Decision making in health care

Decision making in health care is a continuum of resource allocation decisions against a background of increasing demands on limited healthcare budgets. Not everyone can have all the healthcare from which they will benefit and difficult decisions are inevitable.

There are a number of models of decision making that fall into three general categories.

• Rational decision-making identifies the costs and consequence of competing intervention options and chooses the alternative that is compatible with explicit goals and values.
• Incremental decision-making recognises that the healthcare system is complex and goals and values are often ambiguous and the future is uncertain. The emphasis is on marginal change, which often involves negotiation and bargaining.
• Garbage-can decision-making is the antithesis of the rational model. It is characterised by a lack of clarity, of inconsistency where solutions and problems are randomly mixed, collected and removed from the scene.

This session sets the decision-making process within a complex frame of reference that views health care as a dynamic network of interactions, which are invariably non-linear. It argues that the decision-making approach should be determined by how well the relationship between inputs and outputs can be identified which questions the dominance of the rational model in the delivery of health care.