HCA 301 Leadership and Management in Healthcare PDF

HCA 301 Leadership and management in healthcare setting CHAPTER 10 CRITICAL AND CREATIVE THINKING, DECISION –MAKING AND PROBLEM SOLVING Resource: Sullivan, E.J. & Garland, G. (2013), 2nd Edition. Practical Leadership & Management in Healthcare for Nurses and Allied Health Professionals. UK: Pearson...

HCA 301 Leadership and management in healthcare setting CHAPTER 10 CRITICAL AND CREATIVE THINKING, DECISION –MAKING AND PROBLEM SOLVING Resource: Sullivan, E.J. & Garland, G. (2013), 2nd Edition. Practical Leadership & Management in Healthcare for Nurses and Allied Health Professionals. UK: Pearson HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 1 Learning Outcomes 1. Summarize ways to use the critical-thinking process. 2. Compare and contrast individual and collective decision-making processes in various situations. 3. Develop a plan to improve your problem-solving skills. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 2 Critical Thinking Process of: ◦ Examining underlying assumptions ◦ Interpreting and evaluating arguments ◦ Imagining and exploring alternatives ◦ Developing a reflective criticism for the purpose of reaching a conclusion that can be justified ◦ Is not the same thing as criticism, though it does require enquiring attitudes, knowledge about evidence and analysis, and skills to combine them HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 3 Critical Thinking Critical-thinking skills can be used to resolve problems rationally. Critical thinking ◦ An essential component of decision making ◦ A higher-level cognitive process that includes creativity, problem solving, and decision making However, compared with problem solving and decision making, which involve seeking a single solution, critical thinking is broader and involves considering a range of alternatives and selecting the best one for the situation (Ignatavicius, 2001). HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 4 Using Critical Thinking Critical thinking skills are an important part of being a manager or leader. One way to develop this skill is to consider a series of questions when examining a specific problem or making a decision. The following questions are suggested: What are the underlying assumptions? ◦ Underlying assumptions are unquestioned beliefs that influence an individual’s reasoning. ◦ The important first step in critical thinking is identifying the assumptions underlying the issue, and then challenging those assumptions. Is there objective evidence to support the arguments? What evidence is available from the literature? What audits or other studies are being done in the organisation? How is evidence interpreted? What is the context? What are possible alternate perspectives? ◦ Using different basic assumptions and paradigms can help the critical thinker develop several different views of an issue. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 5 Characteristics of an expert critical thinker Outcome-directed Persistent Open to new ideas Caring Flexible Energetic Willing to change Risk-taker Innovative Knowledgeable Creative Resourceful Analytical Observant Communicator Intuitive Assertive 'Out of the box' thinker Source; Ignatavicius, D. D., Six critical thinking skills for at-the-bedside success, Nursing Management, 32( 1), pp. 37-9 HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 6 Creative thinking ◦ Essential to the critical thinking process ◦ The ability to develop and implement new and better solutions ◦ Produces new and better solutions to challenges ◦ One way to keep organizations alive ◦ Must be encouraged and made a priority HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 7 Creative thinking ◦ It is different from critical thinking; It relies less on logic and analysis and more on imagination and innovation. ◦ Creative thinking works differently from critical thinking. Critical thinking starts with a detailed analysis of what is known about the current situation, creative thinking starts with imagining the desired future. Once the desired future is clear, creative thinking works back to the present to identify the steps needed to make the desired future a reality. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 8 Creative thinking ◦ One particularly useful tool for stimulating creative thinking is the use of appreciative questions ◦ Appreciative questions focus on the future, and what is going well, to help people develop more options Examples ◦ What do you want? ◦ How will you know when you have achieved it? What will it be like to work in this way? What will have improved? ◦ What is going well now that can help us achieve this future? ◦ What will we need to change? ◦ What are the first steps? HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 9 Critical thinking Vs Creative thinking HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 10 Decision Making Decision making ◦ May or may not involve a problem ◦ Always involves making a choice; evaluating and selecting one of several alternatives, each of which may be appropriate under certain circumstances Problem solving ◦ Involves diagnosing a problem (data gathering, analysis, generation of potential solutions) and solving it ◦ Decision making is part of that process: decisions on what data to collect, how to analyse data and which solution is the best are all decision steps within problem solving (Figure 10.1) ◦ May or may not require making a decision HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 11 Matching decision technique to decision type The types of decision vary widely and determine the decision-making methods. Routine decisions ◦ Relatively well-defined, common problems ◦ Often using established rules, policies, and procedures Example; ▪Staffing decisions based on the historical staffing pattern ▪In a medication error, the manager's actions are guided by policy ▪Technology can support routine decision making ; Cardiac monitors analyse the heart rhythm and give a preliminary diagnosis HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 12 Matching decision technique to decision type Adaptive decisions Necessary when both problems and alternative solutions are somewhat unusual and only partially understood For example, if you are choosing between having open visiting or defined visiting hours, you may decide to do a SWOT analysis. SWOT is a process of identifying the strengths, weaknesses, opportunities and threats for each alternative, and then deciding based on the information gained. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 13 SWOT analysis Example; An institution aims to educate and train future and current health professionals. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 14 Matching decision technique to decision type Adaptive decisions Tools that help organisations make adaptive decisions Help to organise and analyse information and to develop to confidence in decisions taken ▪cause-and-effect diagrams ▪flow charts ▪Pareto charts ▪run charts ▪Histograms ▪control charts ▪scatter diagrams. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 15 Matching decision technique to decision type Innovative decisions ◦ When problems are unusual and unclear ◦ When creative, novel solutions are necessary Four Stages of Creativity (Figure 10.2). 1. Preparation ◦ ◦ ◦ ◦ ◦ Pick a specific task Gather relevant facts Challenge every detail Develop preferred solutions Implement improvements Figure 10. 2 The creative process HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 16 Matching decision technique to decision type Four Stages of Creativity 2. Incubation ◦ Allow as much time as possible to elapse before deciding on solutions 3. Insight ◦ Solutions often emerge after a period of reflection 4. Verification ◦ Once a solution has been implemented, evaluate it for effectiveness. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 17 Decision-making Conditions ◦ Under certainty ◦ When alternatives and the conditions surrounding each alternative are known, a state of certainty is said to exist. ◦ Uncertainty and risk ◦ Individual or group making the decision does not know all the alternatives, attendant risks, or possible consequences of each option. ◦ Probability ◦ Likelihood, expressed as a percentage, that an event will or will not occur Key element in decision making under conditions of risk is to determine the probabilities of each alternative as accurately as possible. Probability analysis ◦ Expected risk is calculated or estimated. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 18 Decision-making Conditions Objective probability ◦ Likelihood that an event will or will not occur based on facts and reliable information Subjective probability ◦ Likelihood that an event will or will not occur based on manager's personal judgment and beliefs HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 19 The Decision-making Process ◦ Rational or normative, decision-making model ◦ Descriptive or bounded, rationality model ◦ Satisficing ◦ Political decision-making model HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 20 The Decision-making Process ◦ Rational decision-making model ◦ Identify all possible outcomes. ◦ Examine the probability of each alternative. ◦ Take the action that yields the highest probability of achieving the most desirable outcome. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 21 The Decision-making Process ◦Descriptive rationality model ◦ Emphasizes limitations of decision maker and situation ◦ Three ways decision makers depart from the decision-making model: ◦ Limits of time, energy, or money ◦ Lack of adequate information and control of conditions ◦ Use of satisficing strategies HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 22 The Decision-making Process ◦Satisficing ◦ The individual chooses an alternative that is not ideal but either is good enough under existing circumstances to meet minimum standards of acceptance or is the first acceptable alternative. ◦Political decision-making model ◦ 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 what decisions are made. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 23 Steps in Decision Making The decision-making process begins when the individual perceives a gap 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 breaking the components down into individual steps. 1. Identify the purpose 2. Set the criteria 3. Weigh the criteria 4. Seek alternatives 5. Test alternative. 6. Troubleshoot 7. Evaluate the action HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 24 Decision-making Techniques ◦ Vary with the nature of the problem, the decision maker, the situation, and the decision-making method ◦ Routine decisions can be made quickly with established policies and procedures. ◦ Adaptive decisions can be made using several techniques. ◦ Cause-and-effect diagrams can predict outcomes. ◦ Each technique requires data collection and analysis. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 25 Group Decision Making ◦ Professionals function best in organizations with shared governance ◦ Group problem solving of substantial issues casts the manager in the role of facilitator and consultant. ◦ Groups tend to: ◦ Provide more input. ◦ Often produce better decisions. ◦ Generate more commitment. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 26 Group Decision Making The nominal group technique (NGT) ◦ A structured and precise method of eliciting written questions, ideas and reactions from group members. NGT is a group process in name only because no direct exchange occurs among members. NGT consists of; silently generating ideas in writing round-robin presentation by group members of their individual ideas in a brief phrase on a flip chart discussion of each recorded idea for clarification and evaluation voting individually on priority ideas, with the group solution being derived mathematically through rank ordering or rating using the group's decision rule HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 27 Group Decision Making Delphi technique ◦ Judgements on a particular topic are systematically gathered from participants who do not meet face to face. ◦ Ideas are collected through a carefully designed sequence of questionnaires combined with summaries of information and opinions derived from previous questionnaires. ◦ The process may involve many rounds but normally does not exceed three. ◦ This technique can rely on the input of experts who are widely dispersed geographically. ◦ It can be used to evaluate the quality of research proposals or to make predictions about the future based on current scientific knowledge. ◦ This technique is useful when expert opinions are needed and expense would prohibit bringing them together. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 28 Group Decision Making The nominal group technique (NGT) & Delphi technique For fact-finding problems with no known solution, the NGT and the Delphi technique are superior to other group techniques. Both minimise the chances of more vocal members dominating discussion and allow independent consideration of ideas HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 29 Group Decision Making ◦Brainstorming ◦ Group members meet together and generate many diverse ideas about the nature, cause, definition, or solution to a problem without consideration of their relative value. ◦ Premium is placed on generating lots of ideas as quickly as possible and on coming up with unusual ideas. ◦ The wilder the idea, the better! Members do not critique ideas as they are proposed. Evaluation takes place after all the ideas have been generated. ◦ Criticisms of this approach are the high cost factor, the time consumed and the superficiality of many solutions. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 30 Decision-making Techniques Figure shows the results of a brainstorming exercise, presented as a cause and-effect, or fishbone, diagram Figure 10.5 Brainstorming session of a nursing quality focus team. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 31 Group Decision Making Appreciative Inquiry oone method of group decision making or problem solving that is particularly good at getting teams to think about possibilities and to move forward. oIt was developed by David Cooperrider and Suresh Srivastva in the 1980s. o The approach is based on the idea that 'Organisations change in the direction in which they inquire’. oSo an organisation that enquires into problems will keep finding problems but an organisation that attempts to appreciate what is best in itself will discover more and more that is good. o It can then use these discoveries to build a new future in which the best becomes more common (Seel, 2008) HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 32 Group Decision Making The four phases of appreciative inquiry 1. Discover. People talk to one another to discover the times when the organisation is at its best. Storytelling is encouraged and people feel good about what is working well. 2. Dream. People are brought together to envision the organisation as if the peak moments from the discovery phase were the norm rather than the exception. 3. Design. In this phase, people sign up to design particular elements of the future. For example, ward clerks may agree to design the admitting paperwork whereas nurses may sign up to design the care pathway. 4. Deliver. In this phase, experimentation and improvisation occur and the designs are tested and improved. Source: The four phases of the model, Seel, R. 2008, Introduction to Appreciative Inquiry, www.new-paradigm.co.uk/introduction_to_ai.htm. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 33 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). ◦ Critical and creative thinking are both necessary for problem solving. ◦ The use of analytical questions (what is happening now? what evidence is there?) and appreciative questions (what do we want in the future? what is working? what needs to change?) both have a role to play. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 34 Problem-Solving methods Trial-and-error method ◦ Tend to be used by people with little management experience ◦ Applying one solution after another until the problem is solved or appears to be improving Disadvantages Process can be time consuming and may even be detrimental. Although some learning can occur during the process, the manager risks being perceived as a poor problem-solver who has wasted time and money on ineffective solutions. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 35 Problem-Solving methods Experimentation ◦ More rigorous than trial and error ◦ Pilot projects or limited trials are examples of experimentation ◦ Involves testing a (hypothesis) or hunch to enhance knowledge, understanding or prediction. ◦ A project or study is carried out in either a controlled (e.g. a laboratory) or uncontrolled (e.g. a real-life clinical care) setting. ◦ Data are collected and analyzed and results interpreted to determine whether the solution tried has been effective. 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 because of the amount of time and control involved HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 36 Problem-Solving Methods ◦ Past experience and intuition ◦ An individual's experience can determine how much risk to take in present circumstances. ◦ Intuition ◦ Relies heavily on past experience and trial and error ◦ Some problems are self-solving. ◦ If permitted to run a natural course, problems are solved by those personally involved. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 37 Steps in Problem Solving 1. Define the problem 2. Gather information 3. Analyze the information 4. Develop solutions 5. Make a decision 6. Implement the decision 7. Evaluate the solution HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 38 Problem-Solving Group Problem Solving ◦ Today, consensus-based problem solving, inherent in shared governance, is the norm. ◦ Advantages ◦ ◦ ◦ ◦ Groups can deal with more complex problems than a single individual. Groups are more likely than individuals to try several approaches. Groups may generate more complete, accurate, and less biased information than individuals. When groups solve problems, the likelihood of cooperation in implementation increases. ◦ Disadvantages ◦ ◦ ◦ ◦ Time consuming Conflict Benign tyranny Resistance by managers HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 39 Problem-Solving Group Problem Solving ◦Disadvantages ◦ Groupthink ◦ Group members come to think alike and have similar prejudices and blind spots. ◦ Seriously impairs critical thinking; can result in erroneous and damaging decisions. ◦ Risky decisions HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 40 Ponder points ❖Critical thinking requires examining underlying assumptions about current evidence, interpreting information and evaluating the arguments presented to reach a new and exciting conclusion. ❖Creative thinking involves the use of imagination and innovation to identify a desired future, and release the energy to achieve that future. ❖Problem-solving and decision-making processes use critical and creative thinking skills. ❖The decision-making process may employ several models: rational or normative, descriptive or bounded rationality, satisficing and political. ❖Decision-making techniques vary according to the problem and the degree of risk and uncertainty in the situation. ❖Methods of problem solving include trial and error, intuition, experimentation, past experience, tradition and recognising problems that are self-solving. ❖The problem-solving process involves defining the problem, gathering information, analysing information, developing solutions, making a decision, implementing the decision and evaluating the solution HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 41 Useful links The 7 step decision making process | Decision making model https://www.youtube.com/watch?v=d53AFjxT5hQ Group Decision Making Techniques https://www.youtube.com/watch?v=QutaEUel57M Group Problem Solving Steps https://www.youtube.com/watch?v=EUAKPg4uIFE SWOT Analysis - What is SWOT? Definition, Examples and How to Do a SWOT Analysis https://www.youtube.com/watch?v=JXXHqM6RzZQ Groupthink, That's just the way we do it https://www.youtube.com/watch?v=jwHfmlbJX5Q HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 42 Useful links Example of Rational Decision Making https://www.youtube.com/watch?v=s1KFV0PgggY Video 5 Rational Decision Making https://www.youtube.com/watch?v=7hI4SftspM8 How to create cause-and-effect diagrams https://www.youtube.com/watch?v=mLvizyDFLQ4 HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 43