Participation in Decision Making as a Property of Complex Adaptive Systems: Developing and Testing a Measure

Table 5

Decisions included in the participation in decision-making instrument.

Strategic decisions
Operations-strategic decisions: (i)  **Whether to create an admission team whose function it is to do preadmission screening?; (ii) Whether to charge patients for special equipment they require or use a flat fee for all patients?; (iii)^**Whether to create a specialized rehabilitation team to provide rehabilitation services or utilize regular staff?; (iv) Whether to hire a registered dietitian as food service supervisor?; (v) Whether to alter the mix of Medicaid, Medicare, or private pay patients?; (vi)  *Whether to create our own PRN pool of nurses or use an outside agency?	Marketing-strategic decisions: (i)  **Whether to offer an amenities package aimed at private pay patients?; (ii) Whether to develop brochures for specialized markets such as people visiting physician's offices, hospitals, banks, and so forth?; (iii) Whether to expand the traditional nursing homes services offered to include day-care, home health care, and/or community health promotion clinic?; (iv) Whether to run an advertising campaign targeting special populations such as people with aids or multiple sclerosis, suggesting the use of the nursing home's specialized services?; (v)  **Whether to alter patient charges based on charges of competitors?; (vi)  *Whether to mail a quarterly informative newsletter to all referral sources?
Tactical decisions
Core-function tactical decisions: (i) **Whether to convert to a unit-dose medication system?; (ii) **Whether activity personnel or nursing staff will transport residents to scheduled activities?; (iii) Whether to transfer a patient to another unit within the facility?; (iv) Whether to increase or decrease the amount of patient care delegated to nursing assistants?; (v) Whether to use mechanical patient restraints, chemical patient-restraints, or no patient restraints?; (vi) *Which patient procedures (intravenous infusions, tube feedings, dressing changes, etc.) should be accomplished by which staff?	Support-function tactical decisions: (i) **What schedule should be employed for preventive maintenance of patient care equipment?; (ii) Whether to change the charting system to include flow charts or check lists and more or less forms?; (iii) What levels of stock are needed in the satellite supply areas?; (iv) Whether to alter the procedure for incident reporting?; (v) **When to schedule laundry-service hours?; (vi) *When to schedule fire drills?

∗Decision eliminated through item analysis.
**Decision eliminated through factor analysis.