title: Adaptive decision-making: how Australian healthcare managers decide.
abstract: Despite many calls for the utilisation of research evidence in health policy-making, it is not widely practised, and little is known about how decision-makers in healthcare organisations actually make decisions. We recruited a purposive sample of Australian healthcare decision-makers to complete a web-based survey. We then took a sub-sample from willing respondents for individual interviews. All interviews were audio-recorded, transcribed verbatim and coded thematically. We found that resource allocation decision-making varied greatly across the Australian healthcare system. Decision-making was highly dependent on the operational context in time, place and purpose, and that research evidence was rarely exploited to its full potential. Decision-making involved a multifaceted interplay of elements in situation of inquiry. All decisions were made by networks or collectives of people; and no instance of individual decision-making was reported. This varied, social and contextual nature of decision-making points to a complexity that is not reflected in systematic evidence-based reviews or evidence-based models for decision-making, and we did not discover an appropriate model to reflect this complexity in the health- related literature. We developed a model of 'adaptive decision-making' that has potential to guide robust decision-making in complex situations, and could have some value as an explanatory or theoretical model for teaching and practice.
authors.affiliation: Zahedan University of Medical Sciences, Zahedan, Iran. abag2253@uni.sydney.edu.au
authors.forename: Abdolvahab
authors.initials: A
authors.lastname: Baghbanian
authors.forename: Ian
authors.initials: I
authors.lastname: Hughes
authors.forename: Ali
authors.initials: A
authors.lastname: Kebriaei
authors.forename: Freidoon A
authors.initials: FA
authors.lastname: Khavarpour
mesh_terms: D003625:Data Collection; D003659:Decision Making, Organizational; D006270:Health Facility Administrators; D006295:Health Resources / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic