Comparing Two Rational Decision-making Methods in the Process of Resignation Decision

Comparing Two Rational Decision-making Methods in the Process of Resignation Decision Chih-Ming Luo, Assistant Professor, Hsing Kuo University of Management ABSTRACT There is over 15 percent resignation per year in Taiwan resulted in crises of nursing manpower. The purpose of this study is to assists intuitional decision with system of rational thinking, structural practical experiences and tacit knowledge, and overcome the weakness of intuitional decision for lacking scientific decision process. This study is to compare two rational decision-making methods, the Even Swaps method and the Kepner-Tregoe (KT) method, applied in nursing for manpower management. This study used action research methodology to discover an agenda of change in aspects of manpower practice in nursing. This study selected twelve nurses. The nurses required at least 5 years of experience in nursing and must have participated in taking care of SARS patients. Through in-depth interviews, this study analyzed the participants by using rational decision-making method during the period from September 2004 to April 2006. This study found that any drawbacks to intuitive decisions can be overcome by using rational decision-making method. The Even Swaps method will be more complete with the use of the KT method. In addition, it provides intuitive decision-making using a systematic and structural decision-making process. No research has yet compared the Even Swaps of rational decision-making method and KT methods for manpower management in a nursing field. Finding an appropriate decision-making method to assist employee effectively manage their tacit knowledge of intuition has become increasingly important in today s high resignation environment. These two rational decision-making based methods allow a user accurately to improve decision-making quality apply structural practical experiences and tacit knowledge. INTRODUCTION Literature reviews indicated that intuition appears to be used by members of every level of staff from student to expert. However, the disadvantage of intuitive decision processes can not be presented as a systematic and structural approach. There is a need for future study to explore rational decision-making processes in order to manage tacit knowledge of intuition. Thus, research on how to systematically and structurally enhance the process of intuitive decisions is a very important issue. According to the National Health Insurance System, the working environment for nursing staff has become difficult with a reduction in payroll and an increase in workload (Tzeng, 2002). For example, a nurse in Taiwan takes care of an average of 12 patients, whereas in America, a nurse may take care of an average of 3.4 patients (Adams & Bond, 2000). As a result, a resignation crisis arose within the nursing staffs. LITERATURE REVIEW Theorists of decision-making in nursing can be seen to take four different approaches:pragmatists, systematisers, diagnosticians, and intuition (Davies & Fox-Young, 2002). But there is not yet a research The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008 21

comparing Even Swaps (ES) and KT and applying them to decision making in manpower field (Hallett, et al., 2000). The purpose of this study is to assists intuitional decision with system of rational thinking, structural practical experiences and tacit knowledge, and overcome the weakness of intuitional decision for lacking scientific decision process. Theorists of decision-making in nursing take various approaches to their work (Hallett, et al., 2000). 'Pragmatists' focus on the sources of information used in making decisions (Lamond, et al., 1996). 'Systematisers' focus on the decision-making process as a structured, schematic entity and who often draw on cognitive psychology (Bryans and McIntosh, 1996). 'Diagnosticians' see clinical decision-making as a process of 'diagnostic reasoning' (Acton, et al., 1997). Moreover, intuition is a process of problem solving often described in such terms as 'gut feeling', 'pattern recognition', 'know how' and 'tacit knowledge' (Easen and Wilcockson, 1996). Cioffi (1997) further argues that claims to the use of intuition can still make nurses feel stigmatized because of the association of this term with lack of scientific objectivity. Certain studies have shown that clinical health care decisions are deeply affected by intuition (King and Appleton, 1997). However, Easen and Wilcockson (1996) believed that decision-making could not be separated into rational decision-making and intuitive decision-making without concern. In addition, intuition may be considered as an irrational process with a rational basis. Therefore, the purpose of this study is to assists intuitional decision with system of rational thinking, structural practical experiences and tacit knowledge, and overcome the weakness of intuitional decision for lacking scientific decision process. METHODS Methodology Action research is a critical social activity, relying on participation and collaborative working to generate change and new knowledge. One of the benefits of such an approach is the emphasis on using experiential knowledge to inform an agenda of change in aspects of practice, and this is particularly valuable when practitioners are marginalized in some manner (Winter and Munn-Giddings, 2005). Therefore, this study belongs to the category of action research, according to the literature s definition. Data Collection This study uses two methods to collect data, literature review and in-depth interview. These databases include BSP/EBSCO host, and Medline. The period covered was from the early 1990s to 2005. Johnson (2002) believes that in-depth interviewing means seeking deep information and understanding. Based on Bobbie s (1998) and Johnson s (2002) points of view, a successful in-depth interview requires the researcher to have a clear understanding of the research object and to understand the interview questions and the information that the study intents to gain. Research Framework There are four steps in the research framework: 1. Topic research, 2. Data collection method, 3. Research method, 4. Results. The details of each research step will be discussed in the coming section. In methodology, the cycle of Planning- Action- Evaluation- Reflect represents the action research spiral. As shown in Figure 1. 22 The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008

Reflect (revisit the spiral) Action Research Question Resignation in nursing Data collection Literature review In-depth interview Action Research Spiral 1.1990~2005 2. Database: EBSCO host, Medline 12 experts nurses Methodology Planning Tools Participants 1. Criteria for selecting the research participants. In-depth interview At least 5 years working experience 2. Methods familiarity 3. Training classes one-to-one training one-to-one training The average training time was two hours To ensure no difficulty in applying ES and KT methods 4. Post test interview In-depth interview In order to further understand their reflections on the decision-making process Evaluation Result Figure 1: The Research Framework Methods Familiarity in the Research Participants The twelve nursing staffs were required to study the ES and KT methods. The average training time was two hours, with the classes being taught by the researchers on a one-to-one training to ensure no difficulty in applying ES and KT methods. After the twelve nurses accepted the training of ES and KT methods, they were tested with their decision-making ability using vocation selection as the matter to be decided, following the influence of the SARS event. The time required in the decision-making process was also recorded. Post Test Interviews After the test, all participants were subjected to in-depth interviews in order to further understand their reflections on the decision-making process. This study wants to realize the influence of the SARS The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008 23

event on the vocation-selection process targeted twelve participants. The study employed the ES and KT methods in the same decision-making question. It was found that using the two different method, eleven participants resulted in the same decision being made, while the other one produced different results. CASE ILLUSTRATION A nurse was chosen to case illustration for the use of the ES and KT methods. A decision was made regarding to the change of career in this case. Have, Jobs A, B, C, and D represent 'continue in nursing', 'become a hospital administrator', 'start a new business ', and 'employed in the private sector', respectively. Even Swaps Rational Decision-making First, relevant information on objectives and alternatives is presented and these are ordered by causal relationship. For example, in the objective of 'Growth', after comparison, Job A 'Middle', Job B 'Low', Jobs C and D 'High' as shown in Table 1. Table 1: Consequences Table Alternatives Job A (Continue in nursing) Job B (Become a Hospital administrator) Job C (Start a new business) Annual salary ($) 20,000 12,000 30,000 12,800 Working hours 44 44 60 40 Flexibility Low Low Low Middle Nursing staff Business skills development Computing, Word processing Business operations, Vision, Communication, Administration Job D (Employed in the private sector) Computing, Word processing, Growth Middle Low High High Annual vacation 15 7 0 7 Morale Low Low High Middle Work Safety Low Middle Low High Stress High Low High Middle Job Satisfaction High Low High Middle Mission High Low Low Low Ranking all of the alternatives, for example, in the objective of 'Growth', after comparison, Jobs C and D 'High' ranks the first, Job A 'Middle' ranks the third, Job B 'Low' ranks the fourth, as indicated in Table 2. A comparison of the numbers of lagging indicators, ignoring the alternative with the greatest number of lagging indicators, yields the following: Job A has one ranking of 4; Job B has four rankings of 4; Job C has two rankings of 4 and Job D has no ranking of 4. Therefore, Job B will be ignored. 24 The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008

Table 2: Ranking Table Alternatives Job A Job B Job C Job D (be eliminated) Annual salary ($) 2 4 1 3 Working hours 2(tie) 2(tie) 4 1 Flexibility 2(tie) 2(tie) 2(tie) 1 Business skills development 4 2(tie) 1 2(tie) Growth 3 4 1(tie) 1(tie) Annual vacation 1 2(tie) 4 2(tie) Morale 3 4 1 2 Work Safety 3(tie) 2 3(tie) 1 Stress 3(tie) 1 3(tie) 2 Job Satisfaction 1(tie) 4 1(tie) 3 Mission 1 3(tie) 2 3(tie) Making ES, transforming certain objectives into the same units of measurement, and ignoring the objectives with the same grade, allows some objectives to be ignored. For example, converting the 'Annual salary' of Jobs A and D into 30,000, the 'Working hours' of Jobs A and D are converted into 66 and 94, allows the objective 'Annual salary' be ignored. In the objective of 'Business skills development', promoting 'Nursing staff' to 'Nursing supervisor' will also raise the 'Growth' of Job A from Middle to High and increases 'Morale' from Low to High, as shown in Table 3. Table 3: Performing the first Even Swaps pass Alternatives Job A Job C Job D Annual salary ($) 20,000 30,000 30,000 12,800 30,000 Working hours 44 66 60 40 94 Flexibility Low Low Middle Business skills Computing, word development processing, Nursing staff Nursing supervisor Business operation, Vision, Communication, Administration Growth Middle High High High Annual vacation 15 0 7 Morale Low high High Middle Low Work Safety Low Low High Stress High High Middle Job Satisfaction High High Middle Mission High Low Low Rank all the contents of alternatives and compare the number of lagging indicators for the three alternatives; then ignore the alternative with the maximum number of lagging indicators. For example, Job A has no ranking of 3; Job C has one ranking of 3; Job D has four rankings of 3; therefore, the alternative of Job D is ignored, as shown in Table 4. The 'Alternatives' are narrowed to Jobs A and C, and then '' of the same grade are ignored. The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008 25

Table 4: Performing the second Even Swaps pass Alternatives Job A Job C Job D (be eliminated) Working hours 2 1 3 Flexibility 2(tie) 2(tie) 1 Business skills development 1(tie) 1(tie) 3 Annual vacation 1 3 2 Morale 1(tie) 1(tie) 3 Work Safety 2(tie) 2(tie) 1 Stress 2(tie) 2(tie) 1 Job Satisfaction 1(tie) 1(tie) 3 Mission 1 2 2 An analysis of the case using ES leaves three objectives and two alternatives for decision-making. The number of lagging indicators of Job C exceeds those of Job A by one. Therefore, the outcome of this decision-making process is Job A as shown in Table 5. KT is used as follows to analyze the same question. Table 5: Performing the final Even Swaps pass Alternatives Job A Job C (be eliminated) Working hours 2 1 Annual vacation 1 2 Mission 1 2 KT Rational Decision-Making First, identify the pros and cons of all the alternatives to clarify the preliminary question as shown in Table 6. Then implement the following steps: decision analysis, decision assertion, decision objective, weighting alternatives, and potential problem analysis. Table 6: Pros and Cons for Alternatives Alternatives Pros Cons 1 Continue in nursing Familiar with the working environment and profession, high challenge in the work. High stress, low work safety. 2 Become a hospital Lower stress. Low salary. administrator 3 Start a new business (Taiwan Challenge and growth prospect Long working hours, high Salt Industrial Corp. Affiliate) in work, high salary. stress, and high risk. 4 Employed in the private High work safety. Different working profession, sector lower salary. 26 The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008

Must- and Essential The purpose of decision assertion is to provide the focus of the decision and determine the range of the decision. The objectives are the important items for the decision and the distinct details of the decision. There are two kinds of objectives: 'must-' and 'essential'. 'Must -objectives' consist the conditions necessary for successful decision-making. All the objectives, besides the must-objectives, are 'essential objectives'. In this case, the decision assertion involves selecting the optimal working environment to meet the requirements of safety and growth. The must-objectives are judged as Yes-or-No. Any item of an alternative that fails to meet the requirements of must-objectives of decision-maker will be deleted directly. The must-objectives in this case are as follows: 1. Meeting safety requirements; 2. Meeting growth requirements. Jobs A and B are deleted because they fail to meet the must-objectives as shown in Table 7. Table 7: Considering the Alternatives using Must-objectives Must- Safety Growth Job A Accidents such as needle stick Familiarity with nursing skills Contagious diseases such as SARS Yes/No No No Job B Contagious diseases such as Computing, word processing SARS Boring Yes/No No No Job C Average Business administration Challenging Yes/No Yes Yes Job D Higher Related skills Average Yes/No Yes Yes After considering the alternatives, only Jobs C and D remained for consideration. Both jobs were then judged using essential objectives. The following seven necessary objectives were used to rank their overall performance in each of the alternatives: 1 Annual salary, 2. Flexibility, 3. Annual vacation, 4. Morale, 5. Stress, 6. Job satisfaction, and 7. Mission. The evaluation is divided into two parts: The first part involves determining relative scores and weight values of essential objectives for each Job. For example, Job C scores 10 points and Job D scores 5 points on the essential objective of annual salary; the weighted values are 1, 3, 5, 7, 9 etc. A more important essential objective is weighted more heavily. The weighted score is the score of an essential objectives multiplied by their respective weighting value. For example, the 'annual salary' of Job C in this case scores 10 points and the weighted value of the essential objective is 7, hence the weighted score of Job C is 10 7=70. The alternative is evaluated by the weighted score through 'essential objectives' in this case. Job C, with the highest total weighted score, is the 'Initial Scheme' as shown in Table 8. The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008 27

Essential objectives Table 8: Evaluation of the essential objectives of the Alternatives 1 2 3 4 5 6 7 Annual Salary Flexibility Annual Job Morale Stress Mission vacation Satisfaction Weighted value 7 1 3 9 5 13 11 Job C score 10 2 0 10-10 8 6 Weighted Total weighted score 70 2 0 90-50 104 66 284 score Job D score 5 7 6 6-4 5 4 Weighted score 35 7 18 54-20 65 44 203 RESULT This study compares 12 subjects using the rational decision-making methods of ES and KT. Two results are found as follows. 1. Eleven subjects applied both the two methods to evaluate the same scheme and reached the same conclusion, and another one subject reached different conclusions. 2. ES is more difficult, but more precise. That is, ES requires more time to cogitate and the extent of difficulty is also high. Table 10 shows the interview results from the 12 subjects concerning the difficulty of the process, the precision, the difference comparing with the anticipated result, and the time needed for thinking, as shown in Table 10. Table 10: A Comparison of the ES and KT Methods Items ES KT Remarks 1. The different and same results of the two methods 1 different 11 the same 2. The difficulty extent of the process 10 2 3. The precision 10 2 4. The difference comparing with the anticipated result 1 11 5. The time needed for thinking 9 3 The differences between the two decision-making methods are as follows. The ES is more complicated, because some objectives were replaced for same conditions, making this method more difficult to understand and requiring more time to implement. However, ES method is more precise. The ES focuses only on one judgment value at a time through paired comparison between the adopted and rejected values of every objective in the alternatives. Most subjects (eleven out of 12) thought that ES was more complex and difficult, but this obstacle could be overcome with practice, as shown in Table 10. In fact, this is not really slow for an important decision-making process from a practical viewpoint. CONCLUSION ES can be improved by incorporating potential problem analysis of KT, to enable medical staffs to make satisfactory decisions, and overcome the weakness of intuitional decision for lacking scientific decision process in nursing. The methods can not only be applied to nursing, but also can be applied to 28 The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008

enterprise for improving the quality of decision-making. Overall, this study provides insight to the influence of nursing staff resignation crisis under irrational conditions, e.g. Taiwan s SARS epidemic. In addition, these kinds of irrational conditions and challenges for medical staff will be more and more eternally, e.g. H5N1 epidemic. What can we learn from the open black box of intuition decision-making process? Building a structural intuition decision-making process can assist medical staffs clearly present their thinking process. This study proves that the structural intuition decision-making process to manage intuition knowledge is more important than decision result. Two suggestions about rational decision-making can be making as follows: 1. ES combines KT with potential problem analysis to investigate the potential risk of selected the scheme and enhance the integrity of the scheme for assessing risk. 2. If time allows, both ES and KT should be applied simultaneously. If the results of the two decision-making methods are the same, the decision is highly reliable; but if the results are different, the process must be reviewed and find out the possible missing key factors of the problem. These two methods do not take much time and the generated results are indeed valuable. If time does not permit, ES should be applied with the potential problem analysis, KT. REFERENCES Acton, G.J., Irvin, B.L., Jensen, B.A., Hopkins, B.A. and Miller, E.W. 1997, Explicating middle-range theory through methodological diversity, Advance in Nursing Science, 19, 78-85. Adams, A., and Bond, S. 2000, Hospital nurses job satisfaction, individual and organizational characteristics, Journal of Advanced Nursing, 32(3), 536-543. Babbie, E. R. 1998, The Practice of Social Research, 8th edition, CA: Wadsworth. Bryans, A. and McIntosh, J. 1996, Decision making in community nursing: an analysis of the stages of decision making as they relate to community nursing assessment practice, Journal of Advanced Nursing, 24, 24-30. Cioffi, J. 1997, Heuristics, servants to intuition, in clinical decision-making, Journal of Advanced Nursing, 26, 203-208. Davies, E. and Fox-Young, S. 2002, Validating a scope of nursing practice decision-making framework, International Journal of Nursing Study, 39(1), 85-93. Easen, P. and Wilcockson, J. 1996, Intuition and rational decision-making in professional thinking: a false dichotomy? Journal of Advanced Nursing, 24, 667-673. Hallett, C., Austin, L., Caress, A., and Luker, K. 2000, Wound care in the community setting: clinical decision making in context, Journal of Advanced Nursing, 31, 783-793. Johnson, J. M. 2002, In-depth Interviewing: Handbook of Interview Research: Context and Method, London: Sage Publication. King, L. and Appleton, J.V. 1997, Intuition: a critical review of the research and rhetoric, Journal of Advanced Nursing, 26, 194-202. Lamond, D., Crow, R., Chase, J. and Swindells, K.D.M. 1996, Information sources used in decision-making: considerations for simulation development, International Journal of Nursing Study, 33, 47-57. Tzeng, H. M. 2002, The influence of nurses working motivation and job satisfaction on intention to quit: and empirical investigation in Taiwan, International Journal of Nursing Studies, 39, 867-878. Winter, R. and Munn-Giddings, C. 2005, A Handbook for Action Research in Health and Social Care, London, Rutledge. The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008 29