Decision Making and Appropriate Problem Solving Tools - Essay Example

Running Head: Decision Making Case Study Decision Making Case Study: Responding to Budget Cut Given a case scenario, this essay aims to resolve the issues through the utilization of appropriate tools in decision making. The case scenario presented the following, to wit: “you are a manager in a county clinic that provides care to Medicaid clients. Your department budget was recently cut by 15%. From a statewide health policy standpoint, given a defined budget constraint, what clinical services should be eliminated or introduced to best address healthcare needs of a Medicaid population?” Decision making incorporates a range of strategic alternatives to address a certain issue. As the manager of a county clinic faced with a budget cut, an appropriate problem solving tool should arrive at the best decision for the scenario. This essay aims to resolve the issues through the utilization of appropriate tools in decision making. The case scenario presented the following, to wit: “you are a manager in a county clinic that provides care to Medicaid clients. Your department budget was recently cut by 15%. From a statewide health policy standpoint, given a defined budget constraint, what clinical services should be eliminated or introduced to best address healthcare needs of a Medicaid population?” Problem Different studies present varying models of a typical decision-making process depending on their perspectives. Some models follow eight steps, others five. For purposes of making intuitive choices, the following six steps in decision making is utilized, in conjunction with the cause and effect approach in problem solving. The six steps of this natural, intuitive decision-making process, according to Ethics Resource Center (2009, 1) are: “Step 1: Define the problem; Step 2: Identify available alternative solutions to the problem; Step 3: Evaluate the identified alternatives; Step 4: Make the decision; Step 5: Implement the Decision; and Step 6: Evaluate the decision”. The county clinic manager determined how to best address the delivery of health care services to a Medicaid population given a budget cut of 15%. The financial problem evaluates the possibility of streamlining or eliminating identified clinical services. Identify the Tool: Appropriate Problem Solving Tools The budget cut would have serious repercussions for the county clinic in terms of its ability to deliver the same level of quality health care as initially projected. The first step that the manager should do is to envision what would be the effects of the budget cut in addressing the health care needs of his clientele. The alternative courses of action are identified at this stage. A cause and effect analysis should detail the characteristics of the Medicaid population who would be affected by the budget cut. Secondly, it would pinpoint the clinical services to be streamlined to minimize the effect of a lesser amount of budget available to deliver health care services to this population. Description: Cause and Effect Approach In a study conducted by Sipkoff (2004, 7), the characteristics of the Medicaid population are described, to wit: “the Medicaid population is a mix of children and adults in poor, often single-parent families who qualify for federal aid, and low-income pregnant women. Another group includes chronically ill and disabled adults, who are not yet of Medicare age but are eligible for Medicaid by virtue of disability. A third group of people eligible to receive both Medicaid and Medicare are those with incomes below the federal poverty level and 65 years of age or older. This group has complicated health problems and is usually the most costly to serve.” As defined, these groups are the most financially disadvantaged belonging to the poverty level with ages 65 years and over. The next step is a determination of the clinical services which would be affected by the budget cut. The courses of action are hereby evaluated. Using previous years’ performance as a basis for evaluation, the manager can determine the most used clinical services for the Medicaid population. If there are few services which are not at all used, then, these could definitely be eliminated. Otherwise, the budget cut shared pro rated by all clinical services across the line is preferred alternative. For example, if the budget for the coming year is, says $10M, a 15% budget cut would mean $1.5M less in budget appropriation. This amount shared by all clinical services in the county hospital on a pro rated basis or even on an equal rating across the line is applied. If there are 20 clinical services being availed by the Medicaid population, this budget cut would tantamount to $75,000 cut in respective budgets for these clinical services. This alternative is better than eliminating one or two services. By sharing the budget cut prorate, each department could implement cost cutting measures like monitoring the use of office supplies, reusing old documents as scratch papers, putting off lights and electrical appliances when not in use, checking faucets and leaks, putting off overtime, etc. After identification of the cause and effect, the manager can already implement appropriate action. The following steps are recommended: (1) advising top management of the decision including cost and benefit of the given alternatives for cost reduction, (2) relaying the information to the organization through department meetings and through business correspondences, (3) soliciting feedback from both management and other members of the organization, (4) implementing the cost reduction measures, and (5) monitoring its effect to the delivery of health care in the identified Medicaid population. The cause and effect diagram illustrated by Williams (n.d., 7) could be aptly used by the manager to solicit feedback from his constituents as a way to improve the recommendation. Williams averred to “give each team member a copy of the results and discuss them. Attempt to reach consensus on what are the key drivers to the problem.” (Williams n.d., 7) This is the most appropriate decision making approach for this problem because of the specific effects identified by each department giving respective clinical services to the Medicaid population. Based of previous years’ experience, each department would be able to assess and evaluate the effect of the budget cut to its operations. Each respective department head could suggest ways and means to address the budget cut by minimizing costs and maximizing revenues. Effect on Accountability, Knowledge Transfer and a Questioning Organization The proposed changes in cost cutting and maximizing revenues would not change accountability or knowledge transfer in the organization. Through solicitation of suggestions and recommendations and by giving proper advice through department meetings, all health care practitioners informed of the budget cut as well as its effects on clinical services in the county clinic can act accordingly. The only important aspect emphasized is constant monitoring and vigilance on the cost cutting measures for implementation to address the budget cut. All department head must monitor their respective department’s compliance to the recommended strategies. The manager, on the other hand, would frequently assess the success of his plan by taking note of the financial effects of the cost cutting program. The sixth step in the decision making process is implemented. Recommendation After using the cause and effect approach to decision making, the manager would have identified the characteristics of the Medicaid population and thereby determine the percentage of its contribution to organizational revenues. The clinical services most used by the Medicaid population should also be determined. Based on previous years’ experience and from solicitation of consensus from various department heads and constituents, the manager accorded with the relevant information would identify which clinical services could be totally eliminated. Otherwise, the next alternative, which is to share the budget cut pro rated in all departments, would be implemented. Through managed Medicaid plans, the county clinic would be able to address the 15% budget cut. According to Sipkoff (2004, 13), “financial, regulatory, and access problems notwithstanding, managed Medicaid remains a growth industry. State governments view Medicaid managed care as a way to improve access to care for beneficiaries and to slow the growth in Medicaid expenditures, according to Stephen Zuckerman, a principal research associate at the Health Policy Center at the Urban Institute, who has studied the effect of managed Medicaid on access and utilization.” Conclusion Every organization faces diverse challenges along its entire life of productive operations. Each challenge has an appropriate problem solving tool to address it. The task of management is to identify which decision making tool would be best to solve the impending issues. In health care, the task of managers is to implement strategies which would assist in the excellent delivery of health care to their clientele – at the minimum cost without compromising quality. Any challenge could be overcome with leadership skills and correct decision making approach. In the end, it is the collaborative effort of management and all employees down the line, which makes the best decision a success. References Ethics Resource Center. (2009). PLUS: The Decision Making Process. Retrieved 13 October 2009, Sipkoff, M. (2004 July). “Managed Medicaid Business Might Be Worth the Difficulties.” Managed Care Magazine. Retrieved 10 October 2009, Williams, D. (n.d.) “Problem Solving Tools and Techniques.” Read More