The Way Ahead Towards Quality: Evidence Based Health Administrator (EBHA)

بسم الله الرحمن الرحيم KINGDOM OF SAUDI ARABIA \ MINISTRY OF HIGHER EDUCTIONKING SAUD UNIVERSITYRIYADH MALE COLLEGE OF HEALTH SCIENCESHEALTH SERVICES ADMINISTRATION PS DM The Way Ahead Towards Quality PS DM: The “Evidence Based Health Administrator (EBHA)” EISA ALI JOHALIعيسى بن علي الجوحلي2009\2010\2011\2012\2013 PSDM2013

بسم الله الرحمن الرحيم Welcome PS-DM ? • EISA ALI JOHALI • عيسى بن علي الجوحلي • A Lecturer • B A. M. Sc. Heath Education, KSU 1407 /1987 • Short Fellowship Planning Health Professions Education, UIC, USA 1991 • MA (Ed.) Nursing Curriculum, Teaching & Learning, UK 1995 • Author of two published books, the 3rd under publishing, plus 2 projected PSDM2013

JOHALI PROBLEM SOLVING & D MAKINGPROBLEM SOLVING & DECISION MAKING PSDM PSDM2013

Evidences from Holly Quran بسم الله الرحمن الرحيم والصلاة والسلام على سيد الأنام نبينا محمد بن عبدالله (صلى الله عليه وسلم) وبعد نفتتح مذكرتنا هذا بما نتطلع وإياكم له دنيا وآخرة بقول الله عز وجل: • { وَقُلِ اعْمَلُواْ فَسَيَرَى اللّهُ عَمَلَكُمْ وَرَسُولُهُ وَالْمُؤْمِنُونَ وَسَتُرَدُّونَ إِلَى عَالِمِ الْغَيْبِ وَالشَّهَادَةِ فَيُنَبِّئُكُم بِمَا كُنتُمْ تَعْمَلُونَ } التوبة 105 (بعض من براهين الجودة والعمل بإخلاص وجزاءه الجنة) • {ثُمَّ كُلِي مِن كُلِّ الثَّمَرَاتِ فَاسْلُكِي سُبُلَ رَبِّكِ ذُلُلاً يَخْرُجُ مِن بُطُونِهَا شَرَابٌ مُّخْتَلِفٌ أَلْوَانُهُ فِيهِ شِفَاء لِلنَّاسِ إِنَّ فِي ذَلِكَ لآيَةً لِّقَوْمٍ يَتَفَكَّرُونَ }النحل69 • {يَا أَهْلَ الْكِتَابِ لِمَ تُحَآجُّونَ فِي إِبْرَاهِيمَ وَمَا أُنزِلَتِ التَّورَاةُ وَالإنجِيلُ إِلاَّ مِن بَعْدِهِ أَفَلاَ تَعْقِلُونَ }آل عمران65 (من براهين الحث على التعقل والتفكير .. وهي كثيرة جدا.. بل أن الاسلام كله كذلك) (بحث المزيد ذوا العلاقة المباشرة بمواضيع المقرر ”عربي انجليزي“ خيار مشاركة بحثية فرصة لكم) PSDM2013

Preface We are beginning to realize that, everything else being equal, the level of effectiveness and efficiency in an (health services) organization is directly related to the “Quality” of problem – solving and decision – making J. Alexander McMahan in Jonathon Rakich et al 1985 Although, PS is a complex approach, it is like “Yet” the Arabic pronoun that collapses the minds of the scientists. The above citation promotes my attention that “every work, every teacher, and all the health professions of whom your our future “Health Administrators” the master of health care services, should look for Excellency the “Quality”. Therefore, I review most of the literature that emphasis the relation between Quality and our Problem Solving - Decision Making (PS-DM) Course, looking for Quality Centred Health Care Managerial PS-DM (Quality CHCM PS-DM). Staring by reasoning why we have to learn PS-DM?, probing their scientific roots with historical development progress towards quality, and promote my adult learners to be active creative, and finally to share in rebuilding the most common theories and process models to meet the national needs, interests and demands. Finally it is my pleasure, to remind my adult learner that “Every learner Will Success Except Who Don’t Want” The Lecturer PSDM2013

بعون الله ثم بالإخلاص والجد والاجتهادخطتنا لتعليم وتعلم نافعPS-DM Objectives & Lifelong T – L Plan 2012\2013 PSDM2013

PS-DM Major References & Sources • ** Your Smart Reflective Notes. • ** Johali, E. A. (2009/2013) Problem Solving – Decision Making: The Way Ahead Towards Quality PS -DM: The “Evidence Based Health Administrator (EBHA)”A Critical Lecture Notes & Literature Review (Available at Student Copy Centre the Collegeمركز التصوير بالكلية & at al Quiafil Centre near KSUمركز القويفل لخدمات الطلاب طرق الملك فهد جوار جامعة الملك سعود) • *Rakich, Jonathon . S. etal (1985) Managing Health Services Organizations (Chapters 1 & 7). W. B. Saunders. • *Gredler, M. E. (2005) Learning Instruction: Theory into Practice. Pearson. • MaggiSavin-Baden (200) Problem – based Learning in Higher Education: Untold Studies. SRHE & Open University Press. • Scriven, M., & Paul, R. (1992) Critical thinking defined. Handout given at Critical Thinking Conference November, Atlanta, GA. • The related Internet Sites …. www.managementhelp.org/prsn_prd/prob ........... PSDM2013

Be Ready – Define Course Abbreviation • To be "Ready – Welling", Let us "Learn by Thinking about the most popular Course Abbreviations: • Reflect on meaning of (P; PS; DM)? • What do you think (CT/RT) mean? • What is the relations between the above Abbreviations? Our Course is: PSDM? What is it mean? ============== • “PSDM” is not just reflect relation, it is a created formula to explain the "Strong Correlation" between the two approaches of our course the “Problem Solving & Decision Making” • There is no effective & efficient DM without PS; and there is no PS without Critical/Reflective Thinking (CT/RT) • Explaining the CAs Symbols & Sources: - Centre showing how P confused - Math the Creative Problem Solving and Synaptic Problem Solving Strategies - Others reflects approached and models for later PSDM2013

Reasoning Why PS DM? Think in Peer & Small Group • Who are you ? & whom you are working with? • Review your Responsibilities & Duties? • Can you manage without Problem/ PS DM? • Can you reach Excellency “Quality Management” without PS? ----------- To conclude: We are learning PS DM because, it is a part of HA job description (HAJD), to assure the Quality of his Profession, we can not decide effectively and efficiently “reach Quality” without QPS Process PSDM2013

Probing & DefiningThe Sciences of PS DM? • The Histo-Scientific Roots & Definitions of (PS DM); PS/PSL in relation to theirquality leading the CT/RT. • The Most related Theories/Models/ Approaches & Techniques PSDM2013

Probing Scientific Roots of PS-DM PS • Almost, every scientific term comes from education/experience/ PS with Learning the Millennium • Historically, PS is traced back to the Ancient Greek Philosophers of Education mainly Socrates & Aristotle, by their advice “not to teachbut to put a problem in front of students to be solved by them self” • Did our Ancient Muslims Philosophers/Scientists such as al Ghazali, Ibn Sina’a (Avicenna) .. have experiences with Learning /PS/PSL/PBL ?(Ego Reflective) ==== Ego Reflective What is the difference between PS/PSL&PBL?” PSDM2013

Probing Scientific Roots of PS-DM • In the early 1900s,"Rousseau"a French philosopher promote and practice the above advices by his saying: Give your scholar no verbal lessons, he should be taught by experiencealone...Put the problems before him and let him solve them himself. Let him know nothing because you have told him, but because he has learnt it for himself. Let him not be taught science, let him discover(Johali 1995) • Also, Albert Einstein" (1878-1955) the German/US Physicist advised their pupils to use PS (Valcin 2001) • Later, many Western philosophers and scientists and Authors mainly the Psychologists and Humanists such as (Dewey 1938; Rogers 1969; McGuire 1972, Barrows & Tamblyn 1980 Neisser 1982...) were added new concepts/approaches to PS/PBL skills and activities PSDM2013

Probing Scientific Roots of PS-DM • Meanwhile in the 1980s the McMaster Canadian University, the PS introduced to medical education as skills, and developed to ” Problem Solving Learning PSL”, & later to PBL/PBC to & PBM • In the late 1980s, PS widely introduced to the nursing and nursing managerial Decision Making, with Elective/Critical Thinking (Harrison 1981). DM • Decision Making starts early with tale of Management, it used as a synonymous for “Management and Leadership” which have huge philosophical and scientific concepts. • In the late 1940s, Herbert A. Simon’s argument that most managers made decisions that did not fit the objectives rationality theory (Simon 1965), by which PS and CT were used to reach quality DM. (Simon introduced PS to DM by CT ) PSDM2013

Defining PS DM? DM • Decision the choice of one from a set of initially possible alternatives. • DM is the act of choosing; a process of converting information into action (Practice) • DM is the study of identifying and choosing alternatives on the values and preferences of the decision maker (Science) • DM can be describe as the process of sufficiently reducing uncertainly and doubt about alternative to allow other reasonable choices • Decision Maker (D. Maker) is a person, or a group of people (e.g., a committee) who makes the final choice among the alternatives. PSDM2013

Defining PS DM? PS • Every Problem (P) asks for an answer or solution. • Pis the gap between the current and the desired situations/ it is an obstacle /barrier to achieve objective • Trying to find a solution to a problem is known as “Problem Solving (PS) process”. • PS is the act of finding the most appropriate solutions/answers (Act) • In Managerial process, PS is a part of DM, it is a systematic process that focuses on analyzing a difficult situation Ego Reflective thinking “Can you decide without PS? – Can you SP without DM?” PSDM2013

Probing PS-DM/PSL/PBL – A Puzzle? My Students are dismayed when I say to them“ Half of what you are taught as medical students will 10 years have been shown to be wrong, and the Trouble is, none of your teachers known which half Dr Sydney Borwell, Dean of Harvard Medical School In Small Group, read critically, the above “Mystery/Puzzle” statement, discover problem/problems and the associated factors. Finally look for solutions and decide ? Also, I am say “ more than Half of What You are taught at the college in 3 years are Wrong ?! Do You Agree ? (Y / N ) Why ?! --------------- This Puzzle wrote as an introductory for PS/PSL/PBL? Or other further developed “Health/ Medical Education Approaches ?” PSDM2013

Defining PSL/PBL - In PSL Problem is compulsory ( F ) Option \ In PBL Problem an option (F) compulsory PSDM2013

PS DM Most CommonTheories / Models/ ApproachesThat can assure QPSDM PSDM2013

Theories & Models PS + CT/RT = QDM Although only one step in the problem solving process, decision making is an important task that relies heavily on critical thinking skills (Marquis & Huston, 1994) To improve decision–making ability, it is important to use an adequate process model as the theoretical bases for understanding and applying critical thinking skills. The above citations are evidence regarding the strong correlation ( ) not only between PS & DM, but also there is Strong correlation with Critical/Reflective Thinking (CT/RT) Or PS + CT/RT = QDM , there is no Quality DM without PS, there is no QPS without CT. By this equations,we can start probing the most related philosophical scientific concepts . PSDM2013

PS DM Theories & Models There are a huge literature regarding philosophies and sciences of “Managerial=Decision Making the Manager, the leader, and Health Management or H Administration, in addition to “Critical Thinking & Problem Solving”. However, since you a third year student, it is expected that you have learn the most related philosophies and sciences of health managerial and management. By which we have to enlighten our way to assure the “Quality Health Managerial Problem Solving Model” (QHMPSM) • Follow – See by Minds – Predict & Conclude • The Philosophers & Scientists of PS/PB Learning theories: • Plato’s view 327-417 B.C. “the mind was developed through the study of the pure forms of mathematics such as the circle, the square, and the classics”; • Gestaltqualtat. Psychology (Gestalt 1890s, Wertheimer 1939, Murphy 1949, Katona 1967… etc) the sensory elements ‘Perception of Mathematic PS”: • - P1: the 8 Coins?; P2 the 7—5 Matchstick: • Math PS: • P 1: to be one coin touch only 3 coins P2: change to 5 square only? • P3: Measure 20 units of water from jugA= 29 units & B = 3 units? • P4: Measure 99 units from jar A= 14 units, B = 163 units, C=25? • P5: Measure 25 units from A= 28, B=76, C=4 • Solutions later, after your Reflective Thinking PSDM2013

S P1: In the 1st semester, after one week the learners come without solution, they did not even try to think, in It is very easy for those who tried in the class. In the 2nd it seems more difficult in the class.. it is just by moving (3) & (6) the Best PSDM2013

SP2: It seem more / less difficult, with 1St Sem. It was similar as above, no one try to solve. With 2nd “You” ……….. It is just by moving “Three” matchsticks only (the middle “ up, left & right” to reconstruct new square down to the left (more complex the P1) PSDM2013

Gestalt psychology Math. PS (Cont.) P3: Measure 20 units of water from jugA= 29 units, JugB = 3 units? SP3: Fill Jug Aand pour it off into B three times 29 – (3X3) = 20 (complex = multiple solutions, alternatives) P4: Measure 99 units from jugA= 14 units, B = 163 units, C=25? SP4: By “Fill Jar B; pour into A, and then fill C twice jar A” B – A (– 2C )= 163 – 14 – 50 = 99 units (complex = multiple solutions, alternatives) P5: Measure 25 units from A= 28, B=76, C=3 SP5:Only by A – C (a simple one way solution ) PSDM2013

Philosophers & Scientists ofBehavioral Learning by PS • Piaget’scognitive development theory 1920s;1963: Development of Natural Logic from birth to adulthood - Logical Reasoning & Thinking (= Symbolic–Picture–Logic the SPL Computing Program/ Turtle Geometry & LOGO…. ) - Just motivate Readiness • Vygotsky’s Curtural – historical theory 1924-1934: The Problems that the child solves independently represent the actual level of development (Self PS = Real level of Development) • Pandura’s social-cognitive theory 1963: With Self regulatory system, the major function of thoughtis to enable people to predict events and to develop ways tocontrol those that affect their lives. • Skinner’s operant conditions theory: A baby shakes a rattle, a child runs with a pinwheel, a scientists operates a cyclotron – and “ALL ARE “Reinforced” by the Results(Skinner1968; Gredler 2000) • Gagne’s conditions of learning: quality of learning in 9 phases from attendance and expectancy to generalizability “develop, modify, create” new science/skills”. (Just learn by thinking & comparing Not by memorize) PSDM2013

Philosophers & Scientists ofBehavioral Learning by PS • In 1966: Paige and Simoncompared the problem-solving performance of STUDENT to that of human problem solvers. Their intent was to try to describe human behavior while solving algebra word problems. Their results provided evidence that the direct-translation (syntactic) process of STUDENT is a good first approximation in describing human problem-solving performance. Further testing determined that STUDENT could not account for human solution processes that rely on semantic knowledge. • According to Hayes and Simon (1974),UNDERSTAND was based on two underlying assumptions. To understand a written problem, the text is read and encoded both semantically and syntactically; and a representation must be made of the newly encoded information. The resulting representation must include what Newell and Simon (1972) defined as a problem space. A problem space consists of the set of problem elements, the initial state of the problem and its goal, an operator or a set of operators for transforming the initial state into the goal, and the restrictions under which the operator may be applied (later you will discover their related concepts in PS Learning Triangle Model) (Just learn by thinking & comparing Not by memorize) ===== (Again don’t memorize but use your Magic brain to compare, think & learn for “ Ego Q: Question Gagne supports “Reinforced by Result” ( T / F ?) PSDM2013

The PSL Triangular Model (PSLTM) • Add “CAPs” • Cognitive: Know • Attitude: Value • Practice: skills Redraw with CAPS = PSDM PSLTM at center ; C after Understanding; A after experience and P after Rep… Mathias J. Sutton Purdue University http://scholar.lib.vt.edu/ejournals/JITE/v40n4/sutton.html PSDM2013

What is PSLTM ? • This Model traced back to the emphasis on problem solving in technology education which was paralleled the move in general education from behaviorism toward constructivism, or a blend of behaviorism and constructivism. • The Hayes and Simon (1974) Model of human problem solving differentiated between understanding the problem and solving the problem. They explained that the problem-solving process isnonlinear (a Latin word means not created by lines but by Math functions). Solving may begin without a complete representation of the problem. • The circle at the center of the model (1) represents learning transfer (Knowledge- Cognitive) Once the solver (2) completely understands the problem and its underlying structure (Attitude), then transfer to similar situations can occur (Practice). There is a definite link between the understanding of a problem and transfer of learning. In order to transfer knowledge, it is necessary for students to understand the internal connections between problems and domain knowledge(Greeno, 1984; Jonassen, 2003). Learning transfer is at the center of the model because it represents the heart of all learning, applying what has been learned to novel (new work) situations. • At 1966 Hayes and Simon produce model of human problem solving the PSLTM (T\F) correct? • - Hayes and Simon model of human problem solving the PSLTM explain that: • h • h • h PSDM2013

Common PS Types The different types of problem solving: •  Preventative: • � PPS: looks at putting in place solutions prior to abnormalities occurring. Best identified during the design stage prior to transfer to manufacturing using Advanced Quality Tools. •  Pro- active: • �PAPS: looks at the current standards and by analyzing data using the 7 quality control tools seeks to make kaizen improvements (http://kaiserpermenate.org ) •  Reactive: • � RAPS: looks at the abnormalities that have occurred and by gathering and analyzing data using some of the 7 quality control tools aims to provide a customer protection and countermeasure. (more detail regarding Tools later ) PSDM2013

Chiclets’ Table ofProblems & Other PS Types Two • Ref Qs: • Heuristic meta thinking used SPC (F\T)

Characters of Difficult Problems • Intrasparency:Lack of clarity of the situation • Polytely:Multiple Goals • Complexity:Huge numbers of items, interrelations, and decisions • Dynamics:Time considerations(1 Min Manage) PSDM2013

Conclude in a mathematical equations: Secrete of Miracle Mind + Physical training Math+ 6 Sensations the Perception + Motivation + good Conditions = Ready & Welling to reach QDM = PS + CT/RT Think (Where do you place “PS” process in our Mind) At? ---Highest the Complex Level/ Learning PS Thus, Metacognitivedescribes as “Thinking “about, when, and where”of Thinking” = Not only think about deep and wide knowledge or information and one’s awareness to solve problems, buthow, when and where to use appropriate strategies Why P Difficulties & the CT/RT the Meta / Deep the Meaningful Thinking for PS?! (See P Difficulties) PSDM2013

PS-DM Critical/Reflective Thinkingبداية التقييم الثاني (CT/RT)Prime aim of the course - There is no QPS & QDM without CT\RTEgo Reflective Assignment (15 Grades free)Discover Brain the Miracle Creation?!! اكتشف عظمة معجزة العقل وعلاقته بالتفكير PSDM2013

CT Group Work to Reflect these picturesSee & Feel by your Mind’s Eyes & Senses ! PSDM2013

What is CT/RT? • As it deals with using Brain the Miracle creation of “ALLAH” the Only Greatest and Merciful in the whole Universe, CT defines and describes by various philosophers and scientists, all agreed that it is more complex than PS and DM”. • Critical Thinking, sometime referred to as Reflective Thinking, it related to evaluation and has a broader scope than PS-DM. • Reasoning & Creative analysis are the Major Two Elements of CT are • CT requires Reflective = Deep ; Contemplative; Insightful; Philosophical Thoughts Reflective Assignment “Search for Evidences in the Wholly Qura’n” PSDM2013

What is CT/RT ? Critical Thinking is The use of those cognitive skills or strategies that increase “the probability of a desirable outcome” the quality The intellectual process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action Modern, Modified frm (Scriven & Paul, 1992) • It is used to describe thinking that is purposeful, reasoned and goal directed PSDM2013

What is CT/RT? • It is the kind of thinking involved in solving problems, formulating inferences, calculating likelihoods, and making decisions when the thinker is using skills that are thoughtful and effective for the particular context and type of thinking task. • It involves evaluating the thinking process - the reasoning that went into the conclusion we've arrived at the kinds of factors considered in making a decision. Critical thinking is sometimes called directed thinking because it focuses on a desired outcome. PSDM2013

Critical Thinking Definitions:Common Components (5S+S+MT) • Self-assessment. • Self-directed • Self-disciplined • Self-monitored, and, • Self-corrective thinking • Standards for thinking. • Meta-level of thinking: more than just skills or abilities. • Thinking as a basis for informed action. PSDM2013

CT Characteristics C/RT who can (5 Capabilities=AMDDM): 1- Ask critical questions; 2- Make detailed observations; 3- Discover assumptions and define their terms; 4- Distinguish between fact and opinion; 5- Make assertions based on sound logic and solid evidence. Characteristics of Critical Thinker (3As+IAW+LSS+LALEA): • Asks pertinent (relevant) questions • Assesses statements and arguments • Able to admit a lack of understanding or information • has A sense of curiosity • Interest in finding new solutions • Able to clearly define a set of criteria for analyzing ideas • Willing to examine beliefs, assumptions, and opinions and weigh them against facts ( Cont.) PSDM2013

CT Characteristics 8. Listens carefully to others and is able to give feedback 9. Sees that critical thinking is a lifelong process of self-assessment 10. Suspends judgment until all facts have been gathered and considered 11. Looks for evidence to support assumption and beliefs 12. Able to adjust opinions when new facts are found 13. Looks for proof 14. Examines problems closely 15. Able to reject information that is incorrect or irrelevant PSDM2013

FRISCO-Model of CT • Focus- What is the main point/issue, question to resolve? • Reasons- What supports our conclusion, what is the evidence? • Inference (Conjecture)-How well do the reasons support the conclusion? • Situation-What is the context in which we are operating? • Clarity-Have we avoided confusion? • Overview-Review and check mechanism? (Redraw with coming CT-Frisco M) PSDM2013

CT“FRISCO”MODEL Do You Believe in Your Amazing Brain; is it able? Discover some evidences (RQ: Redraw Integrated Model from Frisco + CT Frisco ?) PSDM2013

few old Evidences Amazing Magic Brain PSDM2013 You are the Owner of the World’s Most Powerful Computer

FOUR CT STYLES in three steps Discover Y CT Best Styles PSDM2013

in three step Discover Y CT best Styles - 1st PSDM2013

in three step Discover Y CT best Styles – 2nd PSDM2013

in three step Discover Y CT best Styles – 3rd PSDM2013

in three step Discover Y CT best StylesResults • CS= Concrete(physical, real) Sequential - based in reality, what you can detect by your senses, you can notice and recall easily • CR = Concrete Random - Same as above except that you are willing to take more of a trail – and – error approach, thus,you often have the feeling of true creative thought • AR =Abstract random - Organize information through reflection, and thrive in unstructured - Your real world is feelings and emotions • AS = Abstract (theoretical, conceptual) sequential = You love the world of philosophy (abstract thought) and theory – May, You will be a great philosopher and scientist (Continuing discover your CT Styles ?) PSDM2013

PS DMAPPROACHES & APPLIED MODELS PSDM2013

PS-DM Common Approaches • The Rational Approach: it traditional and more typically used, it involves CAIACIE كياكي7 Steps: • Clarifying description of the problem • Analyzing causes • Identifying alternatives • Assessing each alternative • Choosing one, (*** DM occurs ) • Implementing it, • Evaluating whether the problem was solved or not? ======= R\CTQs • CAIACIE is …………, …. • PS-DM Rational approach is more state of the art … (F) the true “Appreciative inquiry • DM occurs at the 5th Step of CAIACIE (T/F?) PSDM2013

PS–DM Common Approaches • The second PS Approach is the Appreciative Inquiry. • It is more state-of-the-art approach, • it asserts that "problems" are often the result of our own perspectives on a phenomena, eg, if we look at it as a "problem," then it will become one and we'll probably get very stuck on the "problem.“ • It approves / more +ve • Appreciative inquiry includes: • identification of our best times about the situation in the past, • wishing and thinking about what worked best then, • visioning what we want in the future, and • building from our strengths to work toward our vision( ***DM) R\CTQ • Appreciative Inquiry the 2nd PS-DM approach involves CAIACIE (F) the true (the Rational) • PS-DM Rational approach approves more positive (F) the true “Appreciative inquiry) • In Appreciative Inquiry the PS-DM approach, you can decide at the last step (T) PSDM2013

The Way Ahead Towards Quality: Evidence Based Health Administrator (EBHA)