Challenges Faced by Healthcare Leaders in terms of Decision-Making - Literature review Example

Challenges Faced by Healthcare Leaders in terms of Decision-Making within the Team Environment Introduction The process of making decisions in a team environment is a complex phenomenon. Leaders of teams are faced with multiple challenges which, if not checked, have a negative impact upon the final decisions reached by the teams. Yet teams form an important and useful tool of making decisions. From having the potential advantage of generating and processing a high level of information, as a result of numbers, to the credibility that is often attached with team decisions, team decision-making is an important process whose leadership determines the quality of the decisions adopted. This paper examines some of the challenges that healthcare leaders face in making decisions under a team environment. To achieve this objective, the paper is divided into three parts. The first part examines general aspects of team-centred leadership together with the advantages and disadvantages of using teams in making decisions. The second part examines the differences between team-centred and leader-centred approaches to making decisions within teams. The last part examines several challenges faced by leaders in the process of making decisions under a team environment. These challenges are divided into two categories: those that affect communication processes in the practice of making decisions and those that are associated with biases and errors in the process of making decisions. Lastly, a brief examination of some of the measures undertaken by healthcare leaders to overcome these challenges is given. Team-centred leadership and decision making Team-centred leadership entails a complex interaction between members of a team in the process of making decisions which affect all members of the group. To begin with, teams are human aggregations of wide diversity in terms of composition, focus and design (Forsyth, 2010, p. 353). Although teams share the basic characteristics with groups (interaction between members, having common goals pursued by all the members, interdependence between individuals in the team and a structure of leadership within the group) they differ from groups in terms of the intensity and extent of influence of these characteristics. Teams tend to lay much emphasis on the impact of these characteristics in their operations more than is the case for groups (Nutt & Wilson, 2010, p. 236). Since teams have the advantage of having increased access to information and other resources as a result of the collective effort of the members, the decisions they make are inherently better than those made by individuals. The decision making process within the context of a team may fall into the main five basic types of decision making process (Forsyth, 2010, p. 325). In the first category, the leader seeks information from members of the team before making independent decisions. These decisions are later communicated to the team and adopted as the official stance of the team. In the second category, the leader of the team performs individual consultation with the members before making decisions. In this category, the impact of the whole group as a single entity is bypassed and decisions are best made when tasks are divided into smaller units and equally allocated to different members (Levi, 2011, p. 150). The third type of decision-making making process by teams involves the leader consulting with the whole group before making decisions. This is in contrast to the second type in which consultations are made with individual members. In the fourth type of decision-making process, a collaborative and open analysis of the problem is undertaken by the entire group. Decisions are based on mutual understanding as the leader only plays the role of facilitating the process (Nutt & Wilson, 2010, p. 234). In the last type, the group functions independently from the leader. The whole process of deliberation, discussion and final making of decisions is undertaken by the members of the team, free from the influence of the leadership. Forsyth (2010, p. 326), notes that under this type, the role of the leader of the team is confined to providing resources and facilitation to the entire process of making the decisions. Team-centred leadership and how it differs from leader-centred approach to decision-making Different authors have identified various ways in which team-centred leadership differs from leader-centred approach to decision-making. For instance, West and Markiewicz (2004, p. 86), identified six areas in decision-making in which the two approaches exhibit marked differences. For instance, whereas it is the sole responsibility of the leader to have total control over the final choices and in managing task-oriented operations under the traditional leader-centred approach to decision making, the approach to handling these tasks differs when decisions are made by the entire team in a team-centred approach. The responsibility of the group together with tasks and functions of making decisions are shared equally among group members. West and Markiewicz also observe that the leader-centred approach to decision-making discourages individuals from expressing their needs and displaying their socio-emotional processes. This is in contrast to the team-centred approach to making decisions in which these processes are encouraged, discussed and closely observed by the leadership of the group. Levi (2011, p. 74), identified two major differences between the team-centred and leader-centred approaches to making decisions. First, decisions made under the leader-centred centred approach may be made by the leader entirely or by an expert appointed by the leader to make them. This is different from the practice in the team-centred approach whereby the group either reaches consensus or makes decisions basing on the mathematical average. The second difference is the fact that decisions made under the leader-centred approach may as well be a product of consultation between the leader and other individuals, although the leader retains the power to make the final choice. This is different from the approach that focuses on the input of groups in that the group-centred approach requires the members to vote on decisions. Members of groups may also use structured decision techniques to make decisions (Levi, 2011, p. 75). Lastly, Maddux (2000, p. 6), stated that many differences between the two approaches in making decisions lies in the fact that one emphasises positive engagement and full participation of members in the process of making decisions while the other depends on the final word of the leader entirely, regardless of the contributions of the members. It is noted that whereas members in a leader-centred approach may not participate in making the decisions which affect the team, resorting to conformity and apathy, members have full participation in the process of making decisions under the team-centred approach. The focus is on positive results in all decisions made by the team. Challenges of making decisions in a team environment Many of the problems that leaders encounter in facilitating the process of making decisions by a healthcare teams fall into two categories: those that arise as a result of interaction between members of the group in making the actual decisions (member disagreements, pressure resulting from time constraints and stress from external factors) and those that result from the effect of bias in the decision-making process as a function of the impact of interpersonal relationships between members of the teams in making decisions(Hirschhorn, 2002, p. 48). Many of the challenges in the second category are responsible for bias in the decisions made by teams as a result of the groupthink phenomenon. Disagreements in the process of group discussions are common and necessary. In fact it is noted that a complete absence of disagreements in a group discussion stifles the communication process and kills the morale of the members of the team with respect to continuing with the activities of the group (Levi, 2011, p. 154). However, too many disagreements disrupt the process of making decisions by allowing teams to make quick and rash decisions in order to put to an end the disagreements. The result is that further misunderstandings occur in the process of implementing the decisions, therefore making the entire work of the group completely ineffective in the long run (Forsyth, 2010, p. 326). The second problem associated with the actual process of discussion by a team in making decisions is increased pressure from time constraints. DuBrin (2008, p. 163), states that groups are often forced to make rash decisions in order to adhere to strict time deadlines. For instance, teams, in a bid to meet time deadlines, may delegate the whole decision-making process to the leader. This means that the leader finds himself or herself wholly responsible for making the decision, thus avoiding important group input. Additionally, time pressure may force a team to either adopt the first meaningful suggestion or fall back to a decision made earlier in similar situations, thus avoiding careful scrutiny, analysis and examination of other valuable alternatives (Chapman & Sonnenberg, 2000, p. 276). Thirdly, exertion of immense pressure on a team disrupts its process of making decisions. Such kind of pressure may be from external organisations, administrative units and socio-political groups which are stakeholders in the healthcare industry. It is noted that decisions made by teams which are subjected to immense external pressure are characterised by being of generally poor quality because they are made fast in order to avoid uncertainty and meet the expectations of interest groups (Bach & Ellis, 2011, p. 33). Further, DuBrin (2008, p. 165), observes that leaders are faced with the problem of interpersonal inconsistencies in managing decision-making processes by teams. Since teams are made up of individuals with different sensibilities and inclinations, the process of making decisions is bound to involve a certain degree of friction as members seek to reconcile their inherent differences in order to reach a consensus. The implication is that leaders are faced with the problem of balancing the different sensibilities of members who form a body of multiple actors with differences in interest and identity. It is the existence of these differences in interest and identity that exposes the decisions made by teams to common biases and errors such as confirmation bias, shared information bias and errors of commission, omission and imprecision (Forsyth, 2010, p. 331). The last problem that faces teams in making decisions is the risk of falling into the trap of groupthink. This is a phenomenon in which members of the group are concerned more with maintaining good relations between themselves in the team more than working to get to a good decision. Pressure from external forces and errors in the decision-making process and the need to preserve the cohesiveness of the team lead to a situation in which decisions are made for the sake of expediency and to avoid polarization within the team (Hirschhorn, 2002, p. 50). Teams which fall into the trap of groupthink are prepared to defend their position in the face of external scrutiny. This is because they seek to protect the harmony of the group after the quality of decisions made is questioned. Some solutions sought by leaders Several writers have stated that healthcare leaders seek specific solutions to address specific challenges experienced in making decisions under a team environment. For instance, Levi (2011, p. 158) observes that leaders can prevent the effects of groupthink and group polarization by implementing three broad measures: engaging a critical evaluation of the activities and processes of the group by an independent person, allowing a post-decision analysis of any alternatives that were not considered in the process, and enhancing an open discussion with experts who are not members of the team. West (2012, p. 182) states that communication challenges such as poor communication skills among members, interruptions to discussion, failure by other members to participate in the decision-making process, and negative leader behaviours, attitudes and emotions can be solved by increased training and development of the skills of members in the teams. Lastly, Nutt (2010, p. 405), observes that increased use of information and communication technologies in making decisions in the health care industry overcomes many problems associated with making decisions in a team environment. This is because appropriate use of IT tools enhances the quality of decisions made by increasing the speed and effectiveness of communication, pooling of information in the final process of analysis and drawing of conclusions. Conclusion Healthcare leaders are faced with many challenges when making decisions in a team environment. These challenges may either be associated with the actual process of making decisions or result from biases in the way the team handles the issue about which decisions are to be made. Since teams are usually composed of individuals with different interests and identities, problems such as extreme disagreements within the group, increased pressure from limited timeframes and internal inconsistencies result in flawed decision-making processes. A team faced with increasing internal disagreements between its members is forced to make rash decisions in order to contain the situation rather than reaching a good decision. Similarly, increased pressure from outside may force the group to commit errors associated with groupthink. A team may reach decisions which are meant to maintain its internal harmony in the face of perceived external aggression. Such decisions, having escaped the process of critical analysis, are bound to be ineffective and difficult to implement. 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