Making of decisions within the healthcare industry is an intricate process which comprises of imperative milestones made through definable steps to produce efficiency and the desired sequence (Levenson, 2010). As such, these processes are universally applicable, and in all healthcare settings, their utilization is of utmost significance. Central to the role of these decision-making processes are physicians who precisely denote the technical steps needed to achieve holistic care and subsequently, quality service. Therefore, learning to conform to the desired approaches in each phase of the healthcare decision-making process is crucial since it greatly facilitates pertinence and the quality of physician contribution. Overall, diligent adherence to the precise steps in the process of decision formulation in health care leads to positive results that are consistent with the needs and values of the patient. Using relevant and applicable procedures, the utilization of health care resources becomes easy even under incessant imperfect and challenging circumstances. Thus, the use of sound decision-making methods constitutes chief components of augmentation and reform in the health care industry. This paper discusses the decision-making framework of health care and relates it to a case study of poor decision-making processes. Finally, it proposes the best decision-making model and offers ways of using negotiation models in the resolution of conflicts in the described case study.
The underlying principles of the healthcare decision-making process including those related to end-of-life care engage philosophical, medical and legal precedents. The Act of 1991 called The Patient Self-Determination Act gave rights to patients to either accept or refuse specified types of medical care and the identification of legal representation in the making of health care decisions in the event that a patient could not do so. Onwards, in 1993, the state of Maryland passed the law on Health Care Decisions Act (HCDA) which presented a comprehensive law concerning the rights of individual and the making of health care decisions (Liberatore & Nydick, 2008). Moreover, the HCDA detailed procedures to follow in the event that patients were unable to make decisions that mattered to their well-being. Such stipulations offer systematic and consistent processes essential in the address of issues and the accommodation of cultures that are diverse in values and desires.
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Within the health care industry, there are numerous varying degrees of comprehension of matters which include the meaning and implications of treatments such as the right to decline life-sustaining treatments. More often, problems and disputes concerning ethical decisions often come from disagreements on conclusions and the final decision which arises from a varied understanding of facts, fundamental assumptions, or through differing criteria in the making of conclusions. In some cases, sources of disagreements are rarely realized or reconciled.
Consider a case whereby home care is accorded to a patient in his or her private home, group home or through an assisted living setting. Numerous medical homes fall under the category of such care, and they are subsequently a focus on Accountable Care Organizations as stipulated in the Affordable Care Act of 2010 (Levenson, 2010). In this case study, Louis, a quality insurance director, is eager to impress his managers. However, in his quest of impressionability, he finds unusual errors within the home health company he is working in. His analysis indicates that these errors put the company at risk, and more importantly the patients who are under their care. Since it is a big organization, there are three shifts with twenty-seven managers and although there are stipulated protocols to be adhered to, eight managers, who have been in the organization for close to ten years continue to resist and hold on to old traditions in spite of a revamp of the old processes of decision making. Owing to these occurrences, the decision-making process of the home care institution is highly limited and is fraught with errors, inefficiency, and gross unproductiveness. Although the conservative managers complain of the cumbersome nature and obscurity in the new system, the policies implemented are standardizations that are in effect, in most health care centers, predetermined decision-making processes.
Effective health care decision-making processes usually incorporate the roles of physicians, first as primary health care providers and secondly as managers of the services offered in health care institutions. The first step in the framework of the decision-making process is the identification of strategic instances whereby decision-making is highly required. Here, the role of managers is the identification of situations and circumstances that warrant the dialogue of options needed in treatment and their specific choices. As such, key issues such as the routine nature of decision-making processes are necessary due to medical conditions that are acute or present a higher risk of resulting in complications. The second step of this process is the identification and clarification of care instructions that are crucial; this step is highly instrumental in ensuring smooth transitions in cases whereby upgrades of the system are required (Buthion, 2011). In the aforementioned case study, the non-inclusion of all parties involved and the non-clarification of existing care instructions in the process of formulating new ones may have resulted in divisiveness among the managers. Clarification is imperative, and in relation to managers, they are supposed to inquire for existing documents, for example, those that regard to life sustaining treatments and the end-of-life care. Moreover, managers are expected to identify patients who wish to update or initiate advance care planning. Therefore, clarity is of utmost importance in the decision-making process.
The third step in decision-making is the clarification of medical issues. After the identification and clarification of existing care instructions and their upgrades if necessary, medical issues need precise sensitization and comprehension. Here, the roles of physicians as managers include the description of factors that affect the conditions of patients physically and functionally, which includes the quality of life, decision-making capacity, and the prognosis. The definition of impairments, problems, risks and their primary causative agents together with an understanding of their relevance and treatment options is essential. Moreover, having this consistency in decision-making results in cohesive structures which respect the risks involved and therefore works in unity to achieve collective success.
The most crucial step in the decision-making process is the definition of the decision-making capacity (DMC) and the primary decision maker (Williams & Brown, 2013). As managers, physicians should define and assess the DMC effectively and collectively to come up with common directives and ensure inclusivity in making conclusions. Doing this will incrementally optimize individual participation in health care and personal decisions. Such models are similar to negotiations inasmuch as they reflect official frameworks of the decision-making processes.
Ultimately, decision-making models are significant in ensuring unified work ethics and results that are consistent with quality and efficiency. The aforementioned models are efficient in that they provide a way of conflict resolution since they incorporate inclusivity and the indulgence of all physicians and managers in the decision-making process. Other processes such as the prerequisite of the existence of other qualifying conditions, the definition of recurring issues in health care, the implementation of selections related to health care and the review and modifications of approaches of decision-making are relevant. It must, however, be noted that these supplemental processes depend on the organization, its size, administrative structure, services offered among other pertinent variables.
References
Liberatore, M., & Nydick, R. (2008). The analytic hierarchy process in medical and health care decision making: A literature review. European Journal Of Operational Research , 189 (1), 194-207. http://dx.doi.org/10.1016/j.ejor.2007.05.001
Levenson, S. (2010). The health care decision-making process framework. Maryland Medicine Journal , 11 (1), 13-7.
Williams, L., & Brown, H. (2013). Factors influencing decisions of value in health care: a review of the literature (pp. 1-17). University of Birmingham Health Services Management Center.
Buthion, V. (2011). Healthcare management and the decision-making process perspective: could a normative framework from stakeholder theory help (Doctor of Philosophy). University of Lyon.
