Nutt P C
Ohio State University, Columbus 43210.
Hosp Health Serv Adm. 1991 Spring;36(1):57-75.
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.
对描述医疗保健组织中战略决策的案例进行了分析，以确定高层管理人员如何设定指导决策的方向。确定了四种策略——问题、想法、目标和重新构建。决策采用率、决策价值和决策过程的持续时间被用来确定每种策略的有效性。使用每种策略所产生的效果通过描述紧迫性、重要性以及首席执行官和中层管理人员所使用策略之间差异（影响力）的因素来限定。结果发现，策略对决策有效性的影响比紧迫性、重要性和影响力这些干预变量更大。发现在所有情况下重新构建都是最有效的策略，但决策者使用频率最低。问题和想法策略最无效，但想法策略的使用频率高于其他任何策略。当应用于紧急和重要决策时，问题策略甚至更无效。目标在危机情况下以及对于更重要的决策出奇地有效。
