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Said a manager during a discussion of decision-making practices, "When I'm uncomfortable with the situation facing me, and there doesn't seem to be any single logical choice, I just back away-I just don't decide. After a while, either condition changes so there's a clearer choice, or the problem goes away." Upon hearing this, another manager, actually a first-line supervisor, said, "That might be how my boss would describe his own behavior, but to me and a few others it just looks like plain old procrastination."


In even the simplest decision situations imaginable, there are always at least 2 choices: yes or no, this or that, do one thing or another, do something or nothing. The average manager may face dozens of small decisions during an average day and may also may have to contend with a number that are more complex, each potential decision in turn demanding attention. As each potential decision presents itself, the manager may make a final decision, initiate some activity that will result in a decision, or set the matter aside.


Setting a newly arisen matter aside may involve, at one extreme, the thoughtful promise of later attention or, at the other extreme, no intention to ever address the matter. Whichever extreme is the case, however, the manager's inaction will likely be perceived by the staff as procrastination, disinterest, or even deliberate avoidance.


From the viewpoint of a busy manager, there are always a number of seemingly valid reasons for not addressing every little issue as it arises: too much work to do, too many truly significant issues to deal with (meaning, to some, issues that cannot be ignored), and the perceived need to put at least a token amount of investigation and analysis into all but the most trivial decisions. In addition to the reasons that possess at least a shade of validity, there are others borne of disinterest, boredom, annoyance, and even apprehension that channel any number of smaller decision situations into a permanent back-burner position.


There's an old tongue-in-cheek exchange occasionally quoted in discussions about decision making:


Question: "Do you have trouble making decisions?"


Answer: "Well[horizontal ellipsis] yes and no."


A great many potential decisions present themselves to most managers on most days, and many seemingly inconsequential matters or nagging little issues come at the decision maker bearing more questions than answers. For any number of reasons already stated or implied, many such problems are not addressed. Whether failure to address them is valid or not matters little if the resulting perception is one of unconcern, disinterest, or procrastination. And the manager whose conduct concerning the "small stuff" is perceived in such a light will come to be regarded as generally nonresponsive.


What the nonresponsive manager fails to appreciate is that the exercise of the no-decision option, whether through default by procrastination or by deliberately deciding not to decide, is itself a decision-and often it is the decision of the most potentially far-reaching consequences. As the unknown by oft-quoted Murphy is claimed to have said, "Left unto themselves things invariable go from bad to worse." Rarely does the unaddressed problem resolve itself; the manager must eventually deal with it anyway, and when one deals with it later it has usually become larger and more complex. So whether selected by choice or by default, the no-decision option is neither delay nor avoidance; it is a decision to commit to the unknown.


This issue of The Health Care Manager (32:2, April-June 2013) offers the following for the reader's consideration.


* "Health Reform's Impact on Federally Qualified Community Health Centers: The Unintended Consequence of Increased Medicaid Enrollment on the Primary Care Medical Home" addresses the potential substantive changes that may occur in community health center operations as a result of the passage of the Patient Protection and Affordable Care Act.


* "The Effects of Supervisors' Supportive Role, Job Stress, and Work-Family Conflicts on the Nurses' Attitudes" reports on a study involving the development and testing of a research model that examined the effects of supervisor support, work-family conflict, and job stress related to a number of potential consequences using data collected from nursing personnel.


* "The Relationship Between Nursing Staff Levels, Skill Mix, and Deficiencies in Maryland Nursing Homes" presents the results of a data analysis undertaken to explore whether nurse staffing levels and nursing skill mix influenced the number and severity of nursing home deficiencies in Maryland nursing homes.


* "Improvement of Hospital Performance Through Innovation: Toward the Value of Hospital Care" reports on a critical analysis of the relationship between innovation and performance in the hospital sector in Portugal, identifying organizational flexibility and external cooperation as major factors in explaining the differences found among hospitals.


* "Evidence of Psychosocial and Behavioral Effects Related to the Intention to Quit Alcohol in South Korea" reports on a study examining psychosocial and behavioral characteristics and other factors that influenced certain subjects within a population-based sample of Korean drinkers to give up the consumption of alcohol.


* Case in Health Care Management: "The Unrequested Information" asks the reader to consider what a manager might do with disturbing second-hand information and hearsay received "in confidence" from an employee.


* "Can We Associate the Hours of Clinical Service at the Rehabilitation Outcomes: The Case of the Visual Impairment Rehabilitation Program" reports on a study undertaken to determine the effects of clinical interventions by professionals from a visual impairment rehabilitation program on the daily lives and social participation of the elderly.


* "Progression in Understanding and Implementing the Cultural and Linguistic Appropriate Services Standards. Five-Year Follow-up at an Academic Center" reports on a nonrandomized, cross-sectional study undertaken to assess changes and attitudes and applications of CLAS in an academic health care setting over a 5-year period.


* "Results of an Initiative to Charge for Previously Uncompensated Care in an Academic Primary Care Practice" reports on a program to charge for certain after-hours and electronic communications, completion of forms outside office visits, and failure to show for appointments, in response to increasing clinical workload and dwindling compensation for primary care medical practices.


* "A Profile of Hospitals With Leadership Development Programs" identifies and describes significant differences in organizational, operational, performance, and market factors associated with hospital offering leadership development programs compared with hospital lacking such programs.


* "Practical Implications of Pre-employment Nurse Assessments" reports on a study undertaken to address the use of content-and-criterion-related validation design to create an assessment by which nurse applicants can be evaluated for "soft skills" as well as technical knowledge and skill.


* "How to Create a Health Care Organization That Can Succeed in an Unpredictable Future" addresses the selected principles of organization structure, human resources, decision making, and change management that, when applied to health care organizations, will help such organizations succeed in an unpredictable future.