Decision-Making Process in Healthcare Administration - Case Study Example

Introduction During the practicum experience with a major healthcare corporation, it was found out that Kepner Tregoe or KT analysis tool was used in the decision making as to what company must be chosen to provide an efficient Obstetrical Software Program (OSP) for all the hospitals under the health care corporation to follow. Primarily, this selection of the software program is held relevant as the chosen company would be the provider of a standardized documentation process that the health care corporation will apply in the organization and management of its patient medical records and other related files from the different hospitals under its administration. Since documentation process is majorly significant in the provision of care, proper decision making process must be applied so that the steps directed towards lessening, if not totally eradicating, of the troubles that the manual and traditional documentation bring must be realized. By analyzing the applicability of the KT problem solving process using the theories learned about business and administration, and the importance of standardization of documentation in health care through reviewing related literatures, the efficiency of the process taken and the identification of the choice will be known. The Significance of Documentation in Health Care To be able to distinguish the benefit of the standardized electronic documentation process, it must be known first what is documentation, and why a move to an electronic but unfamiliar way to many is seen as beneficial instead of continuing the more common process and the traditional way of medical records documentation. According to the Complete Guide to Documentation book, documentation is the process of record keeping of all the information related to a patient’s care (Lippincott Williams & Wilkins [LW&W], 2008, p. 2). Not only do the hospital staff and direct care provider become involved with this health documentation. Patients, their families and other healthcare-related individuals, organizations and institutions would also require seeing the contents of these documents at one time or another. Hence, the accuracy of information being provided in a certain document must be on top level; and the integration of data from the different healthcare departments must be well-organized not only to avoid future conflicts but also to assist the provision of uninterrupted, effective health care because what has been written guides those who follows next in the care of a certain patient. Thus, it also allows transparency. Existing records show that it was Florence Nightingale who started the process of documentation to provide assistance in the delivery of care to patients (LW&W, 2008, p. 3; Dugger, 2010, p. 540). However, it was only lately that documentation was applied for nurses and the other members of the health care team. As highlighted by Dugger (2010), during the early years of 19th to the early decades of the 20th century, documentation only existed to make sure that the physicians’ orders have been followed and not for any other purposes (p. 540). Today, manual and electronic documentation of medical records exist for the health care institutions to choose from. Although many are opting to use the modern one, there are still others who use the manual and paper-based documentation process. Manual Medical Documentation. Traditionally, nurses, physicians and other individuals involved in the care of patients record their data manually on papers attached to a chart to assist in the communication of information needed in the future care of a patient. Although computerization is now available and a choice, many still regard it as the standard process of keeping and recording data. Their existence paved way to the “standardization of administrative, clinical and financial procedures based on the analysis and summary of information maintained by the manual systems” (Tan, 2001, p. 79). Separate forms are provided for the physicians, nurses, the laboratory findings, and billing information leading to the bulking of paper-based medical records of patients especially when they are to stay in the clinical settings. Disadvantages of Manual Documentation. Despite the admittance of the benefits and improvements that the manual documentation provided to the healthcare profession, many disadvantages still arise during discussions about its efficiency. One apparent disadvantage is the fact that manual documentation takes up 30-50% of the nurses’ time within a shift (Zimmermann, 2002, p. 108; Harris, 2010, p. 159). Although it is a part of the nurses’ responsibilities, to spend that time only for documentation is an unproductive use of time as a healthcare provider. In the book, Medical Legal Aspect of Medical Records, other issues include privacy since there is no one security procedure to ensure that only authorized personnel will be allowed to view the information of a patient’s chart. In connection, there will never be a certainty as to who have accessed and have put or edited the information written in the document which can affect the care that will be provided to the patient. Additionally, written information may be illegible and can hamper effective care. Moreover, the recovery of the information that was lost with it will be difficult and even impossible once paper-based information is lost as it is as well hard to pinpoint tiny information from the bulky record. Iyer, Levin and Shea (2006) also added that the medical personnel can use the charts one person at a time which brings us back to the inefficient use of time which would have been helpful to do more significant medical and health care interventions for the patients (p. 130). Electronic Medical Documentation. In the advent of the use of computers, many hospital institutions have also opted to them as the storage of important medical files. The products of computer usage are called electronic medical records (EMRs). They are also known as electronic patient records (EPRs) or computer patient records (CPRs) (Oppelt, 2005, p. 964). However, unlike the paper-based, manual medical records that must be hand-held and manually brought to wherever it is needed, the use of computers can allow integration of the patient’s medical records to the health care institution information system which can only be accessed by authorized personnel only. The automated information increases data processing efficiency and reduces time spent on paper work. Weerasinghe (2008) specified that with the use of EMRs, “patient assistance will be more effective, faster, and the quality of service will be improved” (p. 117). Ordered medications, laboratory tests or other procedures logged by physicians are immediately sent to the concerned departments that there is no need to go there in person anymore. Institution managers and administrators who need to check up on the activities going around the hospitals only need to browse on the information system to do so; information about errors and complaints from patients and other entities will be directly seen in the information systems for verifications. In another book, EMR is thought to be beneficial as it organizes the papers and in a legible way which prevents medical errors in dealing with different patients (Snook, 2004, p. 117). One major disadvantage, however, of the automated and electronic storage of information is that it actually costs a lot. One hospital, the Banner Estrella Medical Center, spent $11.5 million for the automation of their records system (Williams, 2006). Nevertheless, Williams (2006) stated in the same business article that the users of the process have agreed that “the end results outweigh the cost.” Indeed, it probably is. In fact, Gov. Napolitano had been reported to have signed an executive order mandating all the hospitals in Arizona to follow what Banner Estrella had started and that it must be implemented not later than 2010. Despite the doubts of the financial cost and the possibility of failure once the system will go down, many do believe that the computerization process is a better alternative. The Decision-Making Process Administration basically refers to the “activities of groups cooperating to accomplish common goals” (Simon, Thompson, & Smithburg, p. 3). Hence, whenever a group of persons perform to achieve something that they have agreed with, an administration process has occurred and an organization was formed. In the process of achieving these goals, there will always be problems that must be overcome. For the people behind organizations and institutions, the steps that are taken in solving these problems are treated crucial as every decision affects the present and the future of their organizations and their set goals. On the other hand, other authors see this the other way. As Trotzer (2006) noted, the existence of the problems gave rise to relationships being formed (p. 236). Basu (1994), in another context, mentioned that an American social scientist in the person of Herbert Simon believed that the process of decision-making itself is the essence of administration (p. 159). He even quoted that in forming an organization, the people behind it must focus on choosing the best options possible and carries every activity out to accomplish them. Decision-Making Process in Nursing and Healthcare Administration. In healthcare settings, every decision does not only affect the administration staff and the rest of the hospital personnel. They most importantly affect the consumers of their services – the recipient of care. Although the industry of healthcare is indeed just another business industry, the administrative people behind these corporations must pay keener attention on their decisions and the process they take on arriving with it since theirs is an industry that deals with lives. In their book Decision Making in Nursing, Jones and Beck (1996) identified a routine decision making process that a person assuming any position in a formal organization or even at home most of the time adheres with before arriving at a decision (pp. 4-6). They believe that at the moment a threat or a problem is indentified, people at once enter the first step of the process in which they have to analyze the situation, know the details of the issue and what would have been the agreeable situation. With this first stage, people will start the initial planning and goals will be formulated to respond to the problem. The next step is aimed at pointing out several courses that can lead to reaching the set goals, these alternatives are ranked by importance and feasibility. The ones that have gathered objectively high regards would make up the final list of options from which the best amongst it will be implemented. Once one of them is initiated, evaluation, which is the final step of the routine process, must be done. In case the decision did not serve its purpose, the process will start again. Being a part of the planning stage of the usual management and administrative tasks, it is believed that the decision-making process in the nursing profession is nonetheless just like the others; and like the rest, being able to efficiently apply a sound decision making in the health care setting only encourages improvement in the outcomes of care and conflict resolution abilities (Basavanthappa, 2000, p. 44). Decision Making Using Kepner Tregoe Analysis Tool Kepner Tregoe (KT) analysis tool was created by Dr. Charles Kepner and Dr. Benjamin Tregoe in the year 1958 (Kepner-Tregoe, Inc., n,d.). According to history, the two formulated the analysis tool to employ systematic thinking process in finding resolution to a problem before arriving at a decision. Involving the steps of situation appraisal, problem analysis, decision analysis and potential problem analysis (“Kepner Tregoe,” n.d.), the tool was made to enhance critical analysis in order to solve human, organization and industrial issues, and many other related activities. What makes KT analysis unique from the other decision making processes is that on coming up with a decision, weighing, rating and scoring will be applied. These ranking and rating procedures are directed not only to the main options but also to the alternatives and their negative effects as well. In using the rating, weighting and scoring process, KT analysis tool encourages decision makers to maintain objectivity in their approaches until a decision is reached. Putting scores to each option which is assumed to be initially objective themselves supports the identification of the best choice possible. Another lead of using the KT analysis is the attention that it pays on the adversity and negativity of the options. It is an advantage because not like the others which only “consider” the potential problems and negative consequences of the best alternatives chosen, the analysis tool also analyzes the impact of the adversities of each option by subjecting it to the process of weighing, rating and scoring that was primarily done with the presented decision choices. Once the option with lesser or manageable adverse effects is selected, the routine process of implementation and evaluation will come next. The KT Analysis as an Administrative Tool in the Selection of OSP for a Major Healthcare Corporation. Choosing the provider of the standardized electronic documentation for the group of hospitals is a task that must not be taken for granted. Using electronic medical records is valuable to the healthcare documentation system as it allows access to easy management of the mounting files and records involved in the field; and there are many other factors that must be considered. Financial feasibility, applicability of certain process, the level of difficulty of the process that must be used in utilizing the program, applicability to the specific department, and privacy are only a few of those among the list of considerations that the decision makers should put in mind prior to making the decision because it is not only the administrators who either benefit or become disadvantaged with the program. In fact, pharmacists, medical technologists, physicians, and especially the nurses who are the first-liners in providing healthcare and who have more access to patients’ records are to be given more attention. Additionally, health care is a business; and unlike the daily decisions that people decide upon, each decision that businessmen take can greatly affect the rise and fall of the profit and integrity of their industry. Hence, critical thoughtfulness which is encouraged in the KT analysis must be taken into consideration. In all of the available decision making processes, it is easy to say that an objective point of view was applied for the decision chosen to be held reliable. Indeed, objectivity is one of the most important characteristics that an administrator or decision maker should have to be able to make a sound and reliable choices that will help in reaching the goal at hand. Nonetheless, personal or collective biases can naturally exist unknowingly even in applying the KT analysis tool. However, the KT process is seen to lessen the biases for its weighing, rating and scoring processes. Moreover, KT provides a clear and detailed set of steps that can be reflected in a document. Most importantly, it does not only provide the decision makers the solutions to the problem. It also supplies the things that must be done to achieve them. After performing each step of the KT decision making process, two companies garnered the same weighted score. Although the result is not desirable for it is more practical and functional to use the service of a single provider, the group can always perform a secondary KT analysis which will then focus on the two best possible and practical choices to reach the goal of standardization. It would have been better for the selection group, in addition, to have formulated more detailed goal and expectations instead of generalized ones. They would have as well been more efficient in coming up with only one company if they have provided a wider coverage of expectations than only five. On the other hand, the group can always do so in the next decision making that they would be involved with. The Decision and Potential Problems Analyses. The application of the decision analysis through weighting, rating and scoring in the KT tool in the following tables (“Kepner Tregoe,” n.d.). Tables 2 and 3 are to be repeated until every alternative and its effect has undergone the same process. Objectives Weight Want A 6 Want B 4 Want C 7 Want D 2 Table 1. Objective ranking with their weights. ADVERSE EFFECTS PROBABILITY SIGNIFICANCE WEIGHTED SCORE A 4 7 28 B 3 2 6 C 6 5 30 Table 3. Weighting and scoring of the adversities of Alternative 1. ADVERSITY RATING FOR ALTERNATIVE 1: 64. Summary The process of decision making is an inherent part of each individual, organization and institution to be able to come up with best possible solutions to counter the problems or the situations at hand. Electronic medical documentation is one of the benefits of a computerized world to the field of healthcare and its administration which can eliminate the hassles and disadvantages of the traditional and manual documentation. In choosing what company should provide the standardized documentation in the hospitals under a major healthcare corporation, different decision making process may hold different solutions. The usage of Kepner Tregoe Analysis tool is not regarded as the best process that everyone must apply. Yet, it is undeniable that its unique use of weighting, rating and scoring on the alternatives and its effects helps the decision makers in choosing the best company which can efficiently perform the task to be sure that the chosen option was the best among the choices and will be applied accordingly. References Basavanthappa, B. T. (2000). Nursing administration. Daryaganj, New Delhi: Jaypee Brothers Medical Publishers. Basu, R. (1994). Public administration: concepts and theories (5th Ed.). Phase-II, New Delhi: Sterling Publishers. Dugger, B. (2010). Infusion nursing: an evidenced-based approach (3rd Ed.). M. Alexander, et al., (Eds.). St. Louis, Missouri: Saunders Elsevier. Harris, M. (2010). Handbook of home health care administration (5th Ed.). Sudbury, MA: Jones and Bartlett. Iyer, P., Levin., B. J., & Shea, M. A. (2006). Medical legal aspects of medical records. Tucson, AZ: Lawyers & Judges Publishing Co., Inc. Jones, R., & Beck, S. (1996). Decision making in nursing. 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