The weight of organizational factors on heuristics

Abstract

Purpose The purpose of this paper is to investigate the influence of organizational factors on individual decision-making under conditions of uncertainty and time pressure. A method to assess the impact of individual and organizational factors on individual decisions is proposed and experimented in the context of triage decision-making process. Design/methodology/approach The adopted methodology is based on the bias-variance decomposition formula. The method, usually applied to assess the predictive accuracy of heuristics, has been adjusted to discriminate between the impact of organizational and individual factors affecting heuristic processes. To test the methodology, 25 clinical scenarios have been designed and submitted, through simulations, to the triage nurses of two Spanish hospitals. Findings Nurses’ decisions are affected by organizational factors in certain task conditions, such as situations characterized by complete and coherent information. When relevant information is lacking and available information is not coherent, decision-makers base their assessments on their personal experience and gut feeling. Research limitations/implications Discriminating between the influence of organizational factors and individual ones is the starting point for a more in-depth understanding of how organization can guide the decision process. Using simulations of clinical scenarios in field research does not allow for capturing the influence of some contextual factors, such as the nurses’ stress levels, on individual decisions. This issue will be addressed in further research. Practical implications Bias and variance are useful measurements for detecting process improvement actions. A bias prevalence requires a re-design of organizational settings, whereas training would be preferred when variance prevails. Originality/value The main contribution of this work concerns the novel interpretation of bias and variance concepts to assess organizational factors’ influence on heuristic decision-making processes, taking into account the level of complexity of decision-related tasks.

Under Pressure: Time Management, Self-Leadership, and the Nurse Manager

“…For future study to further support the Time Pressure Mitigation Model, researchers could test whether time management and self-leadership practices improve psychosocial care in units with similar time pressure as emergency departments face. Given the literature on triage practices and decision making though (Mackway-Jones et al 1997;Bucknall 1999, 2001;Cone and Murray 2002;Barberà-Mariné et al 2019), triage decisions in an emergency department may be a good starting point for future empirical research. Yet, the model in this paper is not limited to nurse managers.…”

How to improve the Triage: A dashboard to assess the quality of nurses’ decision-making

“…Existing research on factors affecting nurses' decisionmaking in Triage highlights contextual factors and individual nurse's experience, knowledge, and intuition can cause the variation of nurses' decision-making in assessing patient urgency [36][37][38] and the weight of organizational and individual factors can vary according to task complexity. 18 In addition, given the characteristics of Triage process, the quality of decisions depends also by the capacity of nurses to assign the same priority code to patients with similar urgency. Aside from the wrong priority code, the nurses can exhibit the capacity to discriminate patients according to the different urgency or, on the contrary, put together patients even if they exhibit different clinical conditions.…”

“…15,16 The disparity also depends on nurses' interpretation process of patient's clinical conditions based on few cues, short time, and influenced by experience. 17 Previous research focused on analyzing the different intensity of organizational and individual factors on nurses' dynamic decision-making 18 and on the assessment of factors that affects the nurses' decision. 19 This paper aims at designing performance indexes for assessing the quality of nurses' decision and detecting the prevalence of shared behaviors among nurses in specific situations.…”

The lifecycle of heuristics as managerial proverbs

“…Guercini et al (2015) found that sharing “is mostly in the form of an informal exchange of opinions among close friendly colleagues.” Barberà-Mariné et al (2019, p. 2901) study triage heuristics followed by nurses and show that, in particular, training “acts as a medium to share informal rules among individuals.” Bingham et al (2019) document an informal process, as “knowledge sharing happened daily through informal conversations between managers” (p. 139), but emphasize the role of “extensive communication within and across multiple hierarchical levels” (p. 121). It should also be noted that collectively generated heuristics are born shared.…”

“…Soft adoption occurs through informal communication and heuristics are adopted under the expert authority of the manager who shares them. As an example, during training, “experienced nurses can show beginners how to apply triage protocols for priority levels' assignment” (Barberà-Mariné et al , 2019, p. 2901). The application of a soft adopted heuristic is optional and the adopter is more likely to question, adapt, refine, change or abandon the heuristic.…”