Individuals often use a satisficing strategy
Satisficing is not a misspelled word; it is a decision-making strategy whereby the individual chooses an alternative that is not ideal but either is good enough (suffices) under existing cir- cumstances to meet minimum standards of acceptance or is the first acceptable alternative. Many problems in nursing are ineffectively solved with satisficing strategies.
Elena, a nurse manager in charge of a busy neurosurgical floor with high turnover rates and high patient acuity levels, uses a satisficing alternative when hiring replace- ment staff. She hires all nurse applicants in order of application until no positions are open. A better approach would be for Elena to replace staff only with nurse applicants who possess the skills and experiences required to care for neurosurgical patients, re- gardless of the number of applicants or desire for immediate action. Elena also should develop a plan to promote job satisfaction, the lack of which is the real reason for the vacancies.
CHAPTER 8 • THINKING CRITICALLY, MAKING DECISIONS, SOLVING PROBLEMS 107
Individuals who solve problems using satisficing may lack specific training in problem solv- ing and decision making. They may view their units or areas of responsibility as drastically sim- plified models of the real world and be content with this simplification because it allows them to make decisions with relatively simple rules of thumb or from force of habit.
The political decision-making model describes the process in terms of the particular inter- ests and objectives of powerful stakeholders, such as hospital boards, medical staffs, corporate officers, and regulatory bodies. Power is the ability to influence or control how problems and objectives are defined, what alternative solutions are considered and selected, what information flows, and, ultimately, what decisions are made (see Chapter 7).
The decision-making process begins when a gap exists between what is actually happening and what should be happening, and it ends with action that will narrow or close this gap. The simplest way to learn decision-making skills is to integrate a model into one’s thinking by break- ing the components down into individual steps. The seven steps of the decision-making process (Box 8-2) are as applicable to personal problems as they are to nursing management problems. Each step is elaborated by pertinent questions clarifying the statements, and they should be fol- lowed in the order in which they are presented.
Decision-Making Techniques Decision-making techniques vary according to the nature of the problem or topic, the decision maker, the context or situation, and the decision-making method or process. For routine decisions, choices that are tried and true can be made for well-defined, known situations or problems. Well-designed policies, rules, and standard operating procedures can produce satisfactory results with a minimum of time. Artificial intelligence, including programmed computer systems such as expert systems that can store, retrieve, and manipulate data, can diagnose problems and make limited decisions.
For adaptive decisions involving moderately ambiguous problems and modification of known and well-defined alternative solutions, there are a variety of techniques. Many types of decision grids or tables can be used to compare outcomes of alternative solutions. Decisions about units or services can be facilitated, with analyses comparing output, revenue, and costs over time or under different conditions. Analyzing the costs and revenues of a proposed new service is an example.
Regardless of the decision-making model or strategy chosen, data collection and analy- sis are essential. In many health care organizations, quality teams are using a variety of tools to gather, organize, and analyze data about their work such as decision grids, flow