Decision Making and Communication
Joe Ashford
Sherri H. Lu, PhD
MHA 601: Principles of Healthcare Administration
January 10, 2011

Introduction The case study presents multiple multifaceted dilemmas for the president of Community Medical Center. One surgical nurse is suspected of having HIV/AIDS. The chief of surgery requests the removal of this nurse from the operating room or else he and many of the other surgeons will start scheduling their patients in different facilities. The result would devastate the hospital economically and result in the loss of human resources and job layoffs. When approached, the nurse refused relocation and threatened legal repercussions for the violation of several federal laws. In addition, the media expected a news release within 24 hours after the information leaked by a staff member. The result of negative media coverage would potentially damage the hospitals reputation for quality healthcare and affect the decision of many community members to use the hospital. This paper will discuss three decision-making models the president can use to communicate his or her decisions internally to employees and board members, as well as, to the external environment of the media and public using qualitative, quantitative, and triangulation methods.
Decision Making and Communication In this situation, multiple decisions need to be made which are complex in nature and time sensitive. The Willful Choice decision-making model articulates that “decisions are made by rational, intentional, and willful choice.” (Johnson, 2009, p. 215). In this case, the problem is centered on the nurse who is thought to have HIV/AIDS. He is refusing job relocation at no loss of pay or benefits and has discussed the issue with a lawyer who feels many federal laws would be violated if the hospital insists on relocating the nurse. A willful choice or rational model is the appropriate decision making model in this situation but requires time, collection of information, and the focus of the individuals involved in order to come to a resolution. The CEO of Community Medical Center does not have the time required to initiate a willful choice or rational model when making the decision to remove or allow the nurse to stay in his present position. Therefore, a conflict management style that is useful for a short period is the Avoiding style. The Avoiding style of conflict management is useful “to let people cool down and regain perspective” or “when gathering information supersedes immediate decision making” (Johnson, 2009, p. 154). However, it should only be used temporarily until proper information can be collected. For example, the nurse may test negative for the HIV/AIDS virus or the legal department may find a compromise that defends the hospital from a legal course of action. In addition, the qualitative method is a useful method in decision-making. The qualitative methods the CEO can use when deciding how to handle the issue with the nurse includes discussions with board members, formal and informal interviews, and his or her personal intuition (Johnson, 2009). In the article, “Analysis of the Effect of Conflict-management and Resolution Training on Employee Stress at a Healthcare Organization,” the result of unmanaged conflict causes “personnel turnover, absenteeism, [and] loss of productivity” (Haraway & Haraway III, 2005, p. 12). The surgeons are concerned and threaten not to use Community Medical Center for future procedures if the situation concerning the nurse is not resolved. The outcome of the previously mentioned study found that intervention improves work environment and decreases employee stress (Haraway & Haraway III, 2005). If the physicians and this nurse previously had strong interpersonal relationships, informal and formal communication could have produced a compromise between the nurse and the physicians. The reality of the situation the CEO finds himself or herself dictates a reality-based decision making model, such as, the garbage can model. Johnson (2009) claimed that “garbage can models are attempts at finding logic and order in the mist of decision making chaos” (p. 217). The CEO of Community Medical Center must make both internal and external decisions concerning the media without the luxury of time needed to evaluate possible outcomes. However, the media is requesting an immediate response, which requires the CEO to rely on qualitative methods. The combination of board members and hospital administrators could dump suggestions from their combined experience, knowledge, and common sense into the garbage can and arrive at a decision as to what to present to the media. Strong communication skills are necessary. Johnson (2009) stated that confirming and competent communication is the key ingredient to successful and effective communication. When developing confirming communication, the speaker should be descriptive, problem oriented, spontaneous, and provide and atmosphere of equality and flexibility (Johnson, 2009, p. 226). If the CEO communicates in a fashion that is and appears to be presenting a “strategy, then the media and the public sill perceive the hospital as have something to hide. Additionally, the current economic climate does not allow healthcare organizations many opportunities to increase revenue nor can it withstand loss of productivity from their providers. The CEO must secure at least the immediate cooperation of the surgeons in order to remain economically viable until solutions are attained. Silvers (2004) argued that healthcare organizations cannot completely rely on insurance payments and fee for service to remain economically stabile. This article maintains that healthcare organizations must provide a “balance of profitable current activities, promising future options, and social dividends” to remain economically viable. This is an example of a quantitative method to help in the decision making process. Another example of the quantitative method the CEO can use immediately is the decision tree. The decision tree is used as a tool to choose the appropriate conflict management style in any given situation (Johnson, 2009). For example, the CEO may choose to use the compromising conflict style because the issues are very complex and time constraints require “expedient solutions.” (Johnson, 2009, p.154). Ultimately, the CEO of Community Medical Center will have to come to final resolutions on these issues. The triangulation method for decision-making, as Johnson (2009) described, would allow for a more thorough approach. Triangulation methods use a combination of both qualitative and quantitative methods. For example, the use of the quantitative method can produce mathematical figures and probabilities of the economic stability of the organization in combination with qualitative nominal group techniques that finalize the decision-making process and the issues come to a resolution. Another example of the triangulation method is the IDR model, which was specifically developed to aid healthcare organizations. In the article, “Beyond IDR: Resolving Hospital Disputes and Healing Ailing Organizations through IDR,” Rabinovich-Einy (2007) presented a triangulation method that can aid healthcare organizations. The IDR model facilitates decision-making using qualitative methods including discussions between groups and qualitative methods to attain quality control through the process of “information gathering, effective communication, and ongoing systemic efforts for quality control” (Rabinovich-Einy, 2007, p.192).
Conclusion
In conclusion, the CEO of Community Medical Center has many decisions to make and is under many time constraints. Many of these decisions deserve the time, energy, and participation of many individuals in order to come to the appropriate decisions these issues deserve. However, the CEO must first stabilize the situation. When under time constraints the CEO is currently facing, it is most reasonable for him or her to rely on qualitative methods such as discussions with board members and other hospital administrators or personal intuition. Additionally, the use of the quantitative method, such as the decision tree, can help the CEO decide the appropriate type of conflict-management style that would be most effective in the current situation. However, the most thorough method for decision-making is the triangulation method. Once the situation has moved from the immediate necessary actions, then the CEO can take on a comprehensive decision-making plans.

References
Haraway, D., & Haraway III, W. (2005). Analysis of the effect of conflict-mamangement and resolution training on employee stress at a healthcare organization. Hospital Topics, 83(4), 11-17. Retrieved from Research Library: http://proquest.umi.com
Johnson, J. A. (2009). Health organizations: Theory, behavior, and development. Sudbury, MA: Jones and Bartlett Publishers.
Rabinovich-Einy, O. (2007). Beyond IDR: Resolving hospital disputes and healing ailing organizations through IDR. St. John's Law Review, 81(1/2), 173-203. doi: 10.1080/15205430801950643
Silvers, J. (2004, Winter). Assessing capital: Learning to live in the real world. Frontiers in Health Services Management, 21(2), 43-48. Retrieved from ABI/INFORM Global: http://proquest.umi.com