Strategic Decision Making in Health - Essay Example

Strategic decision making in health Author’s Name Name of Institution Abstract Health care is a unique field and all professionals in the field should always make strategic decisions. This question of strategic decision making has been discussed in many conferences, seminars, workshops and other meetings . However, there are obvious flaws that still need to be ironed out concerning strategic decision making. There are also certain limitations and theoretical entailments of effort that have been placed to assist in strategic decision making. This paper explores the process of strategic decision making and the limitations and flaws associated with the process . Strategic decision making in health Introduction Health care providers are finding themselves in a situation which they need to make strategic decisions. These decisions need to be aligned to ensure the delivery of quality health care provided and effectively manage the institution. This situation is fueled by the increasing demands of patients and other stakeholders such as investors and suppliers. Competitive forces from other organizations all over the world are also fueling this situation. What makes the situation worse is that the marketplace in which they need to make these decisions is highly unusual and there are many stakeholders. All these stakeholders are interrelated, and their relationship depends on the decisions made . Therefore, an appropriate strategy needs to be devised to attempt to understand the real situation on the ground, as opposed to the perceived environment. This is to imply that it is a must for the decision makers to know what is happening on the ground rather than rely on what they believe to happen which may largely deviate from the actual situation . The quality of the decisions made will depend on the strategy that is put in place. The strategy should be set to drive the factors which lead to the success of the organization. Secondly, the strategies need to be focused on a specific element. Thirdly, the strategies should be efficiently linked to the potential of the organization and employees. Lastly, the strategy should be unique in a way that it is difficult to be emulated by competitors . In order to make a strategic decision, the organization must be able to conform to the dynamic environment. In simpler words, the strategy needs to be monitored and evaluated regularly to make sure it is still workable. The decision makers and other stakeholders need to evaluate the strategy often for various reasons. One is that the strategy can be rendered useless if a competitor gains a significant market share due to uprising competition or rivalry . Other factors that can render the strategy futile is if there is increased buying or selling power, decreased barriers to entry of new market players, the terror of replacements or ineffective management of resources available to the organization. In this way, the organization must be able to ingeniously foreshadow and reflect upon the recent activities which will affect or affected the decisions . By doing this, they will be able to effectively manage resources, think about the past, look at the financial implications of the decision, motivate higher-ranking performance of staff and much more, all this in an effort to make strategic decisions and make the strategic decisions count . As technology advances and health care organizations find themselves in a competitive environment, there is a need to develop non-obsolete strategies which are well thought out and which position the institution for economic and market success . Contingency model of strategic decision making The contingency model of strategic decision making makes an assumption that there is no way that can be thought to be the best way of the strategic decision making process . However, according to this model, what can be termed as the best way is defined by how the decision made marries with the content and context of the matter at hand. The contingency model establishes that a decision that is made for a particular context may not be applicable in another, even though the contexts may be similar . It also establishes that a unified role is played by the managers who have the decision making capacity. When faced with a particular issue, the managers must find the best way to deal with the situation and they have to create an effective decision process which minimizes conflict. Whatever the situation, the management has the obligation to analyze it and evaluate the assumption that need to be drawn to align the organization with the changed environment. The conclusion must be evaluated on the basis of the effectiveness, efficiency and the solution it provides for the situation. The contingency model is based on the organization’s theory contingency approach. This approach assumes that there is no one way which is uniquely useful in organizing. The theory states that there is no perfect fit which is contingent upon the performance of the organization. What might be feasible in one organization or condition may backfire terribly in another. According to the model, each decision should be unique and circumstantial . Dimensions of strategic decision making in health There are three dimensions which affect or characterize the decisions to be made. These are the patient’s needs, access to the patient and service or program variants. All decisions made must take into consideration the patient’s needs and access to the patient. The patient is the reason why the health care institution and providers are there. Without the patient, there would be no need for the institution and the providers. Therefore, the patient’s needs must be considered first. On this front, the patient need is to receive health care services. Therefore, in this, the decisions made should always have the motive of improving the provision of health care services to the patient. The second dimension is that of access to the patient. The patient has a right to information. This is a fundamental right that is established by all institutions. Therefore, the patient should be well informed about any procedure being carried, its dangers, its advantages and any other pertinent information. Lastly is the dimension of the program or service variant. Since strategic decisions must be connected to the situation, the program or service in question must be considered. In this case, the strategic decision formulated should be feasible for the particular program or service. Strategic, operational and tactical decision making Strategic decisions are said to be so when their implementation is foreseen to create an enormous impact to the future of the institution or organization. Therefore, it is safe to attach an assumption that these factors also affect the process of making strategic decisions. The only significant difference is that strategic decisions are situational . Tactical decisions, on the other hand, are derived from strategic decisions. Once a strategic decision is made, these are broken down into tactical decisions. For whatever strategic decision, the tactical decision will need to be aligned to the previous strategic decision. In essence, tactical decisions are the answer to or the means to achieving the strategic decisions. In the process of tactical decision making, first the areas of interest need to be outlined. It is from these areas of interest that the solutions are assessed and implemented. Operational decisions are the outcome of the process of tactical decision making. They are the ultimate hands on operations that the organization performs to achieve the strategic decisions. When implementing the operational decisions, the activities should favorably relate to the strategic decision, the foundation of the operational decision making process. Strategic decision making process For a practicable strategic decision to be made, the decision making process must be carefully outlined, and its path must run in a smooth way to make sure it is done in an orderly manner. It is by so doing that the final decision made will reflect what needs to be done to remedy the situation . The process of making a strategic decision is founded on four pillars. These are: 1. Centrality 2. Formalization 3. Information 4. Confrontation The pillar of centrality comes from the chain of command. In the strategic decision making process, the organization’s management must involve the bottom level personnel since these are the people who are well versed with the situation on the ground. Since the strategic decision must reflect the real situation which is best understood by the lower level workers and not the overall management who play a more managerial role. The second pillar of formalization comes from an ad hoc, often improvised situation. For decisions to be considered strategic, they must have guided principals or procedures to direct the decision makers. The third pillar is that of information. All strategic decision should have a strong conceptual and theoretical framework. The pros and cons of effecting the decision must be detailed, and it is only by doing so that the decision will be a well-informed one. The last pillar of the strategic decision making process is that of confrontation. Here, this is the extent to which any political or personal interest present in the decision makers drives the process. These interests will usually conflict with those of other parties who have differing interest and may hinder the process . Apart from these four pillars, two other highly influential factors need to be considered in making strategic decisions. These are content and context. Content is a composite of two other factors which are subject matter and proposed intervention. Subject matter is essentially a significant factor especially when controversy arises. Controversy is a key issue that can inhibit the process of strategic decision making especially in a situation where there is a conflict of interest . The second element under content which influences the strategic decision making process is proposed intervention. This is the solution that is provided to the issue being addressed. Context factors are affected at three levels. This is the level of the individuals charged with the responsibility of making the decision, the level of the organization as the body which is most affected by the decision and eventually the surrounding of the organization . These are the three principal context factors which influence the process. The first context factor is noteworthy since as previously discussed, issues of personal interest, expertise and personal experience or a person’s unique line of thought may arise thus hindering the decision making process. At the level of the organization, the structure of the organization or institution and the culture of the organization are the biggest factors. Lastly, in the environment, there are competitors, the government and regulations, societal and economic factors . Evaluation of a strategic decision Based on the theoretical and conceptual framework analyzed, any strategic decision needs to be critically measured to be valid . The quality of the decision must be of the highest standard possible. This paper gives an evaluation of the strategic decision made by the Boston Massachusetts hospital to establish a quality assurance department to improve delivery of health care and hospital finances. The decision was made as one of strategies for the 2010/2011 fiscal year. The decision making process used in coming up with this decision was well organized in five phases. The first phase was the conception phase. Here, the management team which was involved in the decision making process had to hire professionals to do an analysis of the institution. Based on the recommendations of the independent contractor, they were able to unanimously agree that a quality assurance department was needed. A SWOT (strength, weaknesses, opportunities and threats) analysis was done. Based on the SWOT analysis the management team was able to effectively progress to the second phase of the decision making process. The second phase was the definition phase. Here, the conceived plan was turned into a document which described the idea in sufficient detail. This was a task given to a team of the hospital staff comprising the chief financial officer, director of clinical services and the matron in charge of the hospital. These three were involved in getting appropriate responses from their lower level staff. They were also charged with the responsibility of clearing any ambiguity that may have arisen. The areas of interest were defined and the end results of each were articulated and the viability of each of these areas of interest was analyzed. In this strategic decision, the areas of interest were: Finances Conduct of personnel toward the patients Professionalism and expertise The third phase was the planning and organization phase. Here, the project was planned in details and the SMART (specific, measurable, attainable, realistic, timely) goals were set. Policies and standards to govern the quality assurance department were put in place and members of staff who were to form members of the department were chosen and trained. The head of the department and his assistant were appointed and give their terms of service. The work was then handed over to the quality assurance department under the leadership of the head of department. The first task of the quality assurance department was to generate tactical decisions. Based on these areas of interest, the tactical decisions that were generated were: 1. To ensure there is reasonable and genuine accountability 2. To make sure patients are treated respectfully and their rights are honored 3. To ensure patients are treated with the utmost professionalism and all staff make fully informed decisions based on their knowledge and experience levels. The second last phase was the implementation phase. This was also a task of the quality assurance department. The team was to generate operational decisions from these tactical decisions. The operational decisions generated were: 1. To have a computer-based system which records all transactions handled, and use an effective accounting system to make sure all records are kept up to date and any transactions are recorded. 2. To have anonymous patient complaint and patient suggestion boxes to capture the opinions of the patients towards the health care providers (doctors, nurses, clerks, accounting officers, etc.). 3. To set attainable and maintainable standards for health care delivery. These will govern all those who come into contact with patients. The last phase was the project clean up phase. This was a combined effort of the management team and the heads of the quality assurance department who did the work of monitoring and evaluating the department and checking its performance based on the set milestones and goals. This was set to be a monthly process to always keep the department in check. The decision making process was free from bias and political or personal interests since all members of the management team were principled and carried themselves with professionalism. Conclusion Strategic decisions must be tailored for a particular situation and in health care, they should be made to improve the quality of health care and not compromise the institution’s mission and vision. They need to address the reality and not what is expected to be happening in this situation . These strategic goals, as shown in the case of Boston Massachusetts hospital, should be made by a body which will manage the process without any bias, personal or political interests. At the same time, the decision makers should always keep check to make sure the decisions made are still applicable since the health care environment is one full of dynamic factors which change regularly . 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