ineffective framing that led to a bad decision. My decision was based on whether taking the patient out for a walk would be beneficial or not to his health. Biases that emanate from framing adversely affect the quality of decisions because they introduce numerous errors (Fitzgerald, 2013).

I should have evaluated the situation objectively by reading the recommendations of the physician and following them. Consideration of facts would have strengthened the decision-making process and would have resulted in a more rational decision. I should not have listened to the patient’s pleas because they augmented the influence of ineffective framing. The physician knew what was right for the health of the patient and I should have adhered to the recommendations.

Loss aversion is a tenet of prospect theory that suggests that preferences during decision making depend on the framing adopted by the decision-maker (Tom, Fox, Trepel, & Poldrack, 2005). If a reference point is viewed in a way that gives rise to a positive gain, then the decision-maker will be risk-averse. In contrast, if a reference point is viewed in a way that results in a loss, then the decision-maker will see risk (Tom et al., 2015) should have avoided using reference points to decide whether taking the patient for a walk would result in a loss or again. I should have considered the absolute value of the situation because using reference points introduced biases and ineffective farming.

The decision was made despite the unavailability of adequate information regarding the dangers of defying the physician’s recommendations. Contacting the unit’s resident nurse practitioner would have helped to avoid the bad decision that adversely affected the patient. Nurse practitioners possess great knowledge and experience to make critical decisions that affect patients’ health. According to bounded rationality, decision-making is usually influenced by limited information, inadequate time, and information processing weaknesses (Shapira, 2002).

I took advantage of the physician’s absence to take the patient out for a walk. I should have waited for the physician to report back and get permission. He would have explained in detail the dangers of taking the patient off bed rest and the possible consequences of allowing him to walk in poor health condition. My ignorance, biases, and assumptions influenced my decision-making and as a result, affected the health of the patient in a negative way.

References

Bazerman, M. H., & Moore, D. A. (2008). Judgment in Managerial Decision Making. New York, NY: John Wiley & Sons.

Grune-Yanoff, T. (2007). Bounded Rationality. Philosophy Compass 2(3), 534-563.

Gurevich, G., Kliger, D., & Weiner, B. (2011). The Role of Attribution in Economic Decision Making. The Journal of Socio-Economics 41(4), 439-444.

Fitzgerald, M. (2013). Managing Under Uncertainty: A Qualitative Approach to Decision Making (2nd Ed.). New York: Pearson.

Icheku, V. (2011). Understanding Ethics and Ethical Decision-Making. New York, NY: Xlibris Corporation.

Ipurie, T. D. (2004). The Cumulative Prospect Theory and Managerial Decision Making. Lagreb International Review of Economics and Business7 (1), 61-80.

Madjid, T. (2012). Decision making Theories and Practices from Analysis to Strategy. New York, NY: IGI Global.

Shapira, Z. (2002). Organizational Decision Making. New York, NY: Cambridge University Press.

Tom, S. M., Fox, C. R., Trepel, C., & Poldrack, R. A. (2005). The Neural Basis of Loss Aversion in Decision-Making under Risk. Science 315 (5811), 515-518.

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