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Volume 18, Issue 40;   October 3, 2018: Congruent Decision Making: II

Congruent Decision Making: II

by

Decision makers who rely on incomplete or biased information are more likely to make decisions that don't fit the reality of their organizations. Here's Part II of a framework for making decisions that fit.
A hospital patient

A hospital patient. In decision processes involving hospital policy, representing the concerns of patients is inherently difficult. First, the patient population is fluid in the sense that its members are transient. Second, even when patients are present, they are often in situations that make expressing their concerns difficult for them — some are not even conscious. Patient populations are thus one example of a set of stakeholders that can require faithful and energetic representation by nonpatients. Failure to provide such representation might account, in part, for the finding of Reader and Gillespie that patient neglect frequently correlates with organizational factors such as burnout or high workloads that constrain the behaviors of healthcare staff [Reader 2013] . Perhaps resource allocation decisions made with inadequate consideration of effects on patients can lead to patient neglect.

In Part I of this series, I examined a portion of a framework for making decisions that match the real needs of the organization. I call such decision-making processes congruent, because the resulting decisions fit the organization. That first part of the framework provides guidance to organizational leaders to ensure consideration of the needs and concerns of all stakeholders. That's fine as far as it goes, but it assumes that stakeholders want to — and know how to — express their needs and concerns, if given the opportunity. In this Part II, I offer a framework for stakeholders to guide them in expressing their needs and concerns in a complete and forthright manner.

This second part of the framework is important, because incongruent decisions can result even if the stakeholders or their representatives are free to express their concerns. For example, if stakeholders ask for more than they need in order to have "room to negotiate" then they deprive the decision-making team of access to the stakeholders' true concerns.

Here are four criteria that stakeholders or their representatives can use to express their concerns in ways that support congruent decision making.

Stakeholders express their own true concerns
Each class of stakeholders has its own concerns, independent of the concerns of others. While it's true that a given stakeholder's concerns might conflict with the concerns of other stakeholders, the decision makers' task is to resolve such conflicts, balancing conflicting concerns. They can carry out that task effectively only if they understand the true concerns of all stakeholders.
Stakeholders honor the concerns of other stakeholders
Stakeholders or their representatives who express their understanding of the concerns of other stakeholders provide invaluable assistance to decision makers. Decision makers almost inevitably must balance conflicting concerns. Understanding how different stakeholders see the concerns of other stakeholders is essential to this balancing process. For example, if one set of stakeholders harbors a mistaken view of the concerns of a second set of stakeholders, decision makers can clarify and resolve the misunderstanding only if they know about it.
Every Incongruent decisions can result
even if the stakeholders or their
representatives are free
to express their concerns
stakeholder has a legitimate role relative to the mission of the enterprise. In expressing their own concerns, stakeholders must honor the roles of other stakeholders appropriately.
Stakeholders honor the concerns of the enterprise
The stakeholders in the decision in question have a relationship with the enterprise as a whole. Stakeholders' understanding of the concerns of the enterprise is useful data for decision makers.
The enterprise has concerns independent of the direct concerns of any of the stakeholders in the decision in question. Enterprise leadership must make decisions that balance stakeholder concerns, even when those stakeholder concerns are in direct conflict with each other or with the concerns of the enterprise. Stakeholders in the decisions in question must be aware of enterprise concerns, and they must express their understanding of those concerns to decision makers.
Stakeholders honor society's concerns
Society at large also has concerns, but in most cases, society has no means of expressing them as part of the decision process. When we express our own concerns to decision makers, we must take society's concerns into account. For example, we want our actions to be in compliance with the law, and with societal norms. We might have concerns for the locale, for our nation, or for the global environment.

Finally, decision makers are stakeholders too. Congruence in decision-making processes requires that decision makers assume responsibility for their decisions, but they cannot be responsible for incongruence of the stakeholders. When other stakeholders mislead or manipulate decision makers, they show disregard for decision makers as people, and incongruent decisions can result. First in this series  Go to top Top  Next issue: Help for Finding Help  Next Issue

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Footnotes

[Reader 2013]
Tom W. Reader and Alex Gillespie. "Patient neglect in healthcare institutions: a systematic review and conceptual model." BMC health services research 13:1 (2013), 156. Available here. Back

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