794 resultados para Nursing--Decision making.


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Purpose – Threats of extreme events, such as terrorist attacks or infrastructure breakdown, are potentially highly disruptive events for all types of organizations. This paper seeks to take a political perspective to power in strategic decision making and how this influences planning for extreme events. Design/methodology/approach – A sample of 160 informants drawn from 135 organizations, which are part of the critical national infrastructure in the UK, forms the empirical basis of the paper. Most of these organizations had publicly placed business continuity and preparedness as a strategic priority. The paper adopts a qualitative approach, coding data from focus groups. Findings – In nearly all cases there is a pre-existing dominant coalition which keeps business continuity decisions off the strategic agenda. The only exceptions to this are a handful of organizations which provide continuous production, such as some utilities, where disruption to business as usual can be readily quantified. The data reveal structural and decisional elements of the exercise of power. Structurally, the dominant coalition centralizes control by ensuring that only a few functional interests participate in decision making. Research limitations/implications – Decisional elements of power emphasize the dominance of calculative rationality where decisions are primarily made on information and arguments which can be quantified. Finally, the paper notes the recursive aspect of power relations whereby agency and structure are mutually constitutive over time. Organizational structures of control are maintained, despite the involvement of managers charged with organizational preparedness and resilience, who remain outside the dominant coalition. Originality/value – The paper constitutes a first attempt to show how planning for emergencies fits within the strategy-making process and how politically controlled this process is.

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Artifact selection decisions typically involve the selection of one from a number of possible/candidate options (decision alternatives). In order to support such decisions, it is important to identify and recognize relevant key issues of problem solving and decision making (Albers, 1996; Harris, 1998a, 1998b; Jacobs & Holten, 1995; Loch & Conger, 1996; Rumble, 1991; Sauter, 1999; Simon, 1986). Sauter classifies four problem solving/decision making styles: (1) left-brain style, (2) right-brain style, (3) accommodating, and (4) integrated (Sauter, 1999). The left-brain style employs analytical and quantitative techniques and relies on rational and logical reasoning. In an effort to achieve predictability and minimize uncertainty, problems are explicitly defined, solution methods are determined, orderly information searches are conducted, and analysis is increasingly refined. Left-brain style decision making works best when it is possible to predict/control, measure, and quantify all relevant variables, and when information is complete. In direct contrast, right-brain style decision making is based on intuitive techniques—it places more emphasis on feelings than facts. Accommodating decision makers use their non-dominant style when they realize that it will work best in a given situation. Lastly, integrated style decision makers are able to combine the left- and right-brain styles—they use analytical processes to filter information and intuition to contend with uncertainty and complexity.

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Intuition can produce effective strategic decisions because of its speed and ability to solve less-structured problems. Despite this, there are only a very small number of empirical studies that have examined intuition in the strategic decision-making process. We examine the relationship between the use of intuition in the strategic decision-making process, and strategic decision effectiveness. We propose that the expertise of the decision-maker, environmental dynamism and the characteristics of the strategic decision itself moderate the relationship between the use of intuition in the strategic decision making process, and strategic decision effectiveness. We make a significant theoretical contribution by integrating the management and social-psychology literatures in order to identify the variables that affect the relationship between the use of intuition in the strategic decision-making process, and strategic decision effectiveness. This article builds upon existing empirical research that has examined intuition in the strategic decision-making process, and reconciles some of the confounding results that have emerged. The paper presents a conceptual model and research propositions, which if empirically examined, would make a significant contribution to knowledge in the strategic decision-making domain of literature.

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Despite concerted academic interest in the strategic decision-making process (SDMP) since the 1980s, a coherent body of theory capable of guiding practice has not materialised. This is because many prior studies focus only on a single process characteristic, often rationality or comprehensiveness, and have paid insufficient attention to context. To further develop theory, research is required which examines: (i) the influence of context from multiple theoretical perspectives (e.g. upper echelons, environmental determinism); (ii) different process characteristics from both synoptic formal (e.g. rationality) and political incremental (e.g. politics) perspectives, and; (iii) the effects of context and process characteristics on a range of SDMP outcomes. Using data from 30 interviews and 357 questionnaires, this thesis addresses several opportunities for theory development by testing an integrative model which incorporates: (i) five SDMP characteristics representing both synoptic formal (procedural rationality, comprehensiveness, and behavioural integration) and political incremental (intuition, and political behaviour) perspectives; (ii) four SDMP outcome variables—strategic decision (SD) quality, implementation success, commitment, and SD speed, and; (iii) contextual variables from the four theoretical perspectives—upper echelons, SD-specific characteristics, environmental determinism, and firm characteristics. The present study makes several substantial and original contributions to knowledge. First, it provides empirical evidence of the contextual boundary conditions under which intuition and political behaviour positively influence SDMP outcomes. Second, it establishes the predominance of the upper echelons perspective; with TMT variables explaining significantly more variance in SDMP characteristics than SD specific characteristics, the external environment, and firm characteristics. A newly developed measure of top management team expertise also demonstrates highly significant direct and indirect effects on the SDMP. Finally, it is evident that SDMP characteristics and contextual variables influence a number of SDMP outcomes, not just overall SD quality, but also implementation success, commitment, and SD speed.

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The purpose of this paper is to delineate a green supply chain (GSC) performance measurement framework using an intra-organisational collaborative decision-making (CDM) approach. A fuzzy analytic network process (ANP)-based green-balanced scorecard (GrBSc) has been used within the CDM approach to assist in arriving at a consistent, accurate and timely data flow across all cross-functional areas of a business. A green causal relationship is established and linked to the fuzzy ANP approach. The causal relationship involves organisational commitment, eco-design, GSC process, social performance and sustainable performance constructs. Sub-constructs and sub-sub-constructs are also identified and linked to the causal relationship to form a network. The fuzzy ANP approach suitably handles the vagueness of the linguistics information of the CDM approach. The CDM approach is implemented in a UK-based carpet-manufacturing firm. The performance measurement approach, in addition to the traditional financial performance and accounting measures, aids in firms decision-making with regard to the overall organisational goals. The implemented approach assists the firm in identifying further requirements of the collaborative data across the supply-cain and information about customers and markets. Overall, the CDM-based GrBSc approach assists managers in deciding if the suppliers performances meet the industry and environment standards with effective human resource. © 2013 Taylor & Francis.

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Bioenergy schemes are multi-faceted and complex by nature, with many available raw material supplies and technical options and a diverse set of stakeholders holding a raft of conflicting opinions. To develop and operate a successful scheme there are many requirements that should be considered and satisfied. This paper provides a review of those academic works attempting to deal with problems arising within the bioenergy sector using multi-criteria decision-making (MCDM) methods. These methods are particularly suitable to bioenergy given its multi-faceted nature but could be equally relevant to other energy conversion technologies. Related articles appearing in the international journals from 2000 to 2010 are gathered and analysed so that the following two questions can be answered. (i) Which methods are the most popular? (ii) Which problems attract the most attention? The review finds that optimisation methods are most popular with methods choosing between few alternatives being used in 44% of reviewed papers and methods choosing between many alternatives being used in 28%. The most popular application area was to technology selection with 27% of reviewed papers followed by policy decisions with 18%. © 2012 Elsevier Ltd.

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Strategic decision making (SDM) in a small business is an informal, highly personalised cognitive process which is emergent in nature. SDM determines the extent to which decision makers generate innovative decision-making options, and is therefore critical in order for small businesses to achieve strategic flexibility to enable strategic adaptation to turbulent environments. By examining SDM in small businesses, this research has the potential to address a major criticism of the extant literature in that it has been pre-occupied with measuring the formality of strategic planning and has neglected the informal, highly personalised and cognitive nature of strategic decision making in a small businesses.

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Intuition is a vitally important concept in strategic decision making research because it enables decision-makers to rapidly detect patterns in dynamic environments in order to cope with the time-pressured, ill-structured and non-routine nature of strategic decision-making. Despite a growing body of conceptual literature emphasising the importance of intuition in strategic decision-making; there has been very little development of theory explaining the contextual factors that cause intuition to be used in the strategic decision-making process. This paper demonstrates that by integrating different contextual variables a clear understanding of the influences on the use of intuition in strategic decision-making can be developed. This article develops an integrative theoretical model together with testable research propositions, which if empirically examined, would make a substantial contribution to knowledge.

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This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of 'knowledge structures' when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests.

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This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries have a less well developed mental model of depression for black compared with white patients. © 2014 The Authors.