Manager’s Checklist The nurse manager is responsible for:
● Identifying problem areas ● Generating ideas that might serve as possible
solutions ● Checking with others for advice ● Selecting motivators ● Implementing a solution ● Evaluating the results
CASE STUDY 8-1
CHAPTER 8 • THINKING CRITICALLY, MAKING DECISIONS, SOLVING PROBLEMS 105
The manager knows the alternatives (IV team, anesthesia department, standards) and the conditions associated with each option (reduced costs, assistance with starting IVs, minimum attempts and some cost reduction). A condition of strong certainty is said to exist and the decision can be made with full knowledge of what the payoff probably will be.
Decision Making Under Uncertainty and Risk Seldom do decision makers know everything there is to know about a subject or situation. If everything was known, the decision would be obvious for all to realize.
Most critical decision making in organizations is done under conditions of uncertainty and risk. The individual or group making the decision does not know all the alternatives, attendant risks, or possible consequences of each option. Uncertainty and risk are inevitable because of the complex and dynamic nature of health care organizations.
Here is an example: If the weather forecaster predicts a 40 percent chance of snow, the nurse manager is operating in a situation of risk when trying to decide how to staff the unit for the next 24 hours.
In a risk situation, availability of each alternative, potential successes, and costs are all as- sociated with probability estimates. Probability is the likelihood, expressed as a percentage, that an event will or will not occur. If something is certain to happen, its probability is 100 percent. If it is certain not to happen, its probability is 0 percent. If there is a 50–50 chance, its probability is 50 percent.
Here is another example: Suppose a nurse manager decides to use agency nurses to staff a unit during heavy vacation periods. Two agencies look attractive, and the manager must decide between them. Agency A has had modest growth over the past 10 years and offers the manager a three-month contract, freezing wages during that time. In addition, the unit will have first choice of available nurses. Agency B is much more dynamic and charges more but explains that the reason they have had a high rate of growth is that their nurses are the best and the highest paid in the area. The nurse manager can choose Agency A, which will pro- vide a safe, constant supply of nursing personnel, or B, which promises better care but at a higher cost.
The key element in decision making under conditions of risk is to determine the probabili- ties of each alternative as accurately as possible. The nurse manager can use a probability anal- ysis, whereby expected risk is calculated or estimated. Using the probability analysis shown in Table 8-2, it appears as though Agency A offers the best outcome. However, if the second agency had a 90 percent chance of filling shifts and a 50 percent chance of fixing costs, a completely different situation would exist.
The nurse manager might decide that the potential for increased costs was a small trade-off for having more highly qualified nurses and the best probability of having the unit fully staffed during vacation periods. Objective probability is the likelihood that an event will or will not occur based on facts and reliable information. Subjective probability is