Problem solving and decision-

making in healthcare
Outline
• By the end of the lecture, students should be able to:
• Define problem solving, critical thinking and decision making.
• Understand the difference between them
• Apply adequate tools for problem solving: Pareto analysis

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Introduction
• Decision making is central to health policy and medical practice.
• Because health outcomes are probabilistic, most decisions are made
under conditions of uncertainty.
• 2 Types of decision making in health care settings: decisions made by
providers on behalf of patients, and shared decisions between
patients and providers.
• Problem solving and decision making are essential skills for effective
managment.

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Introduction

Uncertainty
/ Emergency

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Definitions
• Problem Solving is the broad set of activities involved in finding and
implementing a course of action to correct an unsatisfactory
situation.
• Problem solving is an analytical process used to identify the possible
solutions to the situation at hand.
• Making decisions is a part of problem solving. Problem solving is a
complex process, and judgement calls – or decisions – will have to be
made on the way.

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Type of problems
• Recurrent- these problems occur so regularly that organisations
establish policies, procedures, rules and regulations for handling them

• None recurrent problems– unexpected, one-off, non-programmed

decisions that take more time and effort to make as there is no
defined procedure for dealing with them

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What is a problem?
• A problem is a gap or difference in what the situation now is and what you
would like it to be.
• requires critical thinking skills and creativity
• Creativity is basically the production of order out of chaos. Creativity is developing
new, flexible, open-minded approaches or solutions to a problem.
• Critical thinking is examining and reflecting on ideas and thinking. Then judgments
are made and a course of action decided upon.

By combining critical thinking and problem solving, the problem is identified,

information is gathered, beliefs and ideas are challenged, and different
options are examined creatively. Asking questions is the way to build critical
thinking into problem solving.

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THE PROBLEM-SOLVING PROCESS

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1. Define the problem
• People react to what they think the problem is. Instead, seek to understand more about
why you think there's a problem.
Ask yourself and team the following questions:
1. What can you see that causes you to think there's a problem?
2. Where is it happening?
3. How is it happening?
4. When is it happening?
5. With whom is it happening? (HINT: Don't jump to "Who is causing the problem?"
When we're stressed, blaming is often one of our first reactions. To be an effective
manager, you need to address issues more than people.)
6. Why is it happening?
Write down a five-sentence description of the problem in terms of "The following should
be happening, but isn't ..." or "The following is happening and should be: ..." As much as
possible, be specific in your description, including what is happening, where, how, with
whom and why. (It may be helpful at this point to use a variety of research methods.

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Frequent mistakes at the stage of defining the
problem
• Mistake 1: define the problem too narrow or too wide

• Mistake 2: focus on symptoms rather than the causes

• Mistake3: choosing the wrong problem. Leaders should prioritize the

problems and deal with the most important first.

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2. Prioritize the problems:
• If you discover that you are looking at several related problems, then
prioritize which ones you should address first.
• Note the difference between "important" and "urgent" problems.
Often, what we consider to be important problems to consider are
really just urgent problems.
• Important problems deserve more attention. For example, if you're
continually answering "urgent" phone calls, then you've probably got
a more "important" problem and that's to design a system that
screens and prioritizes your phone calls.

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3. Look at potential causes for the problem
• it's critical to get input from other people who notice the problem
and who are effected by it.
• It's often useful to collect input from other individuals one at a time
(at least at first). Otherwise, people tend to be inhibited about
offering their impressions of the real causes of problems.
• Write down what your opinions and what you've heard from others.
• Tools: SWOT analysis, fishbone analysis, 5 whys, brainstorming…..

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4. Identify alternatives for approaches to resolve
the problem
• Evaluate the alternative with the team: benefits, risks of each.

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5. Select an approach to resolve the problem
• When selecting the best approach, consider:
• Which approach is the most likely to solve the problem for the long
term?
• Which approach is the most realistic to accomplish for now? Do you
have the resources? Are they affordable? Do you have enough time to
implement the approach?
• What is the extent of risk associated with each alternative?

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6. Plan the implementation of the best alternative
• Carefully consider "What will the situation look like when the
problem is solved?"
• What steps should be taken to implement the best alternative to solving the
problem? What systems or processes should be changed in your organization,
for example, a new policy or procedure?
• How will you know if the steps are being followed or not? (these are your
indicators of the success of your plan)
• What resources will you need in terms of people, money and facilities?
• How much time will you need to implement the solution?
• Who will primarily be responsible for ensuring implementation of the plan?
• Communicate the plan to those who will involved in implementing it
and, at least, to your immediate supervisor.

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Example of tool in selecting problem
Pareto Analysis
• is a statistical technique in decision-making used for the selection of
a limited number of tasks that produce significant overall effect.
• It uses the Pareto Principle (also known as the 80/20 rule) the idea
that by doing 20% of the work you can generate 80% of the benefit of
doing the entire job.
• Take quality improvement, for example, a vast majority of problems
(80%) are produced by a few key causes (20%).
•

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Example of tool in problem solving
8 steps to identifying the principal causes you should focus on, using Pareto Analysis:
1. Create a vertical bar chart with causes on the x-axis and count (number of occurrences) on the
y-axis.
2. Arrange the bar chart in descending order of cause importance that is, the cause with the
highest count first.
3. Calculate the cumulative count for each cause in descending order.
4. Calculate the cumulative count percentage for each cause in descending order. Percentage
calculation: {Individual Cause Count} / {Total Causes Count}*100
5. Create a second y-axis with percentages descending in increments of 10 from 100% to 0%.
6. Plot the cumulative count percentage of each cause on the x-axis.
7. Join the points to form a curve.
8. Draw a line at 80% on the y-axis running parallel to the x-axis. Then drop the line at the point of
intersection with the curve on the x-axis. This point on the x-axis separates the important
causes on the left (vital few) from the less important causes on the right (trivial many).

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Vital few vs. Trivial many

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Vital few vs. Trivial many

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Decision-making
Decision Making is the process of
identifying and selecting a course of
action to solve a specific problem
Decision making is a choice made by
using one’s judgement.
The art of making sound decisions is a
particularly important skill for leaders
and managers.
Numerous decisions may be taken as
part of the problem-solving process.
Leaders and managers will need to use
their decision-making skills to
determine which solution to pursue.

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Critical thinking

• Both problem solving and decision making involve critical thinking.

• Critical thinking is a process by which you question your own
assumptions – as well as those of others - in order to decide on next
steps to solve a problem.
• Critical thinking often results in using a mix of research, analysis,
questioning and exploration of new ideas in order to gain rich insight
into a situation, becoming informed in a way that isn’t restricted by
the subjective perspectives of peers or the status quo

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Why is critical thinking important for
managers and leaders?
• Those in leadership roles need to make a multitude of decisions quickly in
order to drive business goals.
• As a leader, he/she might find her/himself between a rock and a hard place
and all kinds of people waiting on him/her to decide what should be done.
• Facing stiff time and resource constraints, leader might end up:
• Making quick decisions to get the ball rolling
• Agreeing to the first solution or proposal that comes along - just because it sounds
actionable
• Taking the safe route - just because it's been done before
• On the upside, when leader improves critical thinking, he/she is more likely
to make more effective, informed, objectively better decisions that will
bring true benefit to the organization.

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Golden tips to improve critical thinking :
1. Challenge your assumptions (and those of your team)

• Challenging assumptions is a critical thinking technique that leads to more

informed decisions. Question the assumptions that are so big that it's easy to
forget they're there. If a business goal is proposed, ask why it's a key business
goal - does it have real benefit or is it simply addressing the superficial symptoms
of another, deeper issue or goal? Ask why the proposed solution is the best route
to take. Ask what research there is to back up an opinion or proposal. Ask what is
really known about the consumer habits of the target audience, and how it is
known.
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Golden tips to improve critical thinking :
2. Base your decisions on logic

• Problem solving and analytical thinking often go hand in hand. If you're presented
with a problem to solve - like new hires dropping off rather than staying in the
company - then tackle the issue with logic. Unpick the situation to make sure
there's a real rather than a perceived correlation between cause (to be
determined) and effect (in this case, new hires seeking pastures new after having
just joined the company).

• Assume nothing. Keep an open mind. Aim to be as objective as possible when

examining facts, context and opinions or proposals from within the company.
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Golden tips to improve critical thinking :
3. Maintain a fresh perspective

• Encouraging diversity of thought from team members and stakeholders

• Collaborating with people who have different skillsets and backgrounds on the task at hand

• Allowing information to soak in before agreeing or disagreeing too quickly

• Don't try do make big decisions alone. Involve others. Ask questions and gain richer insight into a
decision's context. Encourage discourse and open thinking in order to explore the most effective
actions.

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Decision-making
• A key role in management and leadership positions is deciding which
problem to treat as a priority.
• Decision making in 3 steps:
1. Use problem solving to identify potential solutions – this may involve
decision making, such as deciding to hold meetings with stakeholders or
assigning team members to tackle particular areas of the problem

2. Determine which solution is the best fit for the problem at hand

3. Make a decision on next steps to action the chosen solution

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Models of decision making
1. The Rational/Classical Model: The classical approach to understand
the decision-making process.
• Problems are clear.
• Objectives are clear.
• People agree on criteria and weights.
• All alternatives are known.
• All consequences can be anticipated.
• Decision makes are rational.

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Models of decision making
2. Administrative Man Model: Herbert A. Simon defines rationality in
terms of objective and intelligent action.
The Administrative man depicts the objective rationality, determining
whether the selected alternative’s course of action is good enough.

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Models of decision making
3. Retrospective decision model (implicit favourite model): Per
Soelberg.
This decision-making model focuses on how decision-makers attempt
to rationalize their choices after they have been made and try to
justify their decisions.
The total process is designed to justify, through the guise of scientific
rigor, a decision that has already been made intuitively. By this
means, the individual becomes convinced that he or she is acting
rationally and taking a logical, reasoned decision on an important
topic.

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Decision making errors
1. Overconfidence Bias – we think we know more than we actually do.
2. Anchoring Bias- the tendency to fixate on the first piece of information we
receive.
3. Confirmation Bias- selectively gathering information that supports our existing
views.
4. Availability Bias- basing judgments on information that is readily available.
5. Representative Bias- assessing the likelihood of an occurrence by matching it
with a preexisting category.
6. Escalation of Commitment- staying with a decision despite clear evidence that
it is wrong.
7. Randomness error- trying to create meaning out of random events.
8. Hindsight Bias- to believe we’d have accurately predicted the outcome of an
event, after that outcome is actually known.

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