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Multiple Ways of Decision-Making in a Hospital : A Process View on Decision-making in Pluralistic Organizations

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abstract Decision-making in pluralistic organizations, like hospitals, is a fragile process, particularly when they span professional boundaries, as in change or merger projects. The fragility is often explained by divergent goals, knowledge-intensive work processes and dispersed power structures. Due to the high autonomy of different actors decisions need to be made collectively and to a certain degree the consent of those affected by the decisions is required. In addition, decision-making is a cyclical process as decision effects feedback on the decision-makers.
However, the question of how actors carry out decisions over time has not been widely explored in management and organization theory. Traditional theories of rational choice do not incorporate the social and cyclical nature of nature of decision-making. We turn to literature of the process perspective that suggests understanding decision-making as a pattern of action unfolding over time. Emphasizing the role of time decisions emerge from the temporal proximity of challenge, solutions and decision maker. This paper uses a process lens to examine how different actors enact different decisions practices in order to enable collective strategic actions.
Although various scholars have established decision-making as a central concern of organizational science, less attention has been paid to the actual decision practices/processes in pluralistic organizations. Apparently, it is assumed that the ways of decision-making do not vary across a pluralistic organization. This paper addresses this gap by analyzing the diverse decision practices of different professions within a hospital.
This paper extends existing understandings of how distinct decision practices shape the process of strategic actions. We elaborate on the role of the professional background in making decisions, based on analysis of a longitudinal case study of a merger process between two hospitals. Our data show distinctly different decision-practices within a hospital: fast and personalized decision-making by surgeons, collaborative decision-making that appeals to the nurses’ notion of caring, consensus-seeking understanding of emerging patterns that fits to the routines of internists and bureaucratically pre-planned project management by administrators. Our study makes two contributions: first, reaching a strategic decision and generating organization action around strategic goals is not only difficult because different interest groups pursue their own goals. But also, it is because the decisions practices within a pluralistic organization differ significantly; second, decision-making is heavily shaped and legitimized by the way actors perform their daily work. Such referencing stabilizes a specific decision-practice inside a professional domain. At the same time, organization-wide decisions during which different ways of decision-making join, making decisions becomes ambiguous.
type conference paper (English)
keywords pluralistic organization; decision-making; process research; organizational change
project HealthCare Excellence
name of conference 4th International Symposium on Process Organization Studies 2012 (Kos, Greece)
date of conference 21-6-2012
title of proceedings Language and Communication @ Work: Discourse, Narrativity and Organizing
page(s) 38
review double-blind review
citation Tuckermann, H., Alexandra, L., & Mitterlechner, M. (2012). Multiple Ways of Decision-Making in a Hospital: A Process View on Decision-making in Pluralistic Organizations. In Language and Communication @ Work: Discourse, Narrativity and Organizing, pp.38.