Quality and Data Base Management

¶ … decision models are used in your a major hospital organization? Does top management; make decisions by a management team, or does it all depends on the type of decision? What method would be the most effective for different types of decisions?

In any large hospital environment, decision models and protocols are often challenged by necessity on a situational basis. In the field, the practitioner of health always faces a paradox of obedience and responsiveness. After all, certain hierarchies in the decision modeling process must be held to for legal and medical reasons. A competent patient's confidentiality must be respected, even if it is not in the patient's best interest -- for instance, a mother who wishes to keep her cancer secret from her adult children must be allowed to do so. Yet during an emergency, the primary goal is always to save a life, and one cannot ask for an insurance card from a patient, or determine if the patient is a legal resident of the United States before dispensing emergency treatment for a gunshot wound. Likewise, top management cannot make even purely bureaucratic decisions regarding the organization as a whole without taking into consideration health care needs. Nothing is ever completely top-down. Every type of decision requires a different type of leadership. Doctors must have input into what methods of healthcare are necessary or unnecessary for patients, and management must take into consideration financial demands and changes in insurance policy of other companies. Shared values of providing quality care at an efficient cost help facilitate cohesive decisions, but different emphasizes on cost over care will vary, depending on the individual's function and place in the hospital hierarchy (Scholl, 1999)