Problem Solving and Decision Making

What is it?

A key skill for procurement practitioners is problem-solving, which is the process of finding solutions to difficult or complex issues. It is usually combined with decision-making in terms of developing and choosing appropriate solutions to the problem. A typical six-step approach to problem-solving is outlined below.

STEP ONE: DEFINE THE PROBLEM

This is about diagnosing the problem: its context, background and symptoms. Once there is a clear idea of what the problem is, the implications are assessed: who it affects and how urgent or important it is to resolve it. Techniques such as brainstorming, interviews and questionnaires are often used at this stage to clarify the problem.

STEP TWO: DETERMINE THE ROOT CAUSES OF THE PROBLEM

This step explores what has caused the problem. There are a number of quantitative and qualitative methods that can be used for this purpose. A simple, popular and visual technique for collating information in a structured way and to focus on the underlying root causes of the problem is the fishbone diagram (named after its appearance), which is sometimes known as the Ishikawa diagram (named after its inventor). It is an analysis tool that provides a systematic way of looking at the problem and the causes that create or contribute to that problem.

STEP THREE: DEVELOP ALTERNATIVE SOLUTIONS

Analytical, creative problem-solving is about creating a variety of solutions, not just one. Often the most obvious answer is not the most effective solution to the problem. This stage focuses on:

• Finding as many solutions to the problem, no matter how outlandish they may seem.
• Looking at how each solution relates to the root cause and symptoms of the problem.
• Deciding if different solutions can be merged to give a better answer to the problem.

At this stage it is not about finding one solution, but eliminating the options that will prove less effective at dealing with both the symptoms and the root cause.

STEP FOUR: SELECT A SOLUTION

This involves evaluating all the selected potential solutions, and narrowing them down to one. This step applies three considerations:

• Is the proposed solution suitable (ie solves the problem)
• Is it feasible (in relation to cost, time and resources)
• Is it acceptable (to the stakeholders)

STEP FIVE: IMPLEMENT THE SOLUTION

This requires a project management approach. There should be a project plan which establishes the project manager, the implementation team, the start and finish dates, the key milestones, and the specific actions required. Progress should be monitored against the project plan. Any deviations should be investigated and remedial action taken.

STEP SIX: EVALUATE THE OUTCOME

The implemented solution needs to be evaluated to ensure it is implemented successfully and that it achieves its intended purpose.

What does it look like?

How does it work in practice? 

When faced with a process failure, organisations should enact short-term measures (first-order problem-solving) to resolve the immediate crisis, but then continue to investigate the process critically and collaboratively to determine the root causes of the failure and implement improvements that prevent a recurrence of that problem (second-order problem-solving). However, this second step often does not take place.

For example, a nurse who detects a shortage of a medical item in the supplies closet may implement any number of solutions (asking others, looking in other places or borrowing from another department) in order to solve the problem and minimise the interruption to patient care. If the nurse or nursing team stops there, the immediate crisis may be resolved, but the same scenario will likely recur because the root causes to the problem have not been addressed. If, on the other hand, the nurse/nursing team investigates more deeply to identify why the stockout occurred, and implements countermeasures to prevent future stockouts, the result would be a longer-term solution to the problem that improves ongoing operational performance.

In an analysis of 18 cases in a 140-bed general hospital with approximately 1200 employees, it was found that when a systematic second-order problem-solving approach was followed, the magnitude of improvements ranged from 77% to 100%.[1]

Creating a culture of problem-solving through teamwork and empowerment is the aim of Cleveland clinic.[2] It found that the best way to sustain a culture of improvement is to provide staff with the skills and encouragement to solve the most pressing problems in their areas. The organisation has worked with more than 12,000 staff in nursing, finance, pharmacy and other departments at many locations, coaching them on how to identify and tackle problems. There is an emphasis on open discussions about problems, prioritising them, and ensuring that staff has the time and capability to work on solving them.  Physicians are engaged with the scheme and it has the backing of the CEO.

At Cleveland’s Home Delivery Pharmacy a number of changes dramatically reduced turnaround times for deliveries, from 10-14 days down to 3 days or less. After identifying problems and posting them on a board, the pharmacy team worked together on solutions. They charted their progress and successes on the board under the headings ‘new idea’, ‘working on idea’ and ‘completed’. The team has sustained both their improvements and their culture for nearly three years.

Another team delivers supplies to operating rooms. This team had a high staff turnover rate, but involving them in making improvements resulted in improved efficiency and engagement. The team saw no staff turnover over the next three years and began to help other teams solve problems in their areas.

A study into medicines shortages in public hospitals in South Africa used a typical second-order problem-solving approach to analyse the procurement challenges.[3]

The overall problem was medicines shortages which led to staff frustration and compromised patient care. The causes were organised into three themes: the procurement process, supplier performance and the integrated computerised inventory system. The causes were identified and solutions proposed as indicated above.

[1] Ghosh, Manimay & Sobek, Durward; A problem-solving routine for improving hospital operations; Journal of Health Organisation and Management, Vol. 29 Iss 2 pp. 252 – 270, 2015

[2] https://consultqd.clevelandclinic.org/why-healthcare-organizations-need-to-develop-a-culture-of-problem-solving/

[3] Medicine shortages and challenges with the procurement process among public-sector hospitals in South Africa; Modisakeng, Cynthia; Matlala, Moliehi; Godman, Brian & Meyer, Johanna; BMC Health Services Research; Vol 20, Article 234, 2020