DDBA 8560 Week 11 Final Decision Paper Example

A Defensible Choice Whatever Next Year Shows: The Decision Paper Recommending Evening MRI Hours at Brookfield, With Its Clinical Limits Stated First and Its Quality Judged by Reasoning Rather Than Outcome

Student Name

Walden University

DDBA 8560: Seminar in Healthcare Managerial Decision Making

Instructor Name

Month Day, Year

A Defensible Choice Whatever Next Year Shows: The Decision Paper Recommending Evening MRI Hours at Brookfield, With Its Clinical Limits Stated First and Its Quality Judged by Reasoning Rather Than Outcome

Abstract

Brookfield Outpatient Imaging's routine MRI wait is 23 days against a 10-day target and will reach about 31 days in a year if nothing changes. This paper recommends opening the 3 tesla scanner on four weeknight evenings, combined later with no-show reduction if evening fill proves strong. It argues that the choice is defensible on the reasoning available now, and that its quality should be judged by that reasoning rather than by how the next year turns out.

The Problem

The question was what the service manager, acting within the manager's own authority, could do to cut the routine MRI wait most. Protocol durations, credentialing standards, the mobile scanner's lease and radiologists' reading assignments are fixed by others. The problem is nonprogrammed: no routine procedure exists for it, and its causes were not agreed when the work began.

The Evidence

Evidence came from four origins: published research on scheduling and access, Brookfield's own data on demand, no-shows and Saturday sessions, the judgment of technologists and schedulers, and patients' reports that work hours caused missed appointments. Organizational data and patient reports carried the most weight, because published studies describe settings unlike Brookfield's.

Criteria and Screens

Four screens excluded any option that would change protocols, weaken credentialing, leave MRI safety screening unstaffed or exceed the reading contract. Five criteria, weighted by the swing method Keeney and Raiffa (1976) described, judged options that passed: routine wait (0.45), annual incremental cost (0.20), staff burden outside the standard shift (0.15), access for working patients (0.15) and time to start (0.05).

Options

Four options passed the screens. Evening hours scored 67.6, no-show reduction 61.7, extending the mobile scanner lease 60.0 and the current arrangement, projected forward, 40.0. Evening hours led narrowly because they reduce the wait substantially while adding slots outside working hours, which no other option does.

Uncertainty

The lead depends on evening slots filling. If fewer than roughly 62 of every 100 evening slots are used, the reminder-and-overbooking option comes out ahead. Brookfield's Saturday sessions filled 52 percent in their first quarter and 78 percent by their fourth, which suggests evening hours may trail at first and lead later.

Cost

From the department's budget perspective, evening hours add about $274,000 in the first year and $557,000 over two years, including radiologist reading blocks the manager cannot negotiate away. Overhead charged by formula stays out, since adding hours would not alter it. A societal perspective, counting patients' lost work time, would make evening hours look more favorable.

Consent and Implementation

Five parties hold consent, and seven clearances are required, in an order that begins with the radiology group. If each clearance has a 90 percent chance of timely success, all seven succeed on time only about half the time, so the plan holds recruitment until reading terms, safety staffing and budget approval are secured.

Limits

This recommendation leaves several things untouched. It does not shorten scan protocols, which remain the radiology group's decision. It does not change reading assignments or turnaround commitments. It does not alter credentialing standards or safety screening practice. It does not address waits for urgent or inpatient MRI, which follow different rules. And it does not resolve whether patients will use evening slots, which only operation can show.

Recommendation

Brookfield should add the four weeknight sessions on its 3 tesla scanner, implemented in the sequence set out in the plan, with a stopping rule held by the chair of the ambulatory operations committee rather than by the manager who proposed the option, since Staw (1976) showed that people defend choices they made: should evening use run under 55 percent across eight straight weeks once the first quarter has passed, the sessions stop. If fill exceeds the switching value by the second quarter, no-show reduction should be added as a second step.

Judging the Decision

Baron and Hershey (1988) asked people to evaluate decisions described with identical information and reasoning but different outcomes, and found that the same decision was rated better when it turned out well. That outcome bias leads organizations to praise lucky choices and blame sound ones. If evening hours fail because patients do not come, the decision may still have been good, given what could be known when it was made; if they succeed, that success does not by itself prove the reasoning was sound.

The standard this paper proposes is process quality: whether the problem was framed without a hidden remedy, whether evidence was weighed by origin, whether criteria were set before options, whether the main uncertainty was tested, whether costs were counted from a stated perspective and whether a stopping rule was set before results arrived. Nutt (1999) found that decisions in organizations fail more often when decision makers adopt the first idea offered and limit their search, and this process was designed to avoid that pattern.

One objection deserves an answer. A critic could argue that process quality is unfalsifiable: any decision can be called well reasoned after the fact. The answer is that the process here was written down at each step, with scores, switching values and stopping rules recorded before results exist. A reviewer a year from now can check whether the reasoning held, not only whether the outcome was good.

Conclusion

The recommendation follows from the work of the term, and its limits are stated first. Whether evening hours succeed will depend on patients' choices that cannot be known in advance. What can be known now is that the decision was framed, weighed and bounded with care, and that it carries its own rule for being reversed.

References

Baron, J., & Hershey, J. C. (1988). Outcome bias in decision evaluation. Journal of Personality and Social Psychology, 54(4), 569-579. https://doi.org/10.1037/0022-3514.54.4.569

Keeney, R. L., & Raiffa, H. (1976). Decisions with multiple objectives: Preferences and value tradeoffs. Wiley.

Nutt, P. C. (1999). Surprising but true: Half the decisions in organizations fail. Academy of Management Perspectives, 13(4), 75-90. https://doi.org/10.5465/ame.1999.2570556

Staw, B. M. (1976). Knee-deep in the big muddy: A study of escalating commitment to a chosen course of action. Organizational Behavior and Human Performance, 16(1), 27-44. https://doi.org/10.1016/0030-5073(76)90005-2