Comparing Two Rational Decision-making Methods in the
Process of Resignation Decision
Chih-Ming Luo, Assistant Professor, Hsing Kuo University of Management
ABSTRACT
There is over 15 percent resignation per year in Taiwan resulted in crises of nursing manpower. The
purpose of this study is to assists intuitional decision with system of rational thinking, structural practical
experiences and tacit knowledge, and overcome the weakness of intuitional decision for lacking scientific
decision process. This study is to compare two rational decision-making methods, the Even Swaps method
and the Kepner-Tregoe (KT) method, applied in nursing for manpower management. This study used
action research methodology to discover an agenda of change in aspects of manpower practice in nursing.
This study selected twelve nurses. The nurses required at least 5 years of experience in nursing and must
have participated in taking care of SARS patients. Through in-depth interviews, this study analyzed the
participants by using rational decision-making method during the period from September 2004 to April
2006. This study found that any drawbacks to intuitive decisions can be overcome by using rational
decision-making method. The Even Swaps method will be more complete with the use of the KT method.
In addition, it provides intuitive decision-making using a systematic and structural decision-making
process. No research has yet compared the Even Swaps of rational decision-making method and KT
methods for manpower management in a nursing field. Finding an appropriate decision-making method
to assist employee effectively manage their tacit knowledge of intuition has become increasingly
important in today’s high resignation environment. These two rational decision-making based methods
allow a user accurately to improve decision-making quality apply structural practical experiences and
tacit knowledge.
INTRODUCTION
Literature reviews indicated that intuition appears to be used by members of every level of staff
from student to expert. However, the disadvantage of intuitive decision processes can not be presented as
a systematic and structural approach. There is a need for future study to explore rational decision-making
processes in order to manage tacit knowledge of intuition. Thus, research on how to systematically and
structurally enhance the process of intuitive decisions is a very important issue. According to the National
Health Insurance System, the working environment for nursing staff has become difficult with a reduction
in payroll and an increase in workload (Tzeng, 2002). For example, a nurse in Taiwan takes care of an
average of 12 patients, whereas in America, a nurse may take care of an average of 3.4 patients (Adams &
Bond, 2000). As a result, a resignation crisis arose within the nursing staffs.
LITERATURE REVIEW
Theorists of decision-making in nursing can be seen to take four different approaches：pragmatists,
systematisers, diagnosticians, and intuition (Davies & Fox-Young, 2002). But there is not yet a research
The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008
21
comparing Even Swaps (ES) and KT and applying them to decision making in manpower field (Hallett, et
al., 2000). The purpose of this study is to assists intuitional decision with system of rational thinking,
structural practical experiences and tacit knowledge, and overcome the weakness of intuitional decision
for lacking scientific decision process. Theorists of decision-making in nursing take various approaches to
their work (Hallett, et al., 2000). 'Pragmatists' focus on the sources of information used in making
decisions (Lamond, et al., 1996). 'Systematisers' focus on the decision-making process as a structured,
schematic entity and who often draw on cognitive psychology (Bryans and McIntosh, 1996).
'Diagnosticians' see clinical decision-making as a process of 'diagnostic reasoning' (Acton, et al., 1997).
Moreover, intuition is a process of problem solving often described in such terms as 'gut feeling', 'pattern
recognition', 'know how' and 'tacit knowledge' (Easen and Wilcockson, 1996). Cioffi (1997) further argues
that claims to the use of intuition can still make nurses feel stigmatized because of the association of this
term with lack of scientific objectivity.
Certain studies have shown that clinical health care decisions are deeply affected by intuition (King
and Appleton, 1997). However, Easen and Wilcockson (1996) believed that decision-making could not be
separated into rational decision-making and intuitive decision-making without concern. In addition,
intuition may be considered as an irrational process with a rational basis. Therefore, the purpose of this
study is to assists intuitional decision with system of rational thinking, structural practical experiences and
tacit knowledge, and overcome the weakness of intuitional decision for lacking scientific decision
process.
METHODS
Methodology
Action research is a critical social activity, relying on participation and collaborative working to
generate change and new knowledge. One of the benefits of such an approach is the emphasis on using
experiential knowledge to inform an agenda of change in aspects of practice, and this is particularly
valuable when practitioners are marginalized in some manner (Winter and Munn-Giddings, 2005).
Therefore, this study belongs to the category of action research, according to the literature’s definition.
Data Collection
This study uses two methods to collect data, literature review and in-depth interview. These
databases include BSP/EBSCO host, and Medline. The period covered was from the early 1990s to 2005.
Johnson (2002) believes that in-depth interviewing means seeking “deep” information and understanding.
Based on Bobbie’s (1998) and Johnson’s (2002) points of view, a successful in-depth interview requires
the researcher to have a clear understanding of the research object and to understand the interview
questions and the information that the study intents to gain.
Research Framework
There are four steps in the research framework: 1. Topic research, 2. Data collection method, 3.
Research method, 4. Results. The details of each research step will be discussed in the coming section. In
methodology, the cycle of Planning- Action- Evaluation- Reflect represents the action research spiral. As
shown in Figure 1.
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The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008
Research
Question
Resignation in nursing
Data collection
Literature review
Action
Research
Spiral
In-depth interview
1.1990~2005
2. Database: EBSCO
host, Medline
Methodology
12 experts nurses
Planning
Reflect (revisit the spiral)
1. Criteria for selecting
the research participants.
Participants
In-depth
interview
At least 5 years
working experience
2. Methods familiarity
“one-to-one”
training
The average training
time was two hours
3. Training classes
“one-to-one”
training
To ensure no
difficulty in applying
ES and KT methods
4. Post test interview
In-depth
interview
Action
Tools
In order to further
understand their
reflections on the
decision-making
process
Evaluation
Result
Figure 1: The Research Framework
Methods Familiarity in the Research Participants
The twelve nursing staffs were required to study the ES and KT methods. The average training time
was two hours, with the classes being taught by the researchers on a “one-to-one” training to ensure no
difficulty in applying ES and KT methods. After the twelve nurses accepted the training of ES and KT
methods, they were tested with their decision-making ability using “vocation selection” as the matter to
be decided, following the influence of the SARS event. The time required in the decision-making process
was also recorded.
Post Test Interviews
After the test, all participants were subjected to in-depth interviews in order to further understand
their reflections on the decision-making process. This study wants to realize the influence of the SARS
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event on the “vocation-selection” process targeted twelve participants. The study employed the ES and
KT methods in the same decision-making question. It was found that using the two different method,
eleven participants resulted in the same decision being made, while the other one produced different
results.
CASE ILLUSTRATION
A nurse was chosen to case illustration for the use of the ES and KT methods. A decision was made
regarding to the change of career in this case. Have, Jobs A, B, C, and D represent 'continue in nursing',
'become a hospital administrator', 'start a new business ', and 'employed in the private sector', respectively.
Even Swaps Rational Decision-making
First, relevant information on objectives and alternatives is presented and these are ordered by
causal relationship. For example, in the objective of 'Growth', after comparison, Job A 'Middle', Job B
'Low' , Jobs C and D 'High' as shown in Table 1.
Alternatives
Objectives
Annual salary (＄)
Working hours
(hours/week)
Flexibility
Business skills
development
Growth
Annual vacation
Morale
Work Safety
Stress
Job Satisfaction
Mission
Table 1: Consequences Table
Job A
Job B
Job C
(Continue in
(Become a
(Start a new
nursing)
Hospital
business)
administrator)
20,000
12,000
30,000
44
Low
Nursing staff
Middle
15
Low
Low
High
High
High
44
Low
Computing,
Word
processing
Low
7
Low
Middle
Low
Low
Low
60
Job D
(Employed in the
private sector)
12,800
40
Low
Middle
Business operations, Computing,
Vision,
Word processing,
Communication,
Administration
High
High
0
7
High
Middle
Low
High
High
Middle
High
Middle
Low
Low
Ranking all of the alternatives, for example, in the objective of 'Growth', after comparison, Jobs C
and D 'High' ranks the first, Job A 'Middle' ranks the third, Job B 'Low' ranks the fourth, as indicated in
Table 2. A comparison of the numbers of lagging indicators, ignoring the alternative with the greatest
number of lagging indicators, yields the following: Job A has one ranking of 4; Job B has four rankings of
4; Job C has two rankings of 4 and Job D has no ranking of 4. Therefore, Job B will be ignored.
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The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008
Alternatives
Objectives
Annual salary (＄)
Working hours
(hours/week)
Flexibility
Business skills
development
Growth
Annual vacation
Morale
Work Safety
Stress
Job Satisfaction
Mission
Job A
Table 2: Ranking Table
Job B
(be eliminated)
Job C
Job D
2
4
1
3
2(tie)
2(tie)
4
1
2(tie)
2(tie)
2(tie)
1
4
2(tie)
1
2(tie)
3
1
3
3(tie)
3(tie)
1(tie)
1
4
2(tie)
4
2
1
4
3(tie)
1(tie)
4
1
3(tie)
3(tie)
1(tie)
2
1(tie)
2(tie)
2
1
2
3
3(tie)
Making ES, transforming certain objectives into the same units of measurement, and ignoring the
objectives with the same grade, allows some objectives to be ignored. For example, converting the
'Annual salary' of Jobs A and D into 30,000, the 'Working hours' of Jobs A and D are converted into 66
and 94, allows the objective 'Annual salary' be ignored. In the objective of 'Business skills development',
promoting 'Nursing staff' to 'Nursing supervisor' will also raise the 'Growth' of Job A from Middle to
High and increases 'Morale' from Low to High, as shown in Table 3.
Table 3: Performing the first Even Swaps pass
Alternatives
Job A
Job C
Objectives
Annual salary (＄)
Working hours
(hours/week)
Flexibility
Business skills
development
Growth
Annual vacation
Morale
Work Safety
Stress
Job Satisfaction
Mission
20,00030,000
44 66
30,000
60
Low
Low
Nursing staff Business operation,
Nursing
Vision,
supervisor
Communication,
Administration
Middle High
High
15
0
Low high
High
Low
Low
High
High
High
High
High
Low
Job D
12,800 30,000
40  94
Middle
Computing, word
processing,
High
7
MiddleLow
High
Middle
Middle
Low
Rank all the contents of alternatives and compare the number of lagging indicators for the three
alternatives; then ignore the alternative with the maximum number of lagging indicators. For example,
Job A has no ranking of 3; Job C has one ranking of 3; Job D has four rankings of 3; therefore, the
alternative of Job D is ignored, as shown in Table 4. The 'Alternatives' are narrowed to Jobs A and C, and
then 'Objectives' of the same grade are ignored.
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Table 4: Performing the second Even Swaps pass
Alternatives
Job A
Job C
Job D
(be eliminated)
Objectives
Working hours
(hours/week)
Flexibility
Business skills
development
Annual vacation
Morale
Work Safety
Stress
Job Satisfaction
Mission
2
1
3
2(tie)
2(tie)
1
1(tie)
1(tie)
3
1
1(tie)
2(tie)
2(tie)
1(tie)
1
3
1(tie)
2(tie)
2(tie)
1(tie)
2
2
3
1
1
3
2
An analysis of the case using ES leaves three objectives and two alternatives for decision-making.
The number of lagging indicators of Job C exceeds those of Job A by one. Therefore, the outcome of this
decision-making process is Job A as shown in Table 5. KT is used as follows to analyze the same
question.
Table 5: Performing the final Even Swaps pass
Alternatives
Job A
Job C
Objectives
(be eliminated)
Working hours
2
1
(hours/week)
Annual vacation
2
1
Mission
2
1
KT Rational Decision-Making
First, identify the pros and cons of all the alternatives to clarify the preliminary question as shown
in Table 6. Then implement the following steps: decision analysis, decision assertion, decision objective,
weighting alternatives, and potential problem analysis.
Alternatives
1 Continue in nursing
Table 6: Pros and Cons for Alternatives
Pros
Cons
Familiar with the working
High stress, low work safety.
environment and profession, high
challenge in the work.
Lower stress.
Low salary.
2 Become a hospital
administrator
3 Start a new business (Taiwan Challenge and growth prospect
Salt Industrial Corp. Affiliate) in work, high salary.
High work safety.
4 Employed in the private
sector
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Long working hours, high
stress, and high risk.
Different working profession,
lower salary.
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Must- and Essential Objectives
The purpose of decision assertion is to provide the focus of the decision and determine the range of
the decision. The objectives are the important items for the decision and the distinct details of the decision.
There are two kinds of objectives: 'must-' and 'essential'. 'Must -objectives' consist the conditions
necessary for successful decision-making. All the objectives, besides the must-objectives, are 'essential
objectives'. In this case, the decision assertion involves selecting the optimal working environment to
meet the requirements of safety and growth. The must-objectives are judged as Yes-or-No. Any item of
an alternative that fails to meet the requirements of must-objectives of decision-maker will be deleted
directly. The must-objectives in this case are as follows: 1. Meeting safety requirements; 2. Meeting
growth requirements. Jobs A and B are deleted because they fail to meet the must-objectives as shown in
Table 7.
Table 7: Considering the Alternatives using Must-objectives
Must-Objectives
Safety
Growth
Job A
 Accidents such as needle stick
 Familiarity with nursing skills
 Contagious diseases such as
SARS
Yes/No
No
No
Job B
 Contagious diseases such as
 Computing, word processing
SARS
 Boring
Yes/No
No
No
Job C
 Average
 Business administration
 Challenging
Yes/No
Yes
Yes
Job D
 Higher
 Related skills
 Average
Yes/No
Yes
Yes
After considering the alternatives, only Jobs C and D remained for consideration. Both jobs were
then judged using “essential objectives”. The following seven necessary objectives were used to rank
their overall performance in each of the alternatives: 1 Annual salary, 2. Flexibility, 3. Annual vacation, 4.
Morale, 5. Stress, 6. Job satisfaction, and 7. Mission.
The evaluation is divided into two parts: The first part involves determining relative scores and
weight values of essential objectives for each Job. For example, Job C scores 10 points and Job D scores
5 points on the essential objective of annual salary; the weighted values are 1, 3, 5, 7, 9…etc. A more
important essential objective is weighted more heavily. The weighted score is the score of an essential
objectives multiplied by their respective weighting value. For example, the 'annual salary' of Job C in this
case scores 10 points and the weighted value of the essential objective is 7, hence the weighted score of
Job C is 10×7＝70. The alternative is evaluated by the weighted score through 'essential objectives' in this
case. Job C, with the highest total weighted score, is the 'Initial Scheme' as shown in Table 8.
The Journal of Human Resource and Adult Learning Vol. 4, Num. 1, June 2008
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Essential
objectives
Weighted
value
Job C
score
Weighted
score
Job D
score
Weighted
score
Table 8: Evaluation of the essential objectives of the Alternatives
1
2
3
4
5
6
7
Annual
Annual
Job
Flexibility
Morale Stress
Mission
Salary
vacation
Satisfaction
7
1
3
9
5
13
11
10
2
0
10
－10
8
6
70
2
0
90
－50
104
66
5
7
6
6
－4
5
4
35
7
18
54
－20
65
44
Total
weighted
score
284
203
RESULT
This study compares 12 subjects using the rational decision-making methods of ES and KT. Two
results are found as follows. 1. Eleven subjects applied both the two methods to evaluate the same scheme
and reached the same conclusion, and another one subject reached different conclusions. 2. ES is more
difficult, but more precise. That is, ES requires more time to cogitate and the extent of difficulty is also
high. Table 10 shows the interview results from the 12 subjects concerning the difficulty of the process,
the precision, the difference comparing with the anticipated result, and the time needed for thinking, as
shown in Table 10.
Table 10: A Comparison of the ES and KT Methods
Items
ES
KT
1. The different and same results of the two methods
2.
3.
4.
5.
The difficulty extent of the process
The precision
The difference comparing with the anticipated result
The time needed for thinking
10
10
1
9
Remarks
1 different
11 the same
2
2
11
3
The differences between the two decision-making methods are as follows. The ES is more
complicated, because some objectives were replaced for same conditions, making this method more
difficult to understand and requiring more time to implement. However, ES method is more precise. The
ES focuses only on one judgment value at a time through paired comparison between the adopted and
rejected values of every objective in the alternatives. Most subjects (eleven out of 12) thought that ES was
more complex and difficult, but this obstacle could be overcome with practice, as shown in Table 10. In
fact, this is not really slow for an important decision-making process from a practical viewpoint.
CONCLUSION
ES can be improved by incorporating potential problem analysis of KT, to enable medical staffs to
make satisfactory decisions, and overcome the weakness of intuitional decision for lacking scientific
decision process in nursing. The methods can not only be applied to nursing, but also can be applied to
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enterprise for improving the quality of decision-making. Overall, this study provides insight to the
influence of nursing staff resignation crisis under irrational conditions, e.g. Taiwan’s SARS epidemic. In
addition, these kinds of irrational conditions and challenges for medical staff will be more and more
eternally, e.g. H5N1 epidemic. What can we learn from the open black box of intuition decision-making
process? Building a structural intuition decision-making process can assist medical staffs clearly present
their thinking process. This study proves that the structural intuition decision-making process to manage
intuition knowledge is more important than decision result.
Two suggestions about rational decision-making can be making as follows: 1. ES combines KT
with potential problem analysis to investigate the potential risk of selected the scheme and enhance the
integrity of the scheme for assessing risk. 2. If time allows, both ES and KT should be applied
simultaneously. If the results of the two decision-making methods are the same, the decision is highly
reliable; but if the results are different, the process must be reviewed and find out the possible missing
key factors of the problem. These two methods do not take much time and the generated results are
indeed valuable. If time does not permit, ES should be applied with the potential problem analysis, KT.
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