HAPTER

19 Problem-solving

Competencies
work toether and wteneer there is 2 diterene between wte
actualy happens and what the ha ersr Wants to t2e
itroduction happen in sirriar situatirs prcien m a j r dthe r r s
Defritions and mearing cf problem-sotving trator has to sotve the prciern ard rae the cerisisrs. Tre
marager must classify the protierrs erd zhe p ry te bg
Decision-making and probiem-sotving
ardimprtant nes. Verios eterrzte hins re orsitere
Types of probiems at the tirne of soingthe prien, erd HUinge est re
Nzture and characteristics of probiern-sovíng DEFINITIONS AND MEANING OF PROBLEM
Prnoipies of probiem-soiving SOLVING
Protiemsoving approach Problerr-5olvingis the process f zking Ureiie acin in Iie
Main steps of probie-soiving to meet otiectiives. Sorrecf ne more eitetive deisiorsiore
- Asproaches of probiem-sovíng process creativity.
Problern-sohing is a process in wtich we percet.e zri rsohe
4 Probem-soing process model a gap between a present situation ard acesirei al wth te
4 Proberr-soiving for better heaith nursing model path to he goal blochei by koon o uraoun ctsacdes. h
ceneral. the situatíon is one ot preiousy encOureredortere
- Obstacies in probiem-soving at least a specific soution irom past experiences is rot known
Problern-soving and decision-making which is par of
- Basic guidelines to probiem-soiving and decision-making problem-solving has been identified as a core function of
-Further readings managerent ard it ís imporart to marageria efteciveness as
viewed by managers of hospitals. nursing facuiies. medica
cinicians. staf. finance and ofner personre
cOMPETENCIES
Problerm-soving appears in the literature under mary names.
Ate nplein f this chapter, the learne will be able to: Allen Morgenson refers the problern-sohving process as
Understand the cncept of problerm-solving, its meaning work sirmplification. Orcanised use of common serse to fnd
ard iefinítions easier. beter ways of doing work
" Donowon equates this prOcess with the nursing process that
I Diferentiate problern-5oving with decision-naking Carson describes as the surm of the activities jointy periomed
D Desribe various types of problerns by the patient and the nurse ie. assessment of the patent
9 Discuss rature and characteristics of problern-soking problern identification. developrment of plan of care, and
DEnurmerate principles of problern-solving evaluation of the care plan's etfectiveness.
I Descrie in detail the steps of problern-oving approach " Kron refers to problem-solving as systematic thinking.
D Appky various approaches of problern-soking in day to day sometimes called the scientific method of thinking
working situation " Druker (1997) defined decision-making simpBy as choosing
identifying and evahuating alternatives and picking the best
J Analyze various obstacles in problern-soving one
D Apply basic guidelines of problern-solving and decision DECISION-MAKING AND PROBLEM-SOLVING
making in working situation.
Decision-making and problem-solving are often used inter
INTRODUCTION changeably, but they are synonymous. Problem-sotving inchudes
decision-making. but all decision-making does not inciude
Problem-solving problem-solving (Higgins, 1991). The problern-soving inchudes
problern analysis and pre decision situation assessment and
Problern-solving is a scientific. systernatic approach to solve the
problern. It invotves ceative ideas. Whenever a group of people post decision implermentation and evaluation Fig. 191).
Z02 Principles and Practice of Nursing Manggement and Administration
Pre decision situation
assessment

2UNIT:
Identificatiion &evaluating
Problem solving Decision making alternative solution

Post decision alternative

solution implementation &
evaluation

Figure 19.1: Problem-solving and decision-making

TYPES OF PROBLEMS NATURE AND CHARACTERISTICS

The problems are of various types depending upon the nature, Problem-solving is an intellectual activity that involves jud¡n e
level, and processes. Some problems may be of serious in nature, evaluation and selection. Since two or more solutions
others may be of routine. The managers may or may not be considered to select the best one. The following are the
familiar to these problems, others may be anticipated. Problems characteristics of problem-solving (Fig. 19.3):
may also arise either due to poor interpersonal relationship or 1. It has process concept: The pattern of events and circumstan
due to work processes. These can also arise at any hierarchical that has shaped the problems and course it is likely to take un
level. These may be structured or unstructured, complex or in future are the factors in problem-solving.
simple, major or minor, urgent or non urgent. These may involve
varying degree of uncertainty, risk, and cost as shown in 2. Time sequence: The fact and information pertaining to the
Figure 19.2. past in which problem grew are gathered. The altematis
are searched and selected the best one in the present and the
time sequencing is completed with the implementation of
solution selected and evaluation of result in future.
3. Action commitment: Selection for the alternative made shoud
Serious, or trivial be sound, accurate, and appropriate and action oriented.
4. Evaluation: It occurs in two stages: At the time of selecting
one of the alternative from two or more solutions and
Familiar or novel
weighing and measuring the results of implementation
5. Rationality or scientific: The nurse has to use her imagination.
Related to work process factual analysis of the past events and circumstances and led
to a solution and should take realistic view of whole situaton.
Types of Interpersonal relation
problems
PRINCIPLES OF PROBLEM-SOLVING
keep
Following are the principles that a nurse manager should
Reacted to own level of responsibility
in mind while solving the problems:
1. Ensure prompt attention
Related to subordinate level 2. Separate large to resolve smaller problems
3. Follow policies to resolve smaller problems
4. Delegate smaller problem to subordinate
Related to supervisor level 5. Consult with management for major problem
6. Consult with experts
7. Relaxed in approaching problem
Figure 19.2: Types of problems 8. Accept the problem.
 Problem-solving 203

Data needs to be processed may reguire collection.

Process classification and analysis.
concept *ldentify the values. and beliefs of the total
organization
Time Study the various norns/policies
sequencing ldentify various sanctions (what rewards or
Rationalty
punishrnent allowed) UNTT: 2
Features " ldentify role of administrator
" Identify role of personnel affected
Step II: Developing and finding out alternative solutions
Hypothetical solutions are established after
Action
Evaluation commitment questioning:
" Whether such problem occurred previously or
not?
" If so, what steps have taken to solve the problem?
" List the action to be taken
19,3:: Characteristics ofiproblem-solving approach Step IV: Selecting the best solution
Fiqure
Consider the various factors as:
PROBLEM-SOLVING APPROACH Availability of resources:cost, manpower, methods.
be taken to solve the problem: Optimum results and consequences
sequential steps are to " Time
lanious
problem in sequence: Take each problem before
19.4. " Take a positive attitude towards solution
understandingthe next as depicted in Figure
and handle one at one time in order of Step V: Testing the best solution
the problem
2 Rank Test the proposed solution either actual or
priornity the identified problems on the
3 Group
the problems: Group simulated conditions to determine the results.
basisof diagnostic
and search activities as depicted in Attempt to look at the solution with two thoughts.
Fgqure19.5. First, there are no perfect solutions and second.
not every problem is solvable, and you may go to
PROBLEM-SOLVING
MAIN STEPS OF compromise.
Gn ldentifying, developing, and stating the problem Step VI: Formulation of final solution
.Select the problem by setting the priority ranking " The proposed solution stands evaluated after
in order testing.
" Develop and state problem selected in a precise " Incorporate the findings into final solution
form Step VIl: Implementation of solution (Decision)
Searched questions: " Put the finat sotuton into operation under actual
Is it a temporary problem or what will be the future conditions
demand? " Introduce the solution to the primary group
Is the time of study appropriate? involved
" Be sure that all who will be aftected by the solution
Will it be successful?
If the problem is solved what type of benefit could
are informed, both verbally and in writing, before
be achieved? the solution is implemented
involved
Sep l: Problem analysis and establish solution " Set a time that is agreeable to the majority
" ldentify the specific problem and diagnose the with the problem for implementing the solution
factors that result in the problem and cause of " Try to give a trial period first and
then involve the
problem entire department.
Searched questions: " Finally wait for feedback
What is the difficulty? " Monitor constantly
How are they affected by it? of implemented
Who is affected by it? Step VIl: Evaluation: It is the effectiveness
solution
How are they affected? " Evaluate the result in term of objective
or goal
Wnat significant event that brought the problem?
 VManagement and Administration
Problem 2
4
5

Figure 19.4: Tackling of

problem

1
6

4 7 8 3
10

2 9 5

10

1 2 3
6

2a 26 - 5a 5

5b

Figure 19.5: Ranking and grouping the problems

APPROACHES OF PROBLEM-SOLVING PROCESS

Problem-solving for Better Health
Nursing (PSBHN) Model
Problem-solving Process Model
Problem-solving for Better Health Nursing (PSBHN) moda.
As per the problem-solving process model given by Rakich JS which is an international approach to problem-solving has bezn
and Krigline AB, the following are the steps of problem-solving: developed and launched by the Dreyfus Health Foundation î
1. Problem analysis 2002 and operationalized in 14 countries. It has following fi?
2. Developing assumptions step framework or process of identifving local health neds
3. ldentifying tentative solutions Step one: Define the problem (nature, size, cause, contibuny
4. Developing and applying decision criteria factors)
5. Selecting the alternative that fits the criteria best Step two: Prioritize the problem (take a realistic piece ot t
problem)
6. Implementing the solution
Step three: Define a solution (ask a good question' to frame ui
7. Evaluating results
project)
 Problem-solving 205

Create an
action plan (design methodology and . Do not pass any jucdgment on the ideas, just write them as
four evaluation)
Sp you hear
to implement the project
Takeaction
Sep
fve
OBSTACLES)
INPROBLEM--SOLVING Select an Approach to Resolve the Problem
Which approach is the most likely to solve the problem tor
the
are obstacles that can hinder the process of the long term
following Which approach is the most realistic to accomplish for UNTT:
now
problem-solvino
The Do you have the 9
resources-men, money and material resources
of
Lack
Are they affordable
1 Limited
time * Do you have enough time to implernent the approach
Sareinfomationsources
4 Inadeguatedata
attitude of manger to solve the problem Plan the Implementation of
onalityor the Best Alternative is
6 Stress
: Oversimplification Carefully consider What willthe situation look like when the
SPlacating
problem is solved
problem is solved appropriately and timely after What systems or what steps should be taken to implemenit
Hthe appropriate information, it helps in developing the best alternative to solving the problem
cathering administrators. The employees feel secured What resources willyou need in terms of people, money and
among
nfdence
in accomplishment
of organizational goal. facilities?
ease
andthat successful manager, the nurse managers should
becomea
To themselves the following questions: Monitor Implementation of the Plan
cUckbiask reasonable?
WhatdoI want? Is it Monitor the indicators of success:
adetailed plan for achieving my plan describes
. DoI have foreseeable bariers? " Are you seeing what you would expect from the indicators
how Ican Overcome " Will the plan be done according to schedule
i lcommitted to working through my plan methodically " If the plan is not being followed as expected
and consciousiy? " Was the plan realistic
track?
Hnw wil Idetermine whether Iam on " Should more priority be placed on various aspects of the
or outside influence sidetrack me, what
I negative thoughts plan
nectfcaly can Ido to get rid myself of those thoughts and Should the plan be changed
iniuences?
in problem-solving culture, these questions enable employees
point
Verify if the Problem has been Resolved or Not
oprogress from point A, which is where
they are, to
" What changes should be made to avoid this type of problem
where they want to go.
in the future
Besic Guidelines to Problem-solving " What did you learn from this problem-solving" Consider
new knowledge, understanding and/or skills
and Decision-making " Consider writing a brief memo that highlights the success of
Define the Problem the problem-solving effort, and what you learmed as a result.
What happened? FURTHER READINGS
"Where did it happen? York: Petroceli
"When did it happen? 1. Awani A. Project Management Techniques. New
Books, 1983.
"Why did it happen? Problem Solver. New York: W.
2. Bransford J, Stein B. The lDEAL
What do you know about the problem? H. Freeman, 1984.
With whom it is happening? Management. New York:
3. Drucker PF An lntroductory View of
Harper's College Press, 1977.
Look at Potential Causes for the Problem Challenge: An lntroduction to
4. Higgins JM. The Management 1991.
Management. New York: Macmillan,
.M down your opinions and what you've heard from others Krigline AB. Problem-solving in health services
" Write down a description of the cause of the problem and in 5. Rakich JS, 74(2):21-7.
terns of what is happening, where, when, how, with whom organizations. Hospital Topics l996;
Managing Health Services
6. Rakich JS, Beautort BL, Darr K.
and why. Organizations. 3d ed. Health Protessions Press, 1992.
S, Collado D, et al. Resources for health:
7. Smith BH, Barnett
entiíy Forum 1994:
ResolveAlternatives
problem-solving for better health. World Health
for
the Problem Approaches o 15: 9-15. Managing Partici
Iny to get as many ideas as possible and then screening them 8. Vroom VH, Jago AG. The New Leadership:
Prentice Hall, Inc.
pation in Organizations. New Jersey:
to find the
best idea