Objectives. To (1) describe participation in decision-making as a systems-level property of complex adaptive systems and (2) present empirical evidence of reliability and validity of a corresponding measure. Method. Study 1 was a mail survey of a single respondent (administrators or directors of nursing) in each of 197 nursing homes. Study 2 was a field study using random, proportionally stratified sampling procedure that included 195 organizations with 3,968 respondents. Analysis. In Study 1, we analyzed the data to reduce the number of scale items and establish initial reliability and validity. In Study 2, we strengthened the psychometric test using a large sample. Results. Results demonstrated validity and reliability of the participation in decision-making instrument (PDMI) while measuring participation of workers in two distinct job categories (RNs and CNAs). We established reliability at the organizational level aggregated items scores. We established validity of the multidimensional properties using convergent and discriminant validity and confirmatory factor analysis. Conclusions. Participation in decision making, when modeled as a systems-level property of organization, has multiple dimensions and is more complex than is being traditionally measured. Managers can use this model to form decision teams that maximize the depth and breadth of expertise needed and to foster connection among them. 1. Introduction Participation in decision making (PDM) by workers, including all types of nurses, is recognized internationally as an important aspect of effective management in nursing and healthcare [1–5]. Prior researchers, however, have noted deficiencies in the conceptualization of PDM [5, 6]. Two factors, little consensus as to its specific meaning [7] and various definitions [8], contribute to inconsistent findings regarding outcomes of participation. These deficiencies may stem from a simplistic view of PDM [4, 5, 9–12], typically measured at the individual level, ignoring systems-level properties. Complexity science suggests that organizations are complex adaptive systems [13, 14] and as such PDM is an emerging property of the system. Emerging properties are generated by local interactions [15] and are particularly important for organizational adaption in complex, chaotic environments, such as the health care environment [16]. Participation emerges as nursing staff and managers of varying expertise and values interact at the local level through a variety of means (e.g., chance encounters, informal meetings, and committee structures) in making
References
[1]
B. A. Kash, G. S. Naufal, R. K. Dagher, and C. E. Johnson, “Individual factors associated with intentions to leave among directors of nursing in nursing homes,” Health Care Management Review, vol. 35, no. 3, pp. 246–255, 2010.
[2]
Y. Liu, “Complexity science and participation in decision making among Taiwanese nurses,” Journal of Nursing Management, vol. 16, no. 3, pp. 291–297, 2008.
[3]
M. J. Rantz, M. Zwygart-Stauffacher, L. Hicks et al., “Randomized multilevel intervention to improve outcomes of residents in nursing homes in need of improvement,” Journal of the American Medical Directors Association, vol. 13, no. 1, pp. 60–68, 2012.
[4]
M. J. Rantz, M. Zwygart-Stauffacher, M. Flesner et al., “The influence of teams to sustain quality improvement in nursing homes that ‘need improvement’,” Journal of the American Medical Directors Association, vol. 14, no. 1, pp. 48–52, 2013.
[5]
C. A. Wong, H. Laschinger, G. G. Cummings, L. Vincent, and P. O'connor, “Decisional involvement of senior nurse leaders in Canadian acute care hospitals,” Journal of Nursing Management, vol. 18, no. 2, pp. 122–133, 2010.
[6]
H. Kim, E. Capezuti, M. Boltz, and S. Fairchild, “The nursing practice environment and nurse-perceived quality of geriatric care in hospitals,” Western Journal of Nursing Research, vol. 31, no. 4, pp. 480–495, 2009.
[7]
E. A. Locke, D. M. Schweiger, and G. P. Latham, “Participation in decision making: when should it be used?” Organizational Dynamics, vol. 14, no. 3, pp. 65–79, 1986.
[8]
Wagner and A. John III, “Participation's effects on performance and satisfaction: a reconsideration of research evidence,” Academy of Management Review, vol. 19, no. 2, pp. 312–330, 1994.
[9]
D. P. Ashmos, D. Duchon, R. R. McDaniel Jr., and J. W. Huonker, “What a mess! Participation as a simple managerial rule to 'complexify' organizations,” Journal of Management Studies, vol. 39, no. 2, pp. 189–206, 2002.
[10]
J. S. Black and H. B. Gregersen, “Participative decision-making: an integration of multiple dimensions,” Human Relations, vol. 50, no. 7, pp. 859–878, 1997.
[11]
C. Colon-Emeric, S. Pinheiro, R. A. A. Anderson et al., “Connecting the Learners: improving uptake of a nursing home educational program by focusing on staff interactions,” The Gerontologist. In press.
[12]
K. M. Simpson, K. Porter, E. S. McConnell et al., “Tool for evaluating research implementation challenges: a sense-making protocol for addressing implementation challenges in complex research settings,” Implementation Science, vol. 2, no. 8, 2013.
[13]
J. A. Alexander, R. Lichtenstein, K. Jinnett, R. Wells, J. Zazzali, and D. Liu, “Cross-functional team processes and patient functional improvement,” Health Services Research, vol. 40, no. 5, pp. 1335–1355, 2005.
[14]
Institute of Medicine, Crossing the Quality Chasm: A New Health System For the 21st Century, National Academy Press, Washington, DC, USA, 2001.
[15]
P. Cilliers, Complexity and Postmodernism: Understanding Complex Systems, Routledge, New York, NY, USA, 1998.
[16]
R. R. McDaniel Jr. and D. J. Driebe, “Complexity science and health care management,” Advances in Health Care Management, vol. 2, pp. 11–36, 2001.
[17]
R. A. Anderson, K. Corazzini, K. Porter, K. Daily, R. R. McDaniel Jr., and C. Colón-Emeric, “CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes,” Implementation Science, vol. 7, no. 1, article 11, 2012.
[18]
R. A. Anderson and R. R. McDaniel, “Taking complexity science seriously: new research, new methods,” in On the Edge: Nursing in the Age of Complexity, C. Lindberg, S. Nash, and C. Lindberg, Eds., pp. 73–95, Plexus Institute, Allentown, Pennsylvania, 2008.
[19]
M. Ryan, “Micro-political strategies and their implications for participative decision making,” International Journal of Value-Based Management, vol. 13, no. 1, Article ID 100779, pp. 79–88, 2000.
[20]
S. A. Kowalik and L. H. Yoder, “A concept analysis of decisional involvement,” Nursing Administration Quarterly, vol. 34, no. 3, pp. 259–267, 2010.
[21]
K. Mainzer, Thinking in Complexity: the Complex Dynamics of Matter, Mind, and Mankind, Springer, New York, NY, USA, 3rd edition, 1997.
[22]
F. Capra, The Hidden Connections, Anchor Books, New York, NY, USA, 2002.
[23]
R. A. Anderson, L. M. Issel, and R. R. McDaniel Jr., “Nursing homes as complex adaptive systems: relationship between management practice and resident outcomes,” Nursing research, vol. 52, no. 1, pp. 12–21, 2003.
[24]
M. Toles, J. Barroso, C. Colón-Emeric, K. Corazzini, E. McConnell, and R. A. Anderson, “Staff interaction strategies that optimize delivery of transitional care in a skilled nursing facility: a multiple case study,” Family and Community Health, vol. 35, no. 4, pp. 334–344, 2012.
[25]
G. M. Pereira and H. G. Osburn, “Effects of participation in decision making on performance and employee attitudes: a quality circles meta-analysis,” Journal of Business and Psychology, vol. 22, no. 2, pp. 145–153, 2007.
[26]
M. Krairiksh and M. K. Anthony, “Benefits and outcomes of staff nurses' participation in decision making,” Journal of Nursing Administration, vol. 31, no. 1, pp. 16–23, 2001.
[27]
A. H. Muhammad, “Procedural justice as mediator between participation in decision-making and organization citizenship behavior,” International Journal of Commerce and Management, vol. 14, no. 3-4, pp. 58–568, 2004.
[28]
J. L. Cotton, L. John, Vollrath, et al., “Employee participation: diverse forms and different outcomes,” Academy Of Management Review, vol. 13, no. 1, pp. 8–22, 1988.
[29]
D. P. Ashmos, J. W. Huonker, and R. R. McDaniel Jr., “Participation as a complicating mechanism: the effect of clinical professional and middle manager participation on hospital performance,” Health Care Management Review, vol. 23, no. 4, pp. 7–20, 1998.
[30]
W. R. Ashby, An Introduction To Cybernetics, Chapman and Hall, London, UK, 1956.
[31]
D. E. Drehmer, J. A. Belohlav, and R. W. Coye, “An exploration of employee participation using a scaling approach,” Group and Organization Management, vol. 25, no. 4, pp. 397–418, 2000.
[32]
E. A. Locke and D. M. Schweiger, Participation in Decision-Making: One More Look Research in Organizational Behavior, vol. 1, 1979.
[33]
S. Kauffman, At Home in the Universe: The Search For Laws of Self-Organization and Complexity, Oxford University Press., New York, NY, USA, 1995.
[34]
M. Gell-Mann, “Complex adaptive systems,” in Complexity: Metaphors, Models and Reality, G. Cowan, D. Pines, and D. Meltzer, Eds., pp. 17–45, Addison-Wesley Publishing Company, Reading, Mass, USA, 1994.
[35]
F. Capra, The Web of Life, Anchor Books Doubleday, New York, NY, USA, 1996.
[36]
J. Holland, Hidden Order: How Adaptation Builds Complexity, Helix, New York, NY, USA, 1995.
[37]
J. Gittell, High Performance Healthcare: Using the Power of Relationships To Achieve Quality, Efficiency and Resilience, McGraw-Hill, New York, NY, USA, 2009.
[38]
J. M. Kruzich, “Empowering organizational contexts: patterns and predictors of perceived decision-making influence among staff in nursing homes,” Gerontologist, vol. 35, no. 2, pp. 207–216, 1995.
[39]
R. R. McDaniel and D. P. Ashmos, “Internal stakeholder group participation in hospital strategic decision- making: making structure fit the moment,” Journal of Health and Human Services Administration, vol. 18, no. 3, pp. 304–327, 1996.
[40]
J. W. Sutherland, Towards A strategic management and Decision Technology, Kluwer Academic Publishers, Boston, Mass, USA, 1989.
[41]
D. P. Ashmos and R. R. McDaniel Jr., “Understanding the participation of critical task specialists in strategic decision making,” Decision Sciences, vol. 27, no. 1, pp. 103–121, 1996.
[42]
D. P. Ashmos and R. R. McDaniel Jr., “Physician participation in hospital strategic decision making: the effect of hospital strategy and decision content,” Health Services Research, vol. 26, no. 3, pp. 375–401, 1991.
[43]
P. E. Connor, “Decision-making participation patterns: The role of organizational context,” Academy of Management Journal, vol. 35, no. 1, pp. 218–231, 1992.
[44]
J. Hage and M. Aiken, “Routine technology, social structure, and organization goals,” Administrative Science Quarterly, vol. 14, no. 3, pp. 366–376, 1969.
[45]
R. D. Dewar, D. A. Whetten, and D. Boje, “An examination of the reliability and validity of the Aiken and Hage scales of centralization, formalization, and task routineness,” Administrative Science Quarterly, vol. 25, pp. 120–128, 1980.
[46]
P. Leatt and R. Schneck, “Technology, size, environment, structure in nursing sub-units,” AARN News Letter, vol. 39, no. 4, pp. 24–25, 1983.
[47]
R. A. Anderson and R. R. McDaniel Jr., “The implication of environmental turbulence for nursing-unit design in effective nursing homes,” Nursing Economic, vol. 10, no. 2, pp. 117–125, 1992.
[48]
L. C. Mullins, C. E. Nelson, H. Busciglio, and H. Weiner, “Job satisfaction among nursing home personnel: the impact of organizational structure and supervisory power,” The Journal of long term care administration, vol. 16, no. 1, pp. 12–18, 1988.
[49]
J. C. Nunnally, Psychometric Theory, McGraw-Hill, New York, NY, USA, 1978.
[50]
L. C. Hughes and R. A. Anderson, “Issues regarding aggregation of data in nursing systems research,” Journal of Nursing Measurement, vol. 2, no. 1, pp. 79–101, 1994.
[51]
W. Joyce and J. Slocum, “Collective climate: agreement as a basis for defining aggregate climates in organizations,” Academy of Management, vol. 27, no. 4, pp. 721–742, 1984.
[52]
D. A. Kenny and L. L. Voie, “Separating individual and group effects,” Journal of Personality and Social Psychology, vol. 48, no. 2, pp. 339–348, 1985.
[53]
S. M. Shortell, D. M. Rousseau, R. R. Gillies, K. J. Devers, and T. L. Simons, “Organizational assessment in intensive care units (ICUs): construct development, reliability, and validity of the ICU nurse-physician questionnaire,” Medical Care, vol. 29, no. 8, pp. 709–726, 1991.
[54]
P. M. Bentler and D. G. Bonett, “Significance tests and goodness of fit in the analysis of covariance structures,” Psychological Bulletin, vol. 88, no. 3, pp. 588–606, 1980.
[55]
K. A. Bollen, Structural Equations with Latent Variables, Wiley, New York, NY, USA, 1989.
[56]
J. A. Parnell and W. Crandall, “Rethinking participative decision making: a refinement of the propensity for participative decision making scale,” Personnel Review, vol. 30, no. 5, pp. 523–535, 2001.
[57]
R. A. Anderson and R. R. McDaniel Jr., “Intensity of registered nurse participation in nursing home decision making,” Gerontologist, vol. 38, no. 1, pp. 90–100, 1998.
[58]
L. M. Issel and R. A. Anderson, “Intensity of case managers' participation in organizational decision making,” Research in Nursing and Health, vol. 24, no. 5, pp. 361–372, 2001.
[59]
R. A. Anderson, C. A. Allred, and F. A. Sloan, “Effect of hospital conversion on organizational decision making and service coordination,” Health Care Management Review, vol. 28, no. 2, pp. 141–154, 2003.
[60]
J. Banaszak-Holl, J. Alexander, N. M. Valentine, M. M. Piotrowski, J. G. Adams-Watson, and J. Davis, “Decision-making activity and influence of nurse executives in top management teams,” Journal of Nursing Administration, vol. 29, no. 4, pp. 18–24, 1999.
[61]
R. A. Anderson and R. R. McDaniel Jr., “RN participation in organizational decision making and improvements in resident outcomes,” Health Care Management Review, vol. 24, no. 1, pp. 7–16, 1999.
[62]
W. O. Brown Jr., “Faculty participation in university governance and the effects on university performance,” Journal of Economic Behavior and Organization, vol. 44, no. 2, pp. 129–143, 2001.
[63]
N. W. Vanyperen, A. E. Van Den Berg, and M. C. Willering, “Towards a better understanding of the link between participation in decision-making and organizational citizenship behaviour: a multilevel analysis,” Journal of Occupational and Organizational Psychology, vol. 72, no. 3, pp. 377–392, 1999.
