DECISION

MAKING
& PROBLEM SOLVINGFRITZ A. BUCAO, RMT

A GOOD DECISION
Should be based on a complete investigation of the root causes and potential problems, as
well as obvious symptoms.
Should identify and evaluate alternative solutions.
Should involve the selection of the best solution by in-depth analysis of the available
information.
Should encompass an effective strategy for implementing the solution.

HUMAN ELEMENT
Emotions, prejudices, peer pressure and personal interest exert tremendous influence on the
choices made.
Never completely eliminated; must be controlled.

DISCLOSURE
Effective control method and balancing action, providing the participants have the power
and independence to consider its impact and to act accordingly.

ASSET
By using objective analytical tools to evaluate the situation and allowing the human touch
to provide the perspective and context for selection and implementation.

STEPS IN MAKING A SOUND DECISION

1. Recognition
2. Investigation
3. Definition
4. Identification of Alternatives
5. Evaluation
6. Selection
7. Implementation
8. Follow-up

•To become aware that something is wrong

and needs the attention of the manager.

as a complaint from a physician or

employee

RECOGNITION as a flag in the quality control data

•Recognizing a problem

•Not as simple as it may appear

•May only be a random occurrence

Includes collecting data, interviewing staff,

and gathering information

During this fact-gathering stage:

INVESTIGATION
Manager should be alert to ancillary issues
that may have contributed to the problem
but were not at first readily apparent.

•Defining the problem

Determining all the issues and aspects of the

question, including people, equipment,
communication, supplies, and the workflow
itself.

•Deviation

DEFINITION A one time, random human error

•Effectural problem

The symptom or surface sign that may hide

the real cause of a problem.
 •Causal problem

The root cause of the problem.

Determining what solutions are available to

remedy the situation.

Key at this stage:

To be aware of as many alternative solutions

as possible; the manager then has a range
IDENTIFICATION OF ALTERNATIVES
of options to choose.

Although some proposals can be rejected

outright, considering each alternative as it
becomes known is time-consuming, and the
manager may settle on a poor choice simply
because of time constraints.

•After the pool of feasible solutions has been

compiled, a thorough evaluation should be
conducted (step 5), and the best alternative
SOLUTION EVALUATION AND SELECTION selected (step 6).

•Variety of tools can be used to select the

most suitable alternative.

Developing a plan to implement the final

decision and devising a mechanism to
monitor compliance – part of the
IMPLEMENTATION AND FOLLOW-UP
management functions and illustrates the
central role of decision making in the overall
operations of the laboratory.

DECISION MAKING TECHNIQUES

QUALITATIVE TOOLS QUANTITATIVE TOOLS

•Involve personal judgment, solicitation of •Include both QC measures and financial

 advice and systematic option review. data.

QUALITATIVE TOOLS
PERSONAL JUDGMENT
Begin at birth to develop skills in choosing between options.
These grow with maturity and experience.
Specific duties and demands of the workplace and profession become familiar through
FORMAL TRAINING and CAREER ADVANCEMENTS.
Personal knowledge – vital resource in evaluating alternatives and making decisions.

SOLICITATION OF ADVICE
Asking for opinions, organizing a committee, seeking a consensus from colleagues and
coworkers, and delegating the task to staff members.
Forming a group or committee to focus on a problem is one of the most common approaches
to decision making:
1. Brainstorming -technique used in groups whereby everyone freely and spontaneously throws
out ideas and solutions for later evaluation without regard for validity.
2. Synectics - group whose members are brought together as a problem-solving team
3. Nominal grouping - a highly structured meeting in which individuals write their original ideas
in private, with the alternative solutions anonymously presented to the group for discussion
and then voted on and tallied in secret.
4. Delphi method - modification of nominal grouping
-input and opinions of experts are solicited on questionnaires before
the meeting.
- results are then discussed and voted on anonymously.

SYSTEMATIC OPTION REVIEW

-Involves prioritizing each option according to its apparent attractiveness.

T CHART
•One popular format for evaluating facts and information
•Clarifies the opportunities and risks associated with each option and makes the selection
process more objective.

QUANTITATIVE TOOLS
Operations Research (OR)
one branch of management science that specializes in providing quantitative tools for decision
making.

Four main areas:

1. Probability analysis - Measures risk by assigning a value, expressed as a percentage, to the

likelihood of a specific event occurring.
2. Queuing theory -Provides recommendations for the number of staff (phlebotomists, clerks,
technical personnel, and so on) needed to handle an unpredictable workload.
3. Linear programming -A tool for allocating limited resources among competing needs.
4. Simulation -Designs models to imitate real-life conditions so the different intervention
scenarios can be compared.

Probability Analysis

A PRIORI PROBABILITY

obtained by deductions based on assumed conditions.

Lab establishes normal ranges but cannot predict with certainty where patient’s result will
fall.

EMPIRICAL PROBABILITY

determined by recording actual events over a specific period of time and calculating the
number of times each event occurs.
Used when the lab establishes QC ranges for a new lot of reagents or controls.

SUBJECTIVE PROBABILITY

Based on the knowledge and experience of the individual or group, a prediction is made of
the likelihood of an event occurring.

Queuing Theory

Was originally designed to determine the number of airline reservation clerks needed for a given
time period

Is designed to determine the staffing requirements of a workstation with the following

operational needs:

[Link] for prompt service

[Link] for an adequate number of servers to meet an urgent demand

Once these parameters have been determined, they can be entered into a queuing program for
staffing level calculations.

Linear Programming

Was designed to resolve the ff. problems:

Limits and restraints on the availability of resources (staff, time, expenses)

Constant need for decisions as to allocation of these limited resources among competing
needs
Pressure to maximize income and minimize losses

Process of elimination and selection illustrates the procedure. Here are some questions and
variables associated with this type of decision:

Does the instrument perform all the tests required, or is additional equipment necessary?
Are the throughout and turnaround time acceptable?
Is the price within the laboratory budget?

Simulation

•The computer has made possible the development of models that closely duplicate the
conditions found in real-life settings.

•Attempt to identify important variables, which the manager can then manipulate to test the
impact of different options on the system.

EXAMPLE:
Computer projection of the impact on length of patient stay in the hospital if CK isoenzymes are
batched and run at different times (e.g. every 2, 4, or 8 hours)instead of on a STAT basis.