Chpt1_Collaborative_Decision_Making_Empowering_Nurse_Leaders.pdf

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Team Concepts

Collaborative decision making: Empowering nurse leaders By Linda S. Burkett, DNP, MSN, RN, FCN

D ecision making is significant to every pro-

fessional organization, guiding trajectory

and success. Understanding the complexity

of decision making is imperative, as is rec-

ognizing the unique human dimensions inherent

in the decision-making process.1-3 Personality

type directly influences how individuals make

decisions. For this reason, decision making is an

elemental component of the Myers-Briggs Type

Indicator (MBTI), a 93 forced-choice-question

personality assessment tool. Corporations have

been using the MBTI for over 60 years to develop

leaders and gain insight to enhance collaboration,

team building, problem solving, career develop-

ment, management training, counseling, and

conflict resolution. Foundational to the MBTI is

Carl Jung’s theory of dichotomous personality

types—extraversion/introversion, energy

sensing/ intuition, thinking/feeling, and

judging/ perceiving—which determine behaviors,

inclinations, and priorities, each innate to decision

making and significant to collaborative work.2

Extraversion is a preference for the outside

world, activities, and others. Introversion is a pref-

erence for personal thoughts, memories, and expe-

riences. A sensing preference is characterized by a

penchant for facts, concrete data, and specifics. An

intuition preference is characterized by a penchant

for assessing the big picture, focusing on relation-

ships, connections, and identifying patterns. Think-

ing reflects a person’s tendency to be objective in

decision making, stepping away from the circum-

stance to analyze and apply reasoning. Feeling

reflects a person’s tendency to be subjective in

decision making, stepping into the circumstance,

considering the impact on all stakeholders’ values,

and applying empathy. Judging indicates people

who prefer to organize the world. Perceiving indi-

cates people who prefer to experience the world.4

Methods

The purpose of this study was to assess the impact

of MBTI educational modules for personality type

comprehension and application by nurse leaders

to enhance collaborative decision making. A

shared governance council at a 228-bed facility

within a seven-hospital network in western Penn-

sylvania was selected as a pilot study venue. The

shared governance council included full-time for-

mal and informal nurse leaders, representing

administration, inpatient units (orthopedics,

psychiatric, oncology, ICU, telemetry, ED), and

outpatient radiology. All members were female,

with educational backgrounds that included

diploma, associate, BSN, and MSN degrees; a

range of years

in nursing

from 5 to over

20; and a range

of years in

nursing leader-

ship from 1 to

over 20. Eight

of the 10 council members completed the 4-month

study. The sample size was strategic for a deep-

dive investigation into the topic.

A noted gap in the literature was assimilating

personality types into the collaborative decision-

making process. The author created a conceptual

framework representing the correlation of person-

ality types to decision-making styles and its im-

pact on leadership constructs. (See Figure 1.) With-

out a published tool to specifically measure nurse

leader collaborative decision making enhanced by

MBTI application, a leadership training survey

created by Dr. Marc DeSimone was used as a

focused assessment.

With permission and consultation, “How Well

Do You Participate in Collaborative Decision

Making?” was created as a 10-item assessment,

using a 5-point Likert scale (1 = “not at all”;

5 = “very much”). The tool queried seven con-

structs of nursing leadership recognized by

research findings: trust, peer appreciation and

understanding, collaboration, communication,

professional growth, ethical conduct, and

www.nursingmanagement.com Nursing Management � September 2016 7

Team Concepts

Figure 1: Conceptual framework4,5,9,10

MBTI personality

dichotomies

Decision-making process

Subjective expected utility

theory + type theory

Extraversion/introversion Focus and energy

Define problem

Collect data

Identify options

Assign utility/weigh outcomes

Project risk

Add stakeholders’ values

Make final decision

Act on decision

Evaluate decision

Decision value

Decision expediency

Decision pragmatism

Sensing/intuition Information and perception

Thinking/feeling Evaluation and synthesis

Judging/perceiving Orientation to outer world

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Constructs of nurse leader

decision making

Trust

Colleague appreciation and understanding

Collaboration

Communication

Professional growth

Ethical conduct

Evidence-based practice

evidence-based practice.2,5-8 In ad-

dition, it surveyed three constructs

of decision evaluation: value (ap-

propriate merit and benefit to all

stakeholders), expediency (efficient

use of time and a defined process),

and pragmatism (practicality of

implementing the decision within

fiscal and strategic confines).9

Every effort was made to ensure

the assessment’s validity and

reliability.

This study employed descriptive

content analysis and survey meth-

odology, utilizing an interrupted

time-series design of four monthly

education sessions, with pre- and

postintervention assessments. Open

discussion and group observation

provided qualitative data and feed-

back. Member self-report methods

were implemented to discern per-

ceived improvement. Individual

session usefulness was evaluated

by asking: 1. Was this session inter-

esting to you? 2. Did this session

add new knowledge for you? 3. Do

you think the session informs di-

mensions of communication for col-

laborative decision making? 4. Was

the presenter effective? 5. Did you

attend session one, completing the

collaborative decision-making as-

sessment and the MBTI? This eval-

uation was completed after each

session using a 5-point Likert scale

(1 = “not at all”; 5 = “very much”)

to measure member buy-in and ap-

praisal of the presented materials.

Implementation

Session one began with an introduc-

tion and opening comments made

by the sole facilitator, a certified

MBTI practitioner. Informed consent

was obtained, with participation

signifying member agreement. The

preintervention assessment tool

“How Well Do You Participate in

Collaborative Decision Making?”

was administered. The MBTI was

given and results were revealed, fol-

lowed by a best-fit education mod-

ule to confirm personality type

through further explanation and

member self-report. Voluntarily dis-

closed member personality types

were then displayed on a poster,

serving as a team type table.

Session two was conducted by

the investigator, beginning with a re-

view of personality type descriptors.

Group discussion enabled a safe en-

vironment for member feedback on

personality type comprehension,

self-awareness, and insight into

8 September 2016 � Nursing Management www.nursingmanagement.com

Team Concepts

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

personality type propensities. Mem-

bers shared new understanding of

personal inclinations toward meth-

ods of engagement, information

collection, and problem resolution.

Discussion of the team type table

followed, demonstrating group

strengths and personality gaps. The

decision-making process was de-

scribed: define the problem; collect

data; identify options; assign utility/

weigh outcomes; project risk; add

stakeholders’ values; make the final

decision; act on the decision; and

evaluate the decision by value,

expediency, and pragmatism.9 Dis-

cussion incorporated the influence

of personality type on each step.

Four diverse activities were com-

pleted to explore personality type

influence on decision making per

scenario. Clear differences in ap-

proaches and priorities were noted

by type.

Figure 2: Members’ dichotomous personality types

8

7

6

5

4

3

2

1

0 Extraversion/ Sensing/ Thinking/ Judging/ introversion intuition feeling perceiving

Figure 3: Nursing leadership constructs and decision evaluation improvement

100 90

Session three explored the im- 80 pact of individual perception and 70 information processing on decision 60

making. A detailed illustration was

briefly presented. What the mem- Perc

ent 50

40 30

bers recalled about the picture 20 was discussed to demonstrate 10 how differently people perceive 0

and interpret information, aligned

with personality type. Divided by

type dichotomy, members were

asked to resolve a nurse staffing

challenge. Solutions were com-

62.5

50

87.5

50

25 25 25

62.5 62.5

0

Trus

t

Appr

ecia

tion

and

unde

rsta

ndin

g

Colla

bora

tion

Com

mun

icat

ion

Prof

essi

onal

grow

th

Ethi

cal c

ondu

ct

Evid

ence

-bas

edpr

actic

e

Deci

sion

val

ue to

stak

ehol

ders

Deci

sion

pro

cess

expe

dien

cy

Deci

sion

prag

mat

ism

pared, highlighting the influence

of person ality type.

Session four included recogniz-

ing team strengths and gaps by in-

creasing member understanding,

group trust, communication, and

collaboration. The decision-making

process was used to navigate a criti-

cal decision team scenario. Atten-

tion was given to personality type

preferences, outcomes, and stake-

holder values. Discussion of the

impact of personality type on nurse

leadership constructs, best practice,

and shared governance council

collaboration followed. Additional

open dialogue about the project,

activities, learned knowledge,

application capacity, and personal

disclosures occurred, and the post-

intervention assessment tool was

administered.

Results

The MBTI and best-fit educa-

tion module disclosed member

self – report of personality type.

(See Figure 2.) Most members had

a preference for feeling over think-

ing. What draws individuals into

caring professions is typically an

empathetic, subjective viewpoint,

defined as feeling.4 More members

reported a preference for extraver-

sion over introversion, common

to groups and demonstrated by

participation degrees during dis-

cussions. Sensing/intuition and

judging/ perceiving had equal

representation.

The coded matched analysis

for the pre- and postassessment

revealed that all members reported

improvement in nursing leadership

constructs and decision evaluation.

www.nursingmanagement.com Nursing Management � September 2016 9

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Team Concepts

(See Figure 3.) Individual improve-

ment ranged from 10% to 70%, ac-

cording to outcome comparison.

The greatest collective improve-

ment was reported in collaboration

at 87.5%. High improvement was

reported in group trust, decision

process expediency, and decision

pragmatism at 62.5%. Peer appreci-

ation and understanding, as well as

communication, revealed a 50% im-

provement. All other constructs re-

ported a 25% improvement, with

the exception of personal profes-

sional growth, which showed no

perceived change during the

4-month project. Group discussion

revealed that each member de-

clared an initial moderate-to-high

regard for this construct and didn’t

waiver.

All four sessions were evaluated

by member report. A cumulative

graph demonstrated the positive

trajectory of evaluation by session,

inclusive of interest; added knowl-

edge; informed communication for

collaborative decision making; and

presenter effectiveness, which

scored highest in all four sessions.

(See Figure 4.) The escalating results

reflected member buy-in and value

placed on the project’s content and

goals.

Significant qualitative data were

gleaned from emergent themes

shared by participants. (To view the

themes, see the Nursing Management iPad app.) The project sample size

and supportive context created a

safe environment for personal dis-

closure of thoughts and reflections.

Understanding the MBTI helped

members define their actions, pro-

pensities, and inclinations. Com-

ments were categorized into the

common themes of personality type

self-awareness, impact on decision

making, awareness of other council

members’ personality types, under-

standing of MBTI application in the

workplace, and enhanced collabora-

tion with other healthcare disci-

plines. Productive and positive

feedback demonstrated substantial

benefits to self, peers, and the inter-

disciplinary team.

Acknowledged inherent limita-

tions of the study were the small

convenience sample, an investigator-

created tool, and self-reported data

collection.

The personality impact

Educating nurse leaders about per-

sonality types is increasingly signif-

icant to nursing practice. This study

exemplifies the prospective benefits

Figure 4: Session total mean scores

17.6

18.1

18.87

19.25

SESSION ONE SESSION TWO SESSION THREE SESSION FOUR

of incorporating personality types

into the nurse leader decision-

making process. Heightened self-

awareness and peer appreciation of

the impact of personality types can

improve communication and col-

laboration within nursing and other

disciplines. Empowering nurses to

engage in decision-making forums

brings sage input from the bedside

to the boardroom. NM

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Group cohesion and nurse satisfaction: examination of a team-building approach. J Nurs Adm. 2005;35(3):110-120.

4. Myers IB, McCaulley MH, Quenk NL, Ham-mer AL. MBTI Manual: A Guide to the De-

velopment and Use of the Myers-Briggs

Type Indicator Instrument. 3rd ed. Moun-tain View, CA: CPP; 2009:5-12.

5. Dougherty MB, Larson EL. The nurse-nurse collaboration scale. J Nurs Adm. 2010; 40(1):17-25.

6. Politi MC, Street RL Jr. The importance of communication in collaborative decision making: facilitating shared mind and the management of uncertainty. J Eval Clin

Pract. 2011;17(4):579-584. 7. Brewton C, Eppling J, Hobley M. Our

VOICE: an interdisciplinary approach to shared governance. Hosp Top. 2012; 90(2):39-46.

8. Moore J, Prentice D. Collaboration among nurse practitioners and registered nurses in outpatient oncology settings in Canada. J Adv Nurs. 2013;69(7):1574-1583.

9. Hough JH, Ogilvie D. An empirical test of cognitive style and strategic decision out-comes. J Management Studies. 2005; 42(2):417-448.

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Linda S. Burkett was an RN-BSN program in-structor. She’s currently pursuing other venues to apply the components of this project.

The author has disclosed no financial rela-tionships related to this article.

DOI-10.1097/01.NUMA.0000491131.60730.d3

10 September 2016 � Nursing Management www.nursingmanagement.com

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