Decision Making

Once you’ve generated a set of ideas (the OPEN part of the decision-making process), it is time to begin to narrow down the list. You enter the NARROW and CLOSE parts of the process.

Reducing the Number of Ideas (Multivoting)

Let’s say that your brainstorming session has identified twenty different countermeasures that could be applied to the root causes of a problem. Rather than discuss each one, in turn, the Multivoting method can be used to reduce the list to a more manageable size. If the Multivoting process leaves you with about 10 ideas, then you can use Rank Ordering to further reduce the list (see next page).

Multivoting Steps

1. Clarify the purpose of the Multivoting activity.

2. Decide the criteria to be applied to the voting (most cost-beneficial, most probable root causes).

3. Decide how many votes each member gets (usually 20 - 25% of the total number of ideas, for example, if you brainstormed a list of 25 ideas, each member would get 5 or 6 votes.).

4. Each member votes for the ideas that best fit the criteria.

5. Votes are recorded - the ideas that get most votes are circled and pursued further. • Voting may occur again, if a large list still remains, or Rank Ordering can be used.

Reducing the Number of Ideas (Rank Ordering)

Rank Ordering is often used to reduce a list of 10 or fewer ideas. Rank Ordering can be used by itself, or following a Multivoting session.

Rank Ordering can be used to reduce the list to three to five ideas that will be pursued further in detail through a consensus process.

Rank Ordering Steps

1. Clarify the purpose of the Rank Ordering activity.

2. Decide the criteria to be applied to the ranking (most cost-beneficial, most probable root causes). 3. Label each idea with a letter.

4. Each member ranks the ideas from “best fit” (rank of 1) to “least fit” (rank of “n,” where n is the total number of ideas). All ideas on the list are ranked.

5. The rankings are recorded from each team member and summed by idea - the ideas that get fewest votes are circled and pursued further.

Reaching Agreement on One Idea (Consensus)

Deciding on the best Countermeasure from several alternatives can be difficult for a group. Consensus is a method used to obtain support for an idea from the members of the group and their agreement to help carry it out, if it requires that action be taken.

Consensus is sometimes hard to achieve and takes time (more than that needed by one person to make a decision or for the group to vote on a decision), but it is worthwhile, since the agreement is generally considered to be a WIN-WIN for everybody in the group.

Consensus Process

1. Clarify what is to be decided and why consensus is important for the decision.

2. Members prepare their own positions, using the facts and data available (this is usually done prior to a consensus meeting).

3. Members share their positions (and the supporting facts and data), with the group actively listening and note taking. 4. General discussion then follows, until agreement is reached.

• From time-to-time, stop, seek out, and record the issues that the group agrees upon, also record the points

of difference. Further discussion, then, can focus on the differences.

• Avoid "giving-in," just to save time. Remember, the group will have to live with the decision.

• A facilitator, detached from the emotions of the decision, can help support the group trying to reach

Team Situations

In which of these following situations do you think a team should be formed to improve quality? If a team is needed, what

type should it be? If you don’t think a team is needed, how could or should the situation be addressed?

• A railroad has been experiencing water leaks on its locomotives’ diesel engines. There are about 1000 locomotives in the railroad’s fleet. The engineer’s failure report includes where the leak is observed, but not why it occurred.

• An architectural firm has been receiving complaints from customers that “they are not responsive” to the customers’ needs. The firm has four design groups, each acting as a design team for projects.

• A small manufacturing company wishes to improve its employee safety record. The company president wants to form a team, but the Safety Officer tells him that he can solve the problem with a new training program for proper lifting techniques.

• An unacceptably high defect rate of integrated circuits has plagued a small electronics firm for the last few weeks. The reliability engineer is working on a test plan, the design engineers are preparing changes to the IC design and manufacturing is changing their “clean room” procedures.

• A hospital’s case managers have identified one physician as being “high” on both patient Length of Stay and Cost per Case for a certain diagnosis.

• Nurse managers have been complaining to the chief nurse executive about delays in receiving laboratory “stat” specimen reports. The lab director says the orders are only being sent to the lab twice a shift.

• A physician called plant maintenance about dust blowing into one of her examining rooms from an air conditioning vent. The problem has existed for three days now.

• Two employees on the evening shift at a plastics plant are chronically late. The other shift members are angry at having to carry their “load” when they are late.

• A manufacturer of ceramics for hobbyists found that their product sales were declining. Projections indicated that the manufacturer would suffer a $10 million loss if the current trend continues.

Team Appropriateness

Comment on the following “team” situations described below. Was the use of a team appropriate? What issues do you see that may lead (or did lead) to the success or failure of these efforts?

• A manager of an engineering division told a group of engineers to investigate computerizing a certain reference document. He told them to make sure and “prove” that the computerization was necessary so the necessary budget approvals could be obtained.

• A new chief engineer of a nuclear engineering department identified a “laundry list” of engineering practice problems. The chief assigned a group of engineering managers to form a team, prioritize the problems and start working on fixing them.

• The senior managers of a bank had just been through quality improvement training and were excited to begin improvement efforts. They assigned 10 projects to branch office and “back office” staff. The branch and “back” office managers were not consulted before these assignments were made.

• Factory management assigned a group of maintenance workers, purchasing and receiving personnel to work on reducing the time to obtain “non-stocked” spare parts for plant equipment. Three weeks after the team began, they realized a new parts inventory database was being installed in the next month.

• A manager of a nursing unit assigned a group of nurses and nurse assistants to improve morale and communication in the unit. She thought that would help reduce turnover in the unit, which was running at 40% annually.

• A president of a small consulting firm had decided to expand the company office space. He assembled a team of clerical support staff to determine the best strategy to “handle the increased need for product inventory space.” The team came back to him with the recommendation to let the consultants “telecommute” from their homes and use their office space for the product inventory. The president disagreed and proceeded to lease additional space.

• Nurses and quality assurance/utilization review staff were assigned to develop “Clinical Pathways,” standardized methods of patient care. After reviewing the first five Pathways developed, the physicians told the chief nurse executive that the “Pathways were worthless, they weren’t going to practice ‘cookbook’ medicine.”

• The corporate quality improvement department told power plant managers that they needed to have a certain number of teams “running” by years end. Over 80% of plant personnel work shifts that only allow for short breaks and lunch. By the end of the year, the only “functioning” teams were composed of administrative clerks.

• A new car dealer assigned members of his sales force to develop “best practices” for selling cars to customers. After three months of meeting, the team had not made any progress. The sales personnel are paid based on commission. • A hospital’s administration has decided to decentralize the respiratory therapy function to the patient care units. The

leader of the team is the current department director. The patient care unit managers don’t want the additional responsibility of respiratory therapy and the department director is reluctant to give up his “power.”

Exercise - Project Planning

1. Review your project charter.

2. Divide the project into phases if appropriate. (You may decide that there is only one phase)

3. Using brainstorming and the work breakdown structure identify the tasks for completing part of the project. 4. Use the network diagram to sequence and link the tasks.

Scoping a Project

List a set of criteria you’d employ to determine if a project’s scope is too large:

Given the following scope, how could you multi-phase it?

Party Brainstorm

With a small group, Brainstorm a list of parties that you might like to throw (Valentine’s Day, Clambake, Birthday, Toga, etc.). If the list has more than 10 ideas, then employ Multivoting to narrow the list. If necessary, then Rank Order the remaining list and reach Consensus on the one you will plan.

Idea Generation and Decision Making

Here are some simple “decisions” that can be reached with the help of the Idea Generating and Group Decision-Making methods. Use these to practice before getting into a “real” situation. Don’t forget to set criteria before you employ the decision-making tools. (Note: these can be conducted as meetings, using the 7 step meeting process):

• Where to have the department picnic.

• What to do for the pediatric cancer patients for Christmas. • What to do for the nursing home patients for Christmas. • What two-mile stretch of road your organization will “adopt.”

• The “best” (you define “best”) sitcom of all time (corollary - which episode is “best.”). • Why women love shopping (top 3 reasons) - except for tools and hardware.

• Why men hate shopping (top 3 reasons) - except for tools and hardware. • Which are the top ten movies of all time.

• Who are the top ten baseball players of all time.

• Who has the “worse” (you define “worse”) TV talk show.

• Who would make the “best” (you define “best”) next President. • What to do for your secretary on Secretary’s Day.

• What to do for your “boss” on Bosses’ Day.

Team Dynamics

Comment on the “dynamics” occurring in these team situations. What would you do to address the situation?

• Six members of a team are working on an improvement project. One of the members, although a solid contributor, is generally negative about the project, and is convinced that management will not adopt the team’s recommendations. The other members of the team have taken to avoiding him, except one who vigorously “counterattacks” him every possible chance. You are the team leader.

• A team is working to reduce supply expenses in the surgical department. The team leader often comes to the meetings late and frequently has to develop the agenda in the first few minutes of the meeting. Team members have begun to avoid coming to meetings. You are a team member.

• A team assigned to design a new engineering scheduling process has a number of very strong personalities. One member frequently verbally attacks other members, another “acts out” and often leaves the meeting for a few minutes or wanders around the meeting room. One member heads the current scheduling department and is not happy about having others “meddle in her process.” Although the team has designed a new process, planning to implement the changes is proceeding slowly. You are a team member.

• A team of assistants has been formed and asked to select their own improvement project. The team leader is a young, shy male. One of the team members is an older, domineering female who thinks this “quality stuff” doesn’t apply to her and that she doesn’t need to be on the team. You are the young assistant’s Black Belt and he has come to you for advice.

• A development specialist has been assigned to lead a team that will design a quality improvement video on control charts. The company president has assigned members to the team, two of whom are consultants who are always joking around. Their language is sometimes “borderline crude” and they often make disparaging comments about the project. However, they have been the main two contributors to the ideas and work of the project. You are the team leader.

• A fossil power plant manager is assigned to lead a team of the company’s “best” quality improvement people. Their assignment is to help the company’s poorly performing nuclear plant “turn-around.” The team members are all strong personalities, frequently disagreeing with the team leader. The team leader is good at developing a “vision” of where he wants to go, but not so good at the details. A small subgroup takes on the role of “translators,” developing coherent, practical plans to implement the leader’s vision.

• You have been brought in as the new Chief Operating Officer of a large, metropolitan hospital. You assess that each of the Vice Presidents has been running their own operations, with little communication between the departments. In fact, department directors have been told not to talk with those directors “belonging” to other VPs. All questions or problems have to come up through the “chain of command.”