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Decision-Making Case Study Essay

The current grave state of the economy has had a significant impact on health care across The United States. Massive budget cuts, reduced services, and limited access to care significantly have affected Medicaid patients. Hennepin County Clinic (HCC), a facility that provides health care to Medicaid patients, is dealing with an additional 15% budget cut that will force management to make decisions about which services must be changed or eliminated while still meeting the basic needs of the clients. Stemming from consumers’ increased demands for enhanced quality of care and greater accountability from health care organizations, leaders must engage in decision-making that incorporates evidence from well-conducted research whenever possible.

The Informed Decisions Toolbox (IDT), a process of evidence-based decision-making, involves six steps in the decision-making process (Rundall, et. al, 2007). While every step is consequential, step two, the process of gathering evidenced-based sources of information, is the most important tool in decision-making. The IDT plays an important role in increasing organizational accountability, facilitating knowledge transfer within a facility, and contributing to a questioning organization.

Step One

The first step in the IDT is formulating a question or questions behind the decision. This is done in such a way that will increase the likelihood of uncovering useful research studies. As a manager, one must discover what information is needed to make the best decision. When investigating the needs of Medicaid clients and deciding which clinical services to change or eliminate, it is vital to research information regarding the various services used by these patients. The manager must ask several questions. Do individuals enrolled in Medicaid have unique health needs that differ from the larger population? What are the services most utilized within HCC at any given time? In what ways will service cuts and elimination of resources  affect the clients? What services can be outsourced to other facilities that accept Medicaid? Can the current physician staff be reduced, and the use of nurse practitioners and physician’s assistants be implemented?

Step Two

After the questions are formulated, step two involves identifying credible sources of information to answer these questions. In an age of abundant technological resources, a large percentage of sources may be found on research-based websites, bibliographic databases, online academic and peer-reviewed journals, books or other publications, and government reports, to name a few (The Center for Health Research, 2011). It may also be helpful for the manager to locate internal information available within the clinic that will tailor to the unique needs of HCC. While the IDT mainly focuses on evidenced-based sources of information, the manager may also utilize supportive colloquial knowledge from and opinions of colleagues, employees, patients, and other health care professionals (Rundall, et. al, 2007).

Steps Three, Four, and Five

Steps three through five take the collected research and evaluate its accuracy, applicability, and “actionability.” First, step three emphasizes the accuracy of the research presented. The manager must question if the research is of high-quality, originates from a credible source, presents complete and balanced viewpoints, and comprises reliable and valid measurements (The Center for Health Research, 2011). Step four highlights the applicability of the research. The manager must ask if the research is relevant to his or her question at hand and whether or not it applies specifically to HCC. Step five focuses on the “actionability” of the research. The manager needs to know how the research is going to be implemented and who exactly is going to do it. Step five also pertains to the implications and importance of the research studied (The Center for Health Research, 2011).

Step Six

Finally, step six allows the manager to look at his or her organization’s needs and values to determine if the research fits the context of its unique situation. The manager must question if the collected research is adequate to make a useful decision and if there is a single best option, multiple practical options, or even inadequate evidence to make a decision (The Center for Health Research, 2011).

Most Valuable Tool

Although every step in the IDT has much significance and step one builds the foundation on which to define the problem at hand, the tool that would be the most valuable is step two, identifying credible evidenced-based sources of information. Health care workers who provide care based on knowledge from evidenced-based studies deliver significantly better care and produce better outcomes (Melynk & Fineout-Overholt, 2005). Because of this, the process of identifying these studies is vital to the survival of an organization. The knowledge discovered during research can be a valuable source of strength to the organization by combining it with the unique employee and patient opinions and preferences.

This process of searching for information can also contribute to organizational growth through the sharpening of knowledge and skills of decision makers. With regard to HCC, step two is very valuable in deciding which clinical services need to be eliminated primarily because locating appropriate research studies is the foundation of finding the solution to the question. Through the selection of evidenced-based articles, the manager can compare and contrast how other organizations dealt with budget cuts and the solutions they implemented.


Utilizing the IDT greatly affects organizational accountability. Hospital organizations and clinics have to function according to the strict rules and regulations of such agencies as JCAHO and CMS, and at the same time, respond to the ever increasing needs demands of consumers for improved quality of care (Rundall, et. al, 2007). These added pressures force management to make comprehensive, precise, and influential decisions that they cannot formulate with personal knowledge and experience alone. Because of this, management needs to apply the best evidence available in making these consequential decisions.

Knowledge Transfer

Knowledge transfer aims to deliver research-based information and guarantee its availability for future members within an organization (Pentland & Forsyth, 2011). Within health care facilities, it is important for newfound research evidence to be transferred into clinical practice and policy development. Management and decision makers must communicate clearly to the health care team and make them aware of decisions that are made and how the decisions will affect them. Team members are encouraged to share their understanding with others to expedite knowledge transfer within the facility. Knowledge transfer facilitates shared intelligence, improved employee performance, higher levels of innovation within the organization, and economic growth (Rundall, et. al, 2007).

Questioning Organization

The IDT affects an organization in a number of positive ways. Most important, it allows the decision-maker and the health care team to reflect on what was learned, what questions still need to be asked, and what should be done differently next time, which is critical to innovation (Buchen & Rowley, 2000). Building a questioning culture within an organization inspires team members to search for answers within evidenced-based research studies and improving the lines of communication among members as well.


The IDT is an exceptional set of tools that assists management and decision-makers in utilizing evidenced-based research in confronting and responding to pressing questions that significantly affect an organization. The IDT plays an important role in increasing organizational accountability, facilitating knowledge transfer, and contributing to a questioning organization. In the case of HCC, the manager utilized the IDT by formulating questions to determine which clinical services to change or eliminate based on the various health care needs of Medicaid clients. The manager identified various credible sources of information to answer these questions, which has been determined the most valuable tool within the IDT. The research evidence was examined to determine its accuracy, applicability, and “actionability.” Finally, the manager assessed to see if the collected research was both adequate and met the specific needs of HCC, which is what the IDT was designed to do.

Buchen, I, & Rowley, L. (2000). The questioning culture: Perpetual state
of the art. Performance Improvement, (39)5, 26-30.
Melynk, B., & Fineout-Overholt, E. (2005). Evidence based practice in nursing and healthcare. Philadelphia, PA: Lippincott Williams & Wilkins.
Pentland, D., & Forsyth, K. (2011). Key characteristics of knowledge transfer and exchange in healthcare: integrative literature review. Journal of Advanced Nursing, 67(7), 1408-25. Rundall, T., Martelli, P., Arroyo, L., McCurdy, R., Neuwirth, E., et al. (2007). The informed toolbox: Tools for knowledge transfer and performance improvement. Journal of Healthcare Management, 25(5), 325-341.

The Center for Health Research. (2011). The informed decisions toolbox. Retrieved from http://www.toolbox.berkeley.edu/overview.

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