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Introduction:

QCHS that is Queenly community Health Service provides the health services in the regional area where it is located. Clients who require the counselling services referred by the healthcare practitioners and self refer to the services of QCHS .Currently QCHS works on the model where client come for the appointment of counselling and then the counselling practitioner assess the needs of clients and refer the client either for the general counselling process or for the counselling by the specialist. Currently the waiting time for client in QCHS is 3 months that is increasing continuously from last 12 months. The CPI that is cost price increase each year in QCHS therefore QCHS require to make some strategic decisions related to the model of care operations and care delivery.

In this article we learn about the strategic decisions require to take by the management to enhance the healthcare policies , role of power and politics in healthcare organizations , persons involved in strategic decision related to healthcare and the processes followed for making decisions regarding healthcare organizations. A decision strategy involves building three types of strategies. These are corporate strategy, competitive strategy and operating strategy (Chilingerian).

Competitive strategy determines the process followed by an organization to make the space in the market by satisfaction of the patients and customers. More satisfied customer result in more market value. This involves meeting the expectations of clinical, nonclinical and the organization.

Corporate strategy determines the strategy by the healthcare organization regarding the management of clinical services and the populations. It includes management of medical suppliers, devices, clinical standards, name branding, skills transferring, sharing of activities, diversification, alliances, partnerships, mergers, and so on.

Operation Strategy is the creation of standards, policies, technologies, human resource practices, people and resources to enhance the organization business and services on day to day basis.

Decision Making Process

Strategic decision making involve six important phases these are:

Different techniques are used for the purpose of strategic decision making these techniques are PEST analysis (Political, economic, social and Technological), SWOT analysis (Strength, weaknesses, opportunities and threats).Any of these techniques can be used for defining the business direction. Strategic decision provides the map of company direction like where the company is moving and the direction how to achieve the target by moving onto the direction specified by the map. It guides all decision also regarding the benefit of the company including the staff, technology, capital and resources. Strategic decision is the future planning of the organization. Strategic decisions are taken by considering the following points: What to do in future, which will get benefit by the strategic planning, How to excel the process. Strategic planning provides the organization to see the future and change the operations accordingly to achieve the bigger objectives. This future picture includes the success factors, goals and objectives, regulatory and competitive pressures and changes done accordingly, current situations, core competencies, organizational culture, department alignment, functional business models and so on. The strategy is created for moving from the current state towards the future or desired state.

Basically any organization develop the strategic decisions for the next 3 to 5 years to enhance the business and to meet the future perspectives. Generally seven steps are define for making the strategic decisions these are as follows (Drewniak, 2010):

Determine the vision and mission

Before starting any task or the business the organization require to define the goals ,objectives ,visions and mission that need to reviewed periodically as change is the constant thing and according to the change sometimes modifications required in the objectives and also according to the demand these factors may change. Mission defines what organization want to achieve and vision defines the strategy require to achieve the target.

Analysis

Analysis defined as the detailed analysis about anything. Here the close analysis of business and operations required. SWOT analysis is one of the common forms of analysis this analyze the strengths, weaknesses, opportunities and threats within an organization. Analysis involves the followings aspects that are image of company. Culture adopted in the company, operational efficiency, market awareness, operational capacity, key staff and overall personnel, financial resources, access to resources.

Development and selection of strategic options

For any strategy development first require identifying the inputs then on the basis of inputs all necessary strategies are building up. After the strategies identification ground rules are identified that contribute tom the decision-making process. These rules are organization merging with other business to expand the business and outsourcing of certain organizational functions. Example if there is goal of increasing the revenue of the organization in physical sector by 10% then to identify the resources in the organization is enough resources are present to corporate in the revenue gain and therefore require to formulate the strategies to achieve this goal.

Execution plan

After the decision made on the options require to execute the strategy. It is require to identify the scope of the strategy that is when and where the particular strategy has to execute. For the successful implementation of any strategy involvement of organizational owner required that includes the involvement of all the staff of organization as well as the executive sponsorship. After that all levels of department in the organization should be well aware of the plan.

Determination of strategic objectives

Different models are applied for the determination of strategy effect on to the organization. These models are applied on each and every strategy. This step also validates the timelines specified or the key measures. This is the testing phase of the strategy once the strategy pass the test the strategic plan is formulated that plan should be SMART plan i.e. specific, measurable, achievable, realistic, and time bound.

Determination of budget and resource allocation

Once all the options of strategy are determine and execution plan of the strategy is defined it is require to build the budget or to arrange the necessary funds for the successful implementation of strategy and to achieve the targeted goals and outcomes. If proper budget and resources are not defined then it ultimately results into the failed strategic plans.

Review

This is one of the important aspects of successful strategic plan review; it is the testing of strategy once builds. Different issues, deviations, challenges, obstacles are also observed while executing strategy. These obstacles sometimes change the direction of execution of the strategy. Therefore the strategy review process play very important role because it determine the overall progress of the strategy, effect of strategy execution on the organization. Determination of the resources involved in this process is very crucial because wrong resources led to the wrong decisions.

Bias in Healthcare Decision making

Bias in healthcare organization observed known as implicit bias that refers to the attitudes or the stereotypes that affects the individual actions, decisions and the understandings in an unconscious manner. These implicit biases encompasses both unfavourable and favourable assessments that are initiated involuntarily without awareness and intentional control of an individual.

According to the research or the hypothesis formulated one’s social behaviour not under our conscious control. The concept of implicit bias indicates that our social behaviour is driven by the stereotypes learnt that automatically operated and hence unconsciously when interacts with other people in social group. Implicit biases test generally measures the automatic and unconscious biases. If one want to examine about the biases then has to take the important step for bias examination by getting knowledge about the own prejudice and the stereotypes in society. The one’s ability to differentiate between the friend and enemy in the humans is defined as one’s ability to categorize the people is considered as the good quality of the human being. Categorization of people play important part in one’s social life it gives basis to the living of individual life. This categorization gives rise to the prejudice, discrimination and stereotypes. Stereotypes and prejudice resist the changes even the evidences also support them. People still possess some hidden prejudices or stereotypes that have negative impact onto the society like teachers in school make to sit white colour students to different classrooms and other colour to different classroom that results into different level of education to both colour students. In many healthcare organizations these implicit biased are observed like in obesity conference the obese people are addressed with negative stereotypes like worthless, lazy, stupid and bad people. Implicit gender bias also observed among the physicians like women are three times less capable than the men for knee arthroplasty.One of the major cause behind this differentiation and biasing is that men are considered as more active in order to participate in the rigorous activity or strenuous activity. Due to this implicit bias or the difference in the treatment and clinical decision making that is not intentional but results in the failures of interpersonal care, patient cantered care, trust between doctor and patient, communication, doctor’s knowledge about the values and beliefs. Subconscious bias is the result of the physician communication either in form of physician body language or verbal communication of physician. Implicit bias proves to be dangerous in health and healthcare organizations because the physician are themselves unaware about the discrimination they form among the patients. Lack of trust and communication problems are some of the reasons of wrong outcomes of the healthcare. Racism interacts with the cognitive bias and affects the clinician’s decisions, clinician’s behaviour, patient’s decisions and patient’s behaviour. There are several examples that determine how implicit bias affects the healthcare that are as follows (Implicit bias in health care , 2016):

  1. Women having black colour are likely to die from the breast cancer.
  2. Non white patients get lesser renal transplants and cardiovascular interventions.
  3. Black patients are less prescribed with the pain medications.
  4. Non white patients are less considers to get the radiation therapy and chemotherapy.

Partnership: Clinicians require building the relation of partnership with the patient because the good partner understands all the needs of patient, consider one team and move towards the common goal along with the patient.

Emotional Regulation skills: clinicians those have emotional regulation skills build the emotional relationship with the parents and experience the positive emotions and less likely to treat their patients on the basis of their individual attributes.

Perspective taking: Perspective taking reduces the bias and unconscious prejudices and stereotypes. Empathy of physician affects the emotional distress, health outcomes, patient satisfaction, adherence and self efficacy perceptions of control.

Power and Politics

Power is defined as influencing capacity of an individual to convince the others or the individual. Power can be associated with teams, groups, individuals, departments, organizations and to the countries. Example one team is said to be powerful than the other team if that team influence all the members of the team towards the same goal and about the team tactics and also influence the team members of other team.

Different types of power exist in decision making depending on the influencing capacity .Reward power is the power that influences the behaviour o other by giving rewards to their desirable behaviour. Example the manager in a company give reward power to employees by giving them promotions, praises, money and so on. Coercive power is the individual’s ability to influence the other behaviour by giving punishment to their undesirable behaviour. Legitimate behaviour refers to the manager’s capability in the organization to influence the subordinates in the organization by means of power of its formal or decent position in an organization. Expert power is the capability of an individual to influence the behaviour of other by means of intelligence, knowledge, competencies; talents.Referent power is the capability of an individual to influence the behaviour of other by means of being admired, respected, and liked (SZOC).

On the other hand politics in an organization is defined as the act of influencing the behaviour of other in order to take care of their own interests, to meet their own goals, to meet their own need or to fulfil their own needs. This political behaviour is the result of getting something on the stack of others or by compromising others requirements or without thinking about an organization. Organizational politics is the politics carried out in a group to achieve the required outcomes when uncertainty or the disagreement exists about certain concepts. Sometimes the power used in healthcare organizations undermine the process of decision making and also the future operations. Both power and political behaviour in an organization lead to the implementation of important decision related to the growth of organization. Inefficiencies caused due to this political activity can be reduced by evenly dividing the organizational rewards, by reducing the heterogeneity and differentiation among the members of organization and the units, by increasing levels of slack resources.

Persons in Decision making

For any strategic decision making process the most important is to determine the person’s involvement in the strategic decision .The common factor behind all these persons that they should be all trustworthy and ready for the growth of organization. The key stakeholders involve the service users and their advocates, healthcare delivery organizations, community leaders, political leaders, regulatory bodies, representative’s bodies who represents the workers in healthcare organization. Senior management can also be involve in the process of making strategic decision for an organization these are involve for enhancing the quality within the health ,ministry. Different leaders who formulate the policies are also involved that determine how the responsibilities are assigned to achieve the decision. From these stakeholder groups one group is formed that is responsible known as board of members or the steering group this group considered important part of the organization and involve in all the processes or decisions related to the organization. The main objective of this steering group is to provide the advice to the decision makers and maintain the communication with all the parties involved in the decision. All the decision in the organizations taken by considering these board of members they all form the foundation of decision making process. (Quality of Care A process for making strategic choices in health systems, 2006)

Conclusion

In this assignment discussed bout the different types of strategies used in making the decision about the organization in order to achieve the success. Power and politics play an important role while deciding about an organization. There are different kinds of biases exist in the healthcare organization that directly or indirectly affects the strategic decision making process. For better growth a strategic decision should be taken by keeping all the aspects into mind. Strategic decision in right direction supports the growth of organization. Strong relationship between the doctor and patient also enhances the decision making process .If there will be good relation of patient and doctor then the chances of stereotypes, prejudices and biases will be negligible. The common analysis required for healthcare is SWOT that not only used in healthcare organizations but also used in several organizations commonly.

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