Decision Making in Today's Environment

By Rose O. Sherman, EdD, RN, NEA-BC

How quickly do you make decisions in your healthcare environment? In our fast-paced world, it is a question that all of us should be asking. A colleague recently told me that their new CNO seemed frustrated with the convoluted decision-making process in their entrenched academic medical center, where everything takes months. She noted that everyone here has gotten used to this, but through fresh eyes, it does seem absurd, and there is a lack of authentic accountability to get things done. One of two things will likely happen with this leader – she will quietly leave or succumb to the process.

Unsurprisingly, our younger staff are not participating in shared governance activities. These young Generation Z or Millennial nurses can order something from Amazon and see it delivered within days or even hours. Yet decision-making in healthcare organizations can take a long time winding their way through multiple committees that rob leaders of the time to spend with staff. I have reviewed decision flow charts in organizations that rival those done for genome sequencing.

Then too often, the loop on a decision is never closed. Baby boomers and Generation X tolerated attending meetings where you might see the same agenda item for discussion month after month, but younger staff will not. As one young nurse recently told me – why should I waste my time when nothing happens with our input. He makes a good point.

The reality of the slowness of decision-making in traditional healthcare environments can be juxtaposed against Amazon’s decision last week to buy One Medical, a national primary care provider. When discussed on a recent financial podcast, a commentator noted that he expected that Amazon would now quickly upscale into healthcare and leave traditional healthcare providers in a cloud of dust. Traditional healthcare systems, he noted, are too slow to move in response to market changes, and it will be their Achilles heel.

I think this commentator could be right. Decision-making processes in many health systems should be reconsidered to identify and communicate who is responsible for making which decisions, what decisions must be made, and how the decision-making process should work. I don’t think we will fully engage our younger staff until they see a more transparent decision-making process and shorter turnaround times.

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