Decision Making within a Team Environment - Essay Example

Decision Making within a Team Environment: Challenges Faced by Health Care Leaders Table of Contents Introduction Leaders in the current health care sector are faced with three broad realities: wide social diversity of individuals involved in the practice, an increasing need for continuous education as a result of rapid technological changes, and lastly, the need for servant leadership and supportive behaviours in the work environment. These realities, apart from being too complex to be adequately addressed by the traditional models of leadership, do offer a number of new challenges to decision makers working in a group setting within health care institutions. According to Burthold (2007, p. 6), decision making is a cognitive process of making a selective judgement or choice. Typically, decision making follows a set process which involves identification of the problem to be solved or the opportunity to be utilised, determination of the aims and objectives of the entire process, collection of all information relevant to solving the problem or exploiting the opportunity at hand, and finally, development of different alternative courses of action. This means that the main aim of making decisions is to obtain the best alternative course of action in a particular situation. In the practice of healthcare, leaders are always faced with the need to use structured and rational decision making processes when dispatching their duties at all levels of the system. Such a process is based on using implicit or explicit ideas, opinions and assumptions to select the best alternative course of action in every situation. The objective of this paper is to examine major challenges facing decision making processes in the healthcare sector. To do this, a brief examination of the general categories of leadership challenges in the healthcare sector is given, followed by a detailed evaluation of these problems with special emphasis being given to challenges associated with decision making processes in groups within healthcare institutions. Categories of leadership challenges in health care Several models of challenges facing leaders in health care institutions have been developed. However, it is important to note that leaders in health care institutions are required to make key decisions throughout all levels of the system. Often, collaboration between teams demands that such decisions be made with respect to the complex interactions within the team itself and between separate teams whose actions are related because they belong to a common system of interconnected departments, sections, institutions and organisations. According to Hartley and Benington (2010, p. 54), decision-making in health care leadership is faced with two broad classes of challenges: those that affect the internal operations of the health care organisation (intra-organizational challenges) and those that influence the relationship between the healthcare organisation and other outside organisations (inter-organisational challenges). Health care leaders, just like political leaders, face challenges which can be described as follows: the need to develop a strategic policy, exercising external influence, ensuring that tasks are accomplished, and implementing the strategic policy of the organisation (Hartley & Benington, 2010, p. 55; Rubino, 2011, p. 31). Challenges in these four areas may either be internal-oriented or external-oriented depending on the impact of the outcome of the decisions. Separately, Stewart (2001, cited by Hartley & Benington, 2010, p. 56), identify two categories of health care leadership challenges facing decision makers as problems which can be described as either “tame” or those can be described as “wicked.” “Tame” problems are conventional problems which have once occurred and solutions thereof are well known. Their solution therefore lies in the ability of the leaders to oversee their successful implementation. On the other hand, wicked problems bear a strong sense of novelty in their nature, form and occurrence. Since they appear new to the organisation, leaders are faced with the challenge of applying knowledge, skills and processes in a highly innovative manner in order to conceptualise and solve such problems. Leaders are therefore required to avoid the potential mistake of creating new and complex problems as a result of their occurrence during the process of addressing the initial problems (McLucas, 2003, p. 113). According to Cathleen and Porter-O'Grady (1999, p. 189), tame problems are generally technical in nature. Their solution largely requires an application of technical skills and knowledge. On the other hand, “wicked” problems are adaptive in nature. Leaders are faced with the challenge of acknowledging first the fact that the need for solving these types of problems requires a detailed involvement of diverse members of the organisation. Unlike technical problems which provide the main challenge of assembling the technical and human resources available in a project-based manner, adaptive problems present leaders with the challenge of confronting the complex nature of the problem and orchestrating diverse individuals to work towards attaining solutions. Challenges faced by health care leaders The first challenge experienced by health care leaders regarding the decision-making process concerns effective use of health care information systems. Health care information systems are complex organisational management technologies that are used to support decision-making processes in an organised delivery system (Tan & Shapes, 1998, p. 71). The importance of decision making support systems in an organised delivery system can not be overemphasised. Since such a system entails a complex vertical and horizontal integration of all administrative and organisation aspects of separate institutions into a system that focuses on provision of a wide range of services apart from primary hospital care, it follows that the decision making process in such an arrangement is characterised by many challenges resulting from the huge number of individuals involved in the process and the nature of the problems occurring. In general, a decision support system (DSS) used by groups in a health care setting is made up of several components: a database, access for use by several members of the group and a network system that links several different sites of the users (Wolper, 2004, p. 454). Such a system is used for combining the input from users in managing and selecting the best alternative solutions when solving complex clinical and administrative problems. However, health care leaders face a number of challenges in using DSSs. First, the effectiveness of the system is hampered by geographical locations of users. Although the system can be easily adapted for use in a local setting, its use in the event of decision makers being scattered in different geographical locations is greatly hampered (Wolper, 2004, p. 455). Such a situation may require the use of technologies that support remote decision making. Second, the current system only supports the traditional processing of operational data (what can be referred to as technical problems whose solution does not require a high degree of novelty). This bias presents a problem to health care decision makers, particularly when a situation in which complex problems which require group-based decision making processes arises. Under such a situation, the decision makers are not able to access integrated information necessary to make quality decisions that are required by government institutions, health care providers and patients. Such problems need a combination of complex technological and communication capabilities to solve general management and clinical problems (Tan & Shapes, 1998, p. 73). Additionally, poor accessibility and network problems in the healthcare DSS affect the efficiency and effectiveness of the process of making decisions (Tan & Shapes, 1998, p. 74). Leaders therefore have to ensure that the system remains accessible at all times to all decision makers within the group. The second challenge facing decision makers in health care institutions is the problem associated with professional domination and corporation within teams. Since the overall health care process depends on different input by different individuals having different professional backgrounds and affiliations (Hernandez & O'Connor, 2010, p. 119), a smooth decision-making process is therefore dependent on a sound working relationship between individuals having different professional backgrounds. Ideally, complete coordination and integration of separate and diverse professional inclinations should be synchronised in such a manner that it serves the primary responsibility of providing outstanding healthcare outcomes in patients. However, this is not the case. More often than not, professional and vested interests supersede the primary responsibility of providing services to the satisfaction of the patients and other primary stakeholders. The efficiency of decision making processes in clinical teams is severely affected by competing attempts to dominate the process of making key decisions. The result is that health care leaders find it difficult to take innovative and coordinated approaches to making decisions at all levels of the system (Cathleen & Porter-O'Grady, 1999, p. 188). Related to the second challenge facing health care leaders when making decisions are the problems associated with maintaining harmony between members of an interdisciplinary team of professionals. Since the concept of health care itself encompasses a complex interaction of different factors working together to accomplish specific objectives, it follows that a successful examination of such issues can be best attained by adopting an interdisciplinary approach (Weiss, Tilin & Morgan, 2013, p. 14). This entails incorporating members of diverse training and background within the team and ensuring that they work as a single unit (Porter-O'Grady, 2009). The interdisciplinary approach presents a number of challenges when it comes to making key decisions within the team. First, there is the risk of competition between the different disciplinary orientations represented in the group. Such differences in status are precipitated by a poor relational coordination between members of the group. Decision makers are therefore constantly faced with the challenge of creating and maintaining a healthy relationship between the various disciplines included in a group. Lussier and Achua (2010, p. 278) note that a healthy relationship between members of a group is a function of high quality communication within the group, mutual positive self-regard between the members and active engagement of all members of the group. The challenge of leaders, similarly, is to foster these factors within their groups in order to ensure that decisions are made more effectively and efficiently. Second, there is always the risk associated with the trend towards specialisation within an interdisciplinary group. Specialisation of professions within the group leads to a less inclusive approach in making decisions because it ignores the basic essence of healthcare as a complex system of relationships aimed at delivering good patient outcomes. Since all the different specialities work for the attainment of a common objective, decisions within the team are meant to reflect a sound understanding of complex group dynamics. Further, sound decision making process within a group of health care professionals is jeopardised by the possibility of members failing to assume leadership roles in running the affairs of the group. Leaders are faced with the challenge of ensuring that each member within the group assumes an individual leadership role in making decisions. Adopting of team leadership through active engagement and participation by all members of the group is a key factor for the successful operation and decision-making by groups in health care institutions (Weiss, Tilin & Morgan, 2013, p. 15). The next decision-making making challenge for health care groups is what Hernandez and O'Connor (2010, p. 212), describe as creating a conducive work environment. The need to identify appropriate individuals to include in a team is the first step towards creating an effective process of making decisions within the group. Leaders are faced with the task of moulding individuals into professionals who are better suited to fulfil the needs of the group. This is achieved through training (refining presently owned skills) and development (adding new skills to what is already possessed). This process presents a number of difficulties to leaders. First, there is the need to identify correctly talented individuals to be included in the group. Leaders have to identify individuals who will suit well into the group after training and development. Such employees need to show engagement in their organisations and be able to demonstrate a high degree of resilience in the face of changes within the organisation. In addition, identification of the unique training and development needs of individual members for a group is a challenge to leaders. Leaders are required to address four key issues as follows: developing the careers of members by adding new skills that enable them tackle different and new tasks; availing opportunities for continuing education which are availed outside the organisation; offering training to members for job-specific skills and attitudes; and lastly, deciding on the needs for orientation and special training for new members in the organisation (Lussier & Achua, 2010, p. 280). Further, leaders face challenges in choosing the right models for member training and development. The key challenge is adapting training and development to the overall needs of the organisation during change. There is always a constant need for change within organisations and this can be best addressed by developing teams that are well equipped to driving and managing the changes that may occur. Hernandez and O’Connor (2010, p. 210) observe that other issues of relevance to leadership with regard to member training and career development include: setting the objectives for the training programme, selection of the right facilities for the programme, coordination, and final evaluation of the entire programme. All these are challenges which must be addressed by the leadership while undertaking training and career development programmes for members. Conclusion The process of making decisions within groups working in health care institutions is complex. Specifically, the health care industry itself comprises complex and diverse factors interacting in different patterns to attain a common objective: delivering good healthcare outcomes to patients. To achieve this, leaders are required to make the best logical decisions that will not only reflect the best available alternative but also take into account all the necessary social, economic, environmental and professional concerns. As a result, leaders are faced with several challenges when making decisions within the groups of professionals. The need to create a favourable working environment for all the members of a group presents a number of problems for decision makers. From understanding the orientation of new employees in administering training and development to assessing the needs and impact of training programmes, leaders face enormous challenges in creating and maintaining a working environment that is conducive for members. As well, the fact that health care entails a number of people with diverse professional backgrounds working together means that teams will always be diverse in their composition. The downside of this is that the risks of dominance, poor relational coordination within the team and interdisciplinary competition are high in creating and maintaining such interdisciplinary teams. Leaders are therefore faced with the challenge of ensuring that clear coordination and harmony is created and maintained within the groups in order to allow an effective and efficient decision-making process to thrive. This can be done by fostering positive factors such as mutual positive regard and active engagement between members of the groups. Additionally, the use of health information support systems (in particular decision support systems) presents a number of challenges to health care group leaders. This is exemplified in the event of the team members being located in different geographical locations. In such cases, application of DSSs requires the use of additional technologies that enable remote participation. Additionally, the DSS fails to adapt to the need for making strategic decisions in administrative and clinical matters as opposed to the traditional scope of processing data. References Burthold, R. G. (2007). Psychology of decision making in legal, healthcare and science settings. New York: Nova Science Publishers. Cathleen, K., W. & Porter-O'Grady, T. (1999). Leading the revolution in healthcare: Advancing systems, igniting performance (2nd ed.). Gaithersburg: Aspen Publishers. Hartley, J. & Benington, J. (2010). Leadership for healthcare. Bristol: The Policy Press. Hernandez, S. R. & O'Connor, S. J. (2010). Strategic management of human resources in health service organizations (3rd ed.). New York: Delmer Cengage Learning. Lussier, R., N., & Achua, C., F. (2010). Leadership: Theory, application and skill development (4th ed). Mason: South-Western Cengage Learning. McLucas, A. C. (2003). Decision making: Risk management, systems thinking and situation awareness. London: Argos Press P/L. Porter-O'Grady, T. (2009). Interdisciplinary shared governance: Integrating practice, transforming health care: Integrating practice, transforming health care (2nd ed.). 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