KỸ NĂNG RA QUYẾT ĐỊNH VÀ GIẢI QUYẾT VẤN ĐỀ GS, TS, BS LÊ HOÀNG NINH

– Phương pháp giải quyết vấn đề– Các bước trong giải quyết vấn đề – Các yếu tố quyết định trong ra quyết định và giải quyết vấn để... Đại cương• Để đối phó với hệ thống y tế hiện nay đòi

KỸ NĂNG RA QUYẾT ĐỊNH

VÀ GIẢI QUYẾT VẤN ĐỀ

GS, TS, BS LÊ HOÀNG NINH

– Phương pháp giải quyết vấn đề

– Các bước trong giải quyết vấn đề

– Các yếu tố quyết định trong ra quyết định và giải quyết vấn để

Đại cương

• Để đối phó với hệ thống y tế hiện nay đòi hỏi người thầy thuốc phải được chuẩn bị để có

những suy nghĩ thấu đáo để có thể ra các

quyết định hay giải quyết các vấn đề găp phải trong quá trình công tác

• Bất kỳ người quản lý, lãnh đạo nào cũng phải đầu tư suy nghĩ và hành động để giải quyết ,

ra các quyết định để lãnh đạo cơ quan , đơn vị đạt được mục tiêu cơ quan đơn vị

Ra quyết định là gì

• Ra quyết định là tiến trình nhận thức Có Hệ Thống để chọn ra được cái phù hợp nhất, tốt nhất trong các giải pháp khác được đề nghị

– Ra quyết định lâm sàng: liên quan đến chất lượng

chăm sóc hay vấn đề năng lực chuyên môn

– Ra quyết định cơ quan : chọn giải pháp để giải quyết vấn đề của cơ quan đơn vị và đạt đến mục tiêu cơ quan, đơn vị

Sự khác biệt giữa ra quyết định

và nói/ thông báo các quyết định

Nói các quyết định (decision talking )

• NÓI CÁC QUYẾT ĐỊNH :

– Sự phán quyết được chọn lựa từ hai hay nhiều giải pháp khác nhau Nó là bước cuối cùng của ra

quyết định

Giải quyết vấn đề ( problem solving)

• Giải quyết vấn đề :

– Là một phần của ra quyết định Là một tiến trình

mang tính hệ thống tập trung trên phân tích tình huống khó khăn, phức tạp Giải quyết vấn đề luôn luôn bao gồm các bước ra quyết định

– Là một tiến trình mà việc chọn lựa ( thế tiến thoái lưỡng nang ) cần được xác định và chỉnh sủa ( is a process whereby a dilemma is identified and

corrected )

Giải quyết vấn đề

• Giải quyết vấn đề và ra quyết định ?:

and decision making synonymously, but there is

a small important difference between the two Although decision making is the last step in the problem solving process, it is possible for

decision making to occur without the full

analysis required in problem solving Because

problem solving attempts to identify the root problem in situations, much time and energy are spent on identifying the real problem.

Sự liên quan giải quyết vấn đề

và ra quyết định

inconsistently or interchangeably.

instances depend on one another, they are not synonymous.

decision making may or may not involve a

problem, but it involves selection of

alternatives.

problem and solving it, which may or may not

entail deciding on one correct solution.

of problem solving

Ba dạng chính trong ra quyết định

– Khi vấn để dễ xác định, phổ biến và đã có luật, chính sách

và qui trình thực hiện giúp giải quyết như: thiếu bs trong bệnh viện

– là các quyết định khi vấn đề và giải pháp khác thường Thí

dụ thay đổi giờ và kiểu hình làm việc, cách điểm danh

nhân viên

• C Quyết định cải cách ( innovative decision) :

• Là các quyết định khi vấn đề là bất thường và chưa rõ khi đó cần các giải pháp sáng tạo để giải quyết : thí du :

tỷ lệ nhiễm trùng vết mổ lên đến 50 %

Levels of decisions

Levels of decisions

Strategic Administrative Operational

Các cấp độ quyết định

1 Quyết định chiến lược ( strategic decision ):

– Quyết định được ra bởi những lãnh đạo về những kế

hoạch hoạt động dài hạn

– Được gọi là chiến lược do nó tập trung trên các mục

tiêu dài hạn của cơ quan đơn vị

2 Quyết định hành chánh ( administrative

decision) : thường được ra bởi cán bộ quan lý cấp trung gian ( khoa/ phòng ) : giải quyết

những vấn đề bất thường và phát triển các kỹ thuật đễ cải thiện chất lượng công việc

Các cấp độ quyết định

• 3 Quyết định vận hành ( operational decision) : là các quyết định thường qui liện quan đến các sự kiện/ biến cố hàng ngày , thường do

cán bộ cấp cơ sở ( first line) hay trung gian ra quyết định

Những yếu tố ảnh hưởng đến việc ra

6 Time available, money, energy

7 Routine # non routine decision

8 Risk associated decision

9 Critical nature of work

10 Written guidelines

11 Organization attitude toward decision making

12 Amount and kind information available

13 Degree of acceptance and support

14 Manager personal ability

Characteristics of effective decision making process:

• Conducted in a systematic , comprehensive way of

• Based on a " Goal-oriented " analysis of the situation,

its problems, and their alternative solutions.

Decision making process

Decision making process

1) Defining the problem:

Prepare a statement of the problem and

find someone you trust to review it

and to talk it over

Qui trình ra quy t đ nh ết định ịnh (Decision making process)

2- thu th p thông tin t đâu ? ập thông tin từ đâu ? ừ đâu ?

- Results from experimentation and studies

- Interviews of "experts" and trusted sources

- Observed events, past or present, either personally

observed

Boundaries

The boundaries or constraints of the situation are difficult to

change. 

Opinions and Assumptions

Opinions of decision makers, committees or groups, or other powerful groups will be important to the success of your decision.  It is important to recognize truth, bias, or prejudice

in the opinion

3) Phát tri n các gi i pháp (Develop ển các giải pháp (Develop ải pháp (Develop

Alternatives)

Look at the problems in different ways; find a new perspective that hasn’t thought of before Once you have listed or mapped alternatives, be open to their possibilities.  Make

notes on those that: 

Need more information

Are new solutions

Can be combined or eliminated

Will meet opposition

Seem promising or exciting

4) Cân nh c các gi i pháp (Weigh Alternatives ắc các giải pháp (Weigh Alternatives ải pháp (Develop )

After listing possible alternatives,

evaluate them without prejudice, 

Consider all criteria while a suitable

solution may solve the problem, it may not work if resources aren't available, if people won't accept it, or if it causes

new problems

5 Select the best alternative

Don't consider any alternative as " perfect solution " If

there were, there probably wouldn't be a problem in the first place

Consider your intuition, or inner feelings in deciding on

a course of action

Return to a trusted outsider: Is there something you

missed?

Does he/she see a problem with your solution?

Compromise when you have a full grasp of the

problem, and your alternatives

Techniques in weighing alternatives:

1-Thomas Saaty's Analytical Hierarchy Matrix:

List alternatives in columns and rows as depicted in the matrix above Starting with Alternative A, go across columns in the matrix and rate each alternative against all the others.

When the alternative under consideration has more value than the others.

Then give the more valuable alternative a score of 1

When the alternative has less value than the others.

Then give the less valuable alternative a score of 0

2- SFF Matrix: thích hợp, khả thi & mềm dẽo:

Suitability Feasibility Flexibility Total Alternative A

Alternative B

Alternative C

Alternative D

A-Suitability: refers to

the alternative itself, whether it is ethical or practical Is it

appropriate in scale or importance? An adequate response? Too extreme?

C-Flexibility: refers to

your ability to respond to unintended consequences, or openness to new possibilities? The alternative itself and whether you can control outcomes once you begin

Total a score for each alternative, compare, prioritize your alternatives

Develop a plan for implementation. Its elements

 Where important or necessary, inform

those who care for you and/or will be affected by the change.  Prepare them as necessary about your decision.

 Resource identification/allocation.

 Timeline for implementation

7) Monitor progress

if results are not what you expect, review your options and alternatives

Whether or not you achieved your goals, it is important

to consider what you have learned from your experience:  about yourself, about what you consider important.

Lastly, if you have done your best, you have this as one measure of success.

1- interpret data in more than one way.

2- set criteria of success beforehand

3- ask other people

4- lest your failure

5- improve feedback by avoid missing and confuse

6- scrutinize the decision making process

7- Change your way of deciding and reevaluate your time, and learning from experience

8- have group do decisions audits too.

9- be rational.

How to improve decision making

How to improve decision making?

10 Educate people so they know how to make appropriate decision 11.Seeking support of top management for decision making at the

lowest possible level, (e.g decentralization)

12.Successful manager stay informed about decision being made at

different levels of the organization after appropriately delegating these responsibilities.

13.The managers should deal only with these decisions requiring their

level of expertise (non routine decisions), support implementation

of decisions, and credit the decision maker.

14.Delegation of decision making (routine decision making) to

subordinates to gain their trust, loyalty and to raise their

self-esteem.

15.Successful manager who is skilled in both decision making and

problem solving serves as a motivator and role model for others

PROBLEM - SOLVING

Traditional Problem-Solving Process

The traditional problem-solving model is widely used and is perhaps the most well known of the various models The seven steps follow (Decision-making occurs at step 5.)

1 Identify the problem

2 Gather data to analyze the causes and consequences of the problem

3 Explore alternative solutions

4 Evaluate the alternatives

5 Select the appropriate solution

6 Implement the solution

7 Evaluate the results

Traditional Problem-Solving Process

Although the traditional problem-solving process is an effective model, its weakness lies in :

1 the amount of time needed for proper implementation This process, therefore, is less effective when time constraints are a consideration

2 lack of an initial objective-setting step Setting a decision goalhelps to prevent the decision maker from becoming sidetracked

The Managerial Decision-Making Process

The managerial decision-making model, a modified traditional model, eliminates the weakness of the traditional model by adding a goal-setting step Harrison (1981) has delineated the following steps in the managerial decision-making process:

Decision making techniques

Decision making techniques vary according to the nature

of the problem or topic, decision maker, situation, and decision making method or process.

Nurses are using tools such as cause- and- effect

diagrams, flow charts, Pareto charts, run charts,

histograms, control charts, and scatter diagrams to help understand facts and relationships in processes they are examining.

Decision making techniques

1 Group decision making:

A number of studies have shown that professional people

do not function well under micromanagement.

Group problem solving casts the manager in the role of facilitators and consultant.

Compare to individual decision making , group can provide more input and better decision.

Decision making techniques

2 Nominal group technique (NGT)

-It is eliciting written questions, ideas, and reactions from group members.

Consists of :

-Silently generating ideas in written.

-Round-robin presentation by group members of their ideas

on a flip chart.

-Discussing each recorded idea and evaluate.

-Voting individually on priority ideas, with group solution being derived mathematically through rank ordering.

Decision making techniques

Decision making techniques

4 Statistical aggregation:

Individuals are polled regarding a specific problem and their responses are tallied

like Delphi technique , does not require a group meeting

no opportunity for group members to strength their

interpersonal tie or interaction

Decision making techniques

5 Brainstorming

The idea generating technique wherein a Group members meet and generate diverse ideas about the nature, cause , definition, or solution to a problem without regard to questions of feasibility or practicality Through this technique, individuals are encouraged to identify a wide range of ideas Usually, one individual is assigned to record the ideas on a chalkboard Brainstorming may be used at any stage of the decision- making process, but it is most effective at the beginning, once a problem has been stated

Decision making techniques

6 fishbone diagram (causes and effect)

Is drawn after a brainstorming session, the central problem is visualized as the head of the fish, with the skeleton divided into branches showing contributing causes of different parts of the problem.

Work system

ED Overcrowding

Resources and facilities

lack of availability of ground ambulance transportation

limited resources of ED in the form of medical

Lack of supplies and medications Unavailability of operating room time shortage of physical plant space

Ancillary services not same hours as ED

Lack of availability of 24-hour laboratory tests

In creased medical records documentation requirements

Increase length of stay due to waiting for test Delay in the services provided by radiology, lab

and ancillary services

Fishbone diagram (Cause and effect)

Delay in treatment and prolonged patient stay in ED

No system available for supervising &evaluating work

Decision making techniques vary according to the nature of the problem or topic, decision maker, situation, and decision making

method or process

7 Thomas Saaty's Analytical Hierarchy

Matrix

Thomas Saaty's Analytical Hierarchy

Matrix

List alternatives in columns and rows as depicted in the matrix above Starting with Alternative A, go across columns in the matrix and rate each alternative against all the others.

When the alternative under consideration has more value than the others,

Then give the more valuable alternative a score of When the alternative has less value than the others.

Then give the less valuable alternative a score of Add the scores for each row/alternative; highest score is the highest rated alternative according to the criteria you used In the matrix above, Alternative C scores highest,

so it's the highest rated alternative.

Problem solving

Problem solving methods:

tried until the problem is solved or appears to be

improving.

knowledge, understanding , or prediction.

Steps in problem solving

1- define the problem

2- gather information

3- analyze the information

4- develop solutions

5- Make a decision

6- implement the decision

7- evaluate the solution

CRITICAL ELEMENTS IN PROBLEM SOLVING AND

DECISION MAKING

1 Define Objectives Clearly :

• If a decision lacks a clear objective or if an objective is not consistent with the individual’s or organization’s stated philosophy, a poor-quality decision is likely Sometimes the problem has been identified

but the wrong objectives are set Problems can be

extremely complex and may need multiple objectives

(Clancy, 2003).