Management and Change
The six step rational decision making process is a well thought out process of analyzing
facts and making a rational decision based on the evidence and facts presented. It is a process
through which managers were able to determine the best approaches to impacting change within
an organization. There are distinguished categories in the decision making. The model compares
the available options and alternatives to come up with a reasonable way of creating change in an
organization. The rational decision making model is comprised of six stages 4 . The models for
rational decision making are defined as linear and sequential processes. The model is comprised
of six well highlighted and analyzed steps that conclusively end up with a well-made choice. Out
of the six steps of rationally making a choice, they should all be well followed step by step
without omission or defiance of one of these steps. Additionally, sometimes the managers may
be forced to repeatedly go back up the chain and ensure that some of the steps are well
implemented to ensure that the model is well applied. Each of the six steps is prone to bias. The
model has been widely applied in the clinical decisional making process over the years with the
model becoming simplified to the main six steps as it was very complex in nature.
The model is very beneficial as it helps consideration of all alternatives before coming
into a conclusion. The application has been an advantage as the choices made are conclusive and
also well thought of thus causing less chaos within the organization. It increases the information
provided within the organization and can lead to a new idea that may not have been considered
initially. It is also easily applicable and a simple well analyzed process that can be used by
anyone in management. The rational theory does not provide a recent empirical knowledge on
human decision making. However, some organizations have attributed the use of the model to
time wastage and poor management as it is a gradual process and not of immediate application.
Additionally, the inclusion of various facts can become challenging for the authority in making a
conclusive decision. As the organization tries to identify the best choice through research, they
may end up getting the wrong one.
The six step rational decision making process
The first step in the model is problem identification. Identifying of the problem is one of
the initial steps of the six step rational decision making process 1 . Such as the case with the
Director of Quality Initiatives, he should prioritize and understand why there is the reason for
introduction of signing of the new tips of the prevention of medical errors and wearing of buttons
indicating hand wash reminders. The remaining six cells order the array of known decision
models. If the employees are very efficient in the management of the patients and they well
handle the prevention of infection spread, then there may be no problem. As they are
experienced personnel who have had quality training, they definitely decline in the requests by
the director. Problem identification is a sure process that requires effective understanding and
research of the circumstances before concluding that change is required. In case the director
identifies some aspects of poor hygiene, then it’s important to proceed to the next step.
The second step after the problem is identified is the decision criteria identification.
Identifying the criteria is very important as it considers the company’s policies and the
preferences of the one responsible to make that change. The criteria should also consider to some
extent the opinions of the other members especially in a clinical setting. Many of the consumers
indicated that they were anxious during the decision making process 5 . The approach used to
make the change is impacted and determined in the second step. As the director determined that
there were challenges with aseptic techniques and infection prevention, he should analyze some
of the contributing factors and the most affected department in the hospital. Through that he is
able to provide an alternative that is very considerate and specific.
The third step is criteria weighing. The third step includes an explanation on the methods
used for weighing these criteria and sub-criteria. At this phase the authority responsible analyses
the benefits and harms of the criteria chosen. Additionally, they analyze and evaluate the
approaches used and the field that will be affected. It is important to research on whether the
criteria, has been used before and how effective was it. Hence, when targeting hygiene changes
in the hospital, it is good to understand that some of the staff members are proficiently
experienced and thus very efficient in managing patients aseptically and could not cause any
secondary infections. As a result, the director can target the newly employed and those handling
more susceptible departments such as the maternity and new born unit. The experienced nurses
find it an insult to impact such measures when they have worked in the institution for several
After weighing of the criteria, the director should then generate alternatives. Application
of the rational decision making model is bounded with rationality and intuition 6 . Alternatives are
back up plans that could be used if the primary criteria fail to benefit the hospital or the members
of staff decline such as in the case scenario. The steps are potential loci for the next resource-
rational approximation. For every decision about to be made there should be close alternatives
that can easily fit in when they fail. Thus, any person in authority should not rely on the single
criteria they have planned out as it may fail terribly. When such a point comes, they initiate the
next closest alternative that is less impactful but also serves the same purpose.
The fifth step is rating of each alternative based on the criterion identified. Rating is
important in categorizing them into the best replacements for the choice made. It is important to
gauge their level of applicability and how well they will suite serving the purpose of change is
the primary one fails. For example, when the nurses fail to adapt the signing and use of the
button badge, the hospital can implement mandatory hand washing before and after every
procedure by placing several hand washing sinks around the hospital wards and using posters
around the hospital that indicate the benefits and risks of failure to hand wash.
The final step of decision making is the computation of the optimal decision. It involves
documenting it as one of the organizations policies and implementing the change made 7 . It is
both practical and theoretical in nature as the members should be there when you introduce the
change and they should be allowed time to adapt.
Kanter’s reasons for change refusal
According to Rosabeth Moss Kanter, one reason for refusing change is fear of loss
control due to the initiation of new modalities. Many of the nurses also refused the new changes
because of excess uncertainty which makes them unaware of what to expect. Another reason is
always the element of surprise which is not very acceptable by many employees in an
organization 3 . Handling the new way of conduct disrupts their normal daily routine. Many people
are always uncomfortable with new ways that affect their autonomy and control over everything
that goes on. Change causes loss of originality as there are new ways which become introduced.
Some of the nurses always opt for the regular flow of events that defines them. Nurses associate
change and introduction of new ways with increased workloads as it is a career based on full
time pressure. Additionally, they also dislike the ripple effects that come along with change. That
may cause disruption and interfere with the smooth running of the hospital facility.
Based on the newly implemented change, the director targeted improvement in
prevention of hospital acquired infections (HAIs). Prevention of hospital-acquired infections
(HAI) is central to providing safe and high quality healthcare 2 . However, the mode of delivery
for the new change was poor which may have resulted in decline by the nurses. Instead of
making it coercion the best alternative is challenging and motivating them to adopt the new
changes through education on the importance of hand washing. Creating an interest in the nurses
will definitely get them on the line of wanting the change. Additionally, posters and banners
should be posted around the hospital as a way of reminder on the negative effects.
1. Bose C. Principles of Management and Administration. Place of publication not
identified: Prentice-Hall Of India; 2013.
2. Filetoth Z. Hospital Acquired Infection: Causes and Control. London: Whurr Pub.; 2003.
3. Holley WH, Ross WH, Wolters RS. The Labor Relations Process. Boston, MA: Cengage
4. Phillips J, Gully SM. Organizational Behavior: Tools for Success. Boston, MA: Cengage
5. Robbins SP. Organisational Behaviour: Global and Southern African Perspectives. Cape
Town: Pearson Education South Africa; 2016.
6. Robbins SP, Judge T, Millett B, Boyle M. Organisational Behaviour. Sydney, N.S.W.:
Pearson Australia; 2017.
7. Robbins SP. OB the Essentials. Frenchs Forest, NSW: Pearson; 2010.