Decision Making in Health Service Managers

The literature on managerial decision making has typically espoused rationality. It contends that managers follow, or should aspire to follow, a rational approach to decision making. This article argues that this rarely occurs. It proposes that managers form a personal and simplified “model” of the real situation, incorporating personal and environmental factors, to facilitate their decision making. The study used repertory grid to explore the decision making model of 16 National Health Service managers, investigating, in particular, what factors were important to them when considering strategic decisions. Results indicated the complex and idiosyncratic nature of managerial decision making, vindicating the view that to understand decision making in any detail requires knowledge of the individual′s model. Rationality did not emerge as the driving force underlying the managers′ decision making behaviour. For many managers, emotional items seemed to exert a significant influence on their decision making. A link between patterns of construing and stress was hypothesized. Managers whose construing was “simpler”, contained contradictions, or was more “emotional” in content, reported experiencing more stress.