How top managers in health organizations set directions that guide decision making.

Cases describing strategic decisions made in health care organizations were analyzed to determine how top managers set directions that guide decision making. Four tactics were identified--issue, idea, objective, and reframing. Decision-adoption rates, decision merit, and duration of the decision-making process were used to determine the effectiveness of each tactic. The effects that stem from using each tactic were qualified by factors describing urgency, importance, and differences between the tactics used by CEOs and middle managers (leverage). Tactics were found to have more influence on decision effectiveness than the intervening variables of urgency, importance, and leverage. Reframing was found to be the most effective tactic under all conditions but was the least frequently used by decision makers. Issue and idea tactics were the least effective, but idea tactics were used more often than any other tactic. Issue tactics were even less effective when applied to urgent and important decisions. Objectives were surprisingly effective in a crisis and for the more important decision.