THINKING CRITICALLY, MAKING DECISIONS, SOLVING PROBLEMS 109
encouraged to improve on each other’s ideas. These sessions are enjoyable but are often unsuc- cessful because members inevitably begin to critique ideas, and as a result, meetings shift to the ordinary interacting group format. Criticisms of this approach are the high cost factor, the time consumed, and the superficiality of many solutions.
Problem Solving People use problem solving when they perceive a gap between an existing state (what is going on) and a desired state (what should be going on). How one perceives the situation influences how the problem is identified or solved. Therefore, perceptions need to be clarified before prob- lem solving can occur.
Problem-Solving Methods A variety of methods can be used to solve problems. People with little management experience tend to use the trial-and-error method, applying one solution after another until the problem is solved or appears to be improving. These managers often cite lack of experience and of time and resources to search for alternative solutions.
In a step-down unit with an increasing incidence of medication errors, Max, the nurse manager, uses various strategies to decrease errors, such as asking nurses to use calcu- lators, having the charge nurse check medications, and posting dosage and medication charts in the unit. After a few months, by which time none of the methods has worked, it occurs to Max that perhaps making nurses responsible for their actions would be more effective. Max develops a point system for medication errors: When nurses accumulate a certain amount of points, they are required to take a medication test; repeated failure of the test may eventually lead to termination. Max’s solution is effective and a low level of medication errors is restored.
As the above example shows, a trial-and-error process can be time-consuming and may even be detrimental. Although some learning can occur during the process, the nurse manager risks being perceived as a poor problem solver who has wasted time and money on ineffective solutions.
Experimentation, another type of problem solving, is more rigorous than trial and error. Pilot projects or limited trials are examples of experimentation. Experimentation in- volves testing a theory (hypothesis) or hunch to enhance knowledge, understanding, or pre- diction. A project or study is carried out in either a controlled setting (e.g., in a laboratory) or an uncontrolled setting (e.g., in a natural setting such as an outpatient clinic). Data are collected and analyzed and results interpreted to determine whether the solution tried has been effective.
Lin, a nurse manager of a pediatric floor, has received many complaints from mothers of children who think the nurses are short-tempered. Lin has a hunch that 12-hour shifts, which have been recently implemented on her floor, are contributing to the problem; she believes that nurses who must interact frequently with families would perform better on eight-hour shifts. She can test her theory by setting up a small study comparing the two staffing patterns with patient satisfaction.
Experimentation may be creative and effective or uninspired and ineffective, depending on how it is used. As a major method of problem solving, experimentation may be inefficient be- cause of the amount of time and control involved. However, a well-designed experiment can be persuasive in situations in which an idea or activity, such as a new staffing system or care proce- dure, can be tried in one of two similar groups and results objectively compared.