Common Sense is Not Common. So How Can A Leader Make Good Decisions?

In education today there is a move away from top-down leadership toward a more inclusive, shared or participative leadership model. This model includes shared decision-making, which has the potential to empower and radically change any organization willing to take the risk of implementing this type of leadership. This article combines another important aspect of leadership to the concept of shared decision-making: servant leadership. With a servant-leader at the helm and shared decision-making in place, a school has the potential to grow in sync with the needs and desires of its stakeholders

Shared decision making between registrars and patients : web based decision aids

BACKGROUND: Current evidence suggests that doctors do not always involve patients in decisions; this may be due to lack of training. This study explores the feasibility of using web based decision aids (DAs) to improve the skills of general practice registrars in sharing decisions with patients. METHOD: Interviews were conducted with registrars to explore their attitudes to shared decision making. Following an educational intervention, registrars were asked to adopt shared decision making within their consultations using DAs as appropriate. The registrars were interviewed again to explore their experiences and any barriers to the process. RESULTS: Registrars had positive views about the shared decision making process but required more training. They had mixed opinions about the use of DAs and identified several barriers to their use. They felt that they had learned from the project and process without necessarily wanting to pursue the use of DAs as interactive tools, preferring to use them as educational resources

How do nurses facilitate shared decision making in HIV care?: an exploratory study of UK nurses knowledge, perspective and experience of facilitating shared decision making in clinical practice

Shared Decision Making (SDM) enables clinicians to promote self-management and to empower patients with long-term health conditions. Whilst it has been reported in other health conditions, there is little empirical research on the nature and practice of SDM in HIV care. This project aimed to explore current views and practices amongst UK HIV Nurses regarding SDM. A mixed methods study utilised focus groups and an online survey to identify opportunities, challenges and training needs. Nurses are supportive of SDM but face patient related, organisation and health system challenges to implement it, especially in supporting complex patients. SDM is an important aspect of nursing care for people living with HIV. Nurses need more training and resources to implement SDM effectively. In order to develop such training and resources to better understand SDM in relation to HIV care, there is a need for research on patient perspectives and experiences in this area

Patients’ understanding of shared decision-making in a mental health setting: The importance of the patient-provider relationship

Shared decision making is a fundamental component of patient-centered care and has been linked to positive health outcomes. Increasingly, researchers are turning their attention to shared decision making in mental health; however, few studies have explored decision making in these settings from patients’ perspectives. We examined patients’ accounts and understanding of shared decision making. We analyzed interviews from 54 veterans receiving outpatient mental health care at a Department of Veterans Affairs Medical Center in the United States. Although patients’ understanding of shared decision making was consistent with accounts published in the literature, participants reported that shared decision making goes well beyond these components. They identified the patient–provider relationship as the bedrock of shared decision making and highlighted several factors that interfere with shared decision making. Our findings highlight the importance of the patient–provider relationship as a fundamental element of shared decision making and point to areas for potential improvement

Strengthening group decision making within shared governance: a case study

Shared governance is an approach to empowering nurses and other health care workers to have authority for decisions concerning their practice. Commonly, visible definers of shared governance are groups of workers known as ‘councils’ whose membership works collectively to realise a shared goal. The literature is replete with rhetoric as to the benefits of shared governance yet the evidence base concerning shared governance and especially decision-making within shared governance is scant. This paper presents a case study of group decision-making within a UK shared governance council model. The evidence which informs the case study is drawn from a doctoral action-research study to strengthen decision-making within the model. Eight key factors affecting decision-making and four supportive conditions are presented and incorporated into a conceptual model. Within the case study, presence of these factors was found to be necessary but not sufficient to enhance decision-making. Factors included having a clear issue, clear aim, fitting issue, manageable issue, size, lead person allocated, level of authority, background information, key informant/s, a mechanism for evaluation, adequately skilled members, support/guidance and sufficient/appropriate membership. Aspects of group decision-making processes are highlighted and compared with established management, shared governance and group dynamics theory

What lies beneath? The role of informal and hidden networks in the management of crises

Crisis management research traditionally focuses on the role of formal communication networks in the escalation and management of organisational crises. Here, we consider instead informal and unobservable networks. The paper explores how hidden informal exchanges can impact upon organisational decision-making and performance, particularly around inter-agency working, as knowledge distributed across organisations and shared between organisations is often shared through informal means and not captured effectively through the formal decision-making processes. Early warnings and weak signals about potential risks and crises are therefore often missed. We consider the implications of these dynamics in terms of crisis avoidance and crisis management

Getting Obligations Right: Autonomy and Shared Decision Making

Shared Decision Making (‘SDM’) is one of the most significant developments in Western health care practices in recent years. Whereas traditional models of care operate on the basis of the physician as the primary medical decision maker, SDM requires patients to be supported to consider options in order to achieve informed preferences by mutually sharing the best available evidence. According to its proponents, SDM is the right way to interpret the clinician-patient relationship because it fulfils the ethical imperative of respecting patient autonomy. However, there is no consensus about how decisions in SDM contexts relate to the principle of respect for autonomy. In response, I demonstrate that in order to make decisions about what treatment they will or will not receive, patients will be required to meet different conditions depending on the approach proponents of SDM take to understanding personal autonomy. Due to the fact that different conceptions of autonomy yield different obligations, I argue that if physicians and patients satisfied all the conditions described in standard accounts of SDM, then SDM would undermine patient autonomy

Shared decision-making and patient decision aids in dermatology

Shared decision making combines individual patient interests and values with clinical best evidence under the guiding principle of patient autonomy. Patient decision aids can support shared decision making and facilitate decisions that have multiple options with varying outcomes for which patients may attribute different values. Given the variable psychosocial impact of skin disease on individuals and relative uncertainty regarding best treatments and their adherence in many dermatological conditions, informed shared decision making, supported by patient decision aids, should constitute a central component of dermatological care

Approaches to decision-making among late-stage melanoma patients: a multifactorial investigation.

PurposeThe treatment decisions of melanoma patients are poorly understood. Most research on cancer patient decision-making focuses on limited components of specific treatment decisions. This study aimed to holistically characterize late-stage melanoma patients' approaches to treatment decision-making in order to advance understanding of patient influences and supports.Methods(1) Exploratory analysis of longitudinal qualitative data to identify themes that characterize patient decision-making. (2) Pattern analysis of decision-making themes using an innovative method for visualizing qualitative data: a hierarchically-clustered heatmap. Participants were 13 advanced melanoma patients at a large academic medical center.ResultsExploratory analysis revealed eight themes. Heatmap analysis indicated two broad types of patient decision-makers. "Reliant outsiders" relied on providers for medical information, demonstrated low involvement in decision-making, showed a low or later-in-care interest in clinical trials, and expressed altruistic motives. "Active insiders" accessed substantial medical information and expertise in their networks, consulted with other doctors, showed early and substantial interest in trials, demonstrated high involvement in decision-making, and employed multiple decision-making strategies.ConclusionWe identified and characterized two distinct approaches to decision-making among patients with late-stage melanoma. These differences spanned a wide range of factors (e.g., behaviors, resources, motivations). Enhanced understanding of patients as decision-makers and the factors that shape their decision-making may help providers to better support patient understanding, improve patient-provider communication, and support shared decision-making