As Yogi Berra said, "If you come to a fork in the road, take it." We all have to make decisions. It could be choosing a vendor, purchasing a new chemistry analyzer, assigning unpopular shifts, choosing a new hire, or disciplining a difficult employee. Eventually, we decide or let others decide. Understanding how good decisions are made can make the difference between great leadership and just catching what the job is throwing at us.
While decisive action is a hallmark of great leadership, we are all decision makers. Everyone in an organization makes hundreds of decisions a day that in aggregate accomplish the mission. It's the big decisions that appear to take the most effort and get the most attention, but it all adds up. As a bench tech, for example, you might decide what result to verify, repeat, accept, and reject while answering the telephone and watching a timer. These kinds of operational decisions are no less important to the organization than major purchases or staffing plans.
Many decisions are made routinely, partly because our experience has taught us expectations that limit choices: a manager renewing a standing order adjusts quantities depending on test volumes; a bench level supervisor reviewing quality control decides to calibrate a method that shows a shift; a weekend bench tech who receives a cerebrospinal fluid from the emergency department performs the Gram stain first. Much of laboratory work is making these kinds of decisions.
And making decisions is work. As Swarthmore College professor and author Dr. Barry Schwartz points out, "The mere act of thinking about whether you prefer A or B tires you out."1 This leads to one of three situations: we make poorer decisions, become dissatisfied with choices, or don't decide at all. Research has focused on consumer choices, but the same mental energy is used in the workplace to make decisions. Decision fatigue saps mental energy, causing us to dismiss colleagues, become short-tempered, and look for ways to simplify remaining decisions.
Types of Decisions
Broadly speaking, there are three types of decisions to consider:2
- Strategic. Made by senior management, strategic decisions shape the direction of the organization and have a long-term impact. A decision to add and staff a primary care clinic to your hospital is one example.
- Tactical. Made by middle managers to implement the strategy. In the above example, your laboratory may make a decision to expand outpatient phlebotomy hours to accommodate patients from the clinic.
- Operational. Made by middle managers and bench level supervisors on a day to day basis. All staff have a direct impact on operations. In the above, for example, extra supplies and collection kits may have to be ordered and inventoried.
From daily patient care to major initiatives, decisions are ideally all driven by core values. Your organization likely has an official Mission, Vision, and Values statement; values define what it believes in, how it will behave, and what is important. Decisions by necessity reflect values. As one Human Resources web site puts it, "For an organization to have an effective values statement, it must fully embrace its values and use them to guide its attitudes, actions and decision-making on a daily basis."3
Values guide and simplify decisions. For example, if "The best patient care" is a core value in the above example, good decisions will reflect creating a service-centered, quality patient experience. If "Cooperation with partners in excellence" is a core value, these decisions may represent greater participation with other organizations, including outreach.
Bad decisions are often misaligned with core values and can be easy to spot. If, for example, your organization values treating employees with respect, deciding to arbitrarily change a weekend rotation will stand out. Decisions won't make sense if they don't reflect your organizational values.
Dos and Don'ts
Given the complexity of the laboratory and the changing nature of healthcare, decision fatigue is inevitable. You need a strategy to ensure that your last decision is as good as the first. Here are a few dos and don'ts as suggested by the US Small Business Administration:4
- Do be as specific as possible. What is the decision, and do you have to make it? If you don't have at least two choices, there is no decision.
- Do brainstorm. Write down as many alternatives as you can think of using resources such as colleagues, experts, and the Internet. This will help you understand the impact of the decision.
- Do it and move on. Worrying or second-guessing yourself will cause stress, and you can always change the decision later.
- Don't under- or overestimate the input from others. Experts have their own biases, and colleagues agendas.
- Don't hear only what you want to hear. This is called "cognitive bias," in which we tend to filter out information that doesn't support our view.
- Don't ignore your gut. Our consciousness filters out most of the sensory input we receive throughout the day, but our bodies can provide clues by how it reacts. Remember that "gut" rhymes with "but."
When all members of your organization or team make decisions based on core values, choices are limited. It's a good idea to review these values in daily huddles, team meetings, and when an incident occurs to ensure they are reinforced. Ask yourself, "Is this decision based on our values?" If not, then it may not be a good decision. Good decisions not only reflect but reinforce clear values and create a stronger team.
Poor decisions will still be made, but they can be unmade. A hallmark of good leadership is recognizing and acknowledging core values that make choices clear; good leaders aren't afraid to back off a bad decision. Sticking with a poor decision isn't a sign of strength, doesn't create new values, and erodes trust within the team.
As Roy Disney said, "When your values are clear to you, making decisions becomes easier." If this happens at all levels of the organization from the bench to the CEO, a stronger, more cohesive team results that provides better patient care.
Scott Warner is laboratory manager, Penobscot Valley Hospital, Lincoln, Maine.
- Los Angeles Times. Too many choices can tax the brain, research shows. Available at: http://articles.latimes.com/2009/mar/16/health/he-choices16. Last accessed May 3, 2014.
- Businesscasestudies.co.uk. Levels of decision making -- Improving strategic decision making -- Chartered Institute of Management Accountants. Available at: http://businesscasestudies.co.uk. Last accessed May 3, 2014.
- Society for Human Resource Management. Mission & Vision Statements: What is the difference between mission, vision and values statements? Available at: www.shrm.org. Last accessed May 3, 2014.
- Sba.gov. Making decisions. Available at: www.sba.gov/content/making-decisions. Last accessed May 4, 2014.