Factors Influencing Clinical Decision Making: The Impact Of Non-Medical Managers

Clinical Decision Making: The Foundation of Patient Care


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Discuss About The Cost Of Medical Decision Making From Non-Medical Managers?

Clinical decision making can be defined as the most fundamental part of any clinical practice, which enables the medical practitioner to take valid, logical and scientific decisions regarding the care planning and implementation of the interventions. In any clinical scenario, where a patient presents his or her medical complications, the very first course of action by the health care professional will require a logical clinical decision making. Therefore, the importance of the clinical decision making is paramount when it comes to the health care industry; although it also needs to be considered that this operations action is very tricky and a single mistake while making clinical critical decisions can cost the patient even his or her life (Allen et al., 2012).

Hence, clinical decision making can be considered as the foundation based on which the treatment delivery and recovery of the patient will be carried on. However, a common misconception when discussing clinical decision making is that it only depends on the will of the health care professionals, like the nurses, doctors or so on (Park 2016). Though, the clinical decision making is the part of health care that is the most influenced sector, both by internal and external factors. This literature review will explore and evaluate these factors and will focus on one particular element which has been by far the most impactful on the health and wellbeing of the patients, the influence of the nonmedical managers.

Literature review is considered to be one of the most essential elements of any research study. It acts like a bridge between literature published previously and the aims and objectives of the present research study, validating the need for the research. This literature review will incorporate articles retrieved from databases like google scholar, PubMed, WebMD, and Medscape. 15 articles in total will be selected for this literature review and the selection criteria will mandate selection of journal articles published after 2012 and written in English language. Articles published before the selected timeline that are irrelevant to the research topic and published in other languages were rejected.

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By definition, clinical decision making is the unique process of devising the care strategy and implementation of it by a step by step action involving explicit patient information, pre-existing knowledge on the Pathological conditions of the patient,  experiential nursing care and treatment, etc.  It is considered to be the first step of the treatment procedure for any patient, the defenders reality of the medical complications and the patient is suffering from the complexity and criticality of clinical decision making increases (Bright et al., 2012). There are different models of clinical decision making; however two particular models are the most abundantly utilized all over the globe in healthcare settings. These models are information processing model and intuitive-humanist model, and both models have helped the health care professional make logical and scientifically reasonable decisions for the health and wellbeing of the patient (Allen et al., 2012). However, according to Croskerry, 2013, a more recent addition to clinical decision making models is the theoretical multidimensional model that utilizes the evaluation of current literature and assessment of clinical research studies based on pseudo-clinical settings (Croskerry,  2013). This model allow the inexperienced nurses to explore the different aspects of clinical decision making before they have to take up the responsibility of the patients and caring for them. According to many research scientists, this new concept to clinical decision making is extremely beneficial and has successfully made the entire process of planning and implementing care very scientific, logical and patient-centred (Elwyn et al., 2012).

Influential Factors on Clinical Decision Making

As mentioned above in the assignment there are a number of different factors that influence the clinical decision making procedure. Elaborating more on these factors, one of the major factors are the patient preferences, with the patient centred care at the heart of the health care industry, patient preferences are given the highest priority (Park 2016). While, the benefits of the care plan and treatment setting being completely focussed around the specific needs and requirements of the patient, the downside of the same is the unrealistic demands of the patient which interferes with the care needed by the patient, and the Lee in their article approve of the same fact (Lee 2016).

Another very important factor that influences the clinical decision making is the personal compatibility and competency of the health care professionals. According to the Jansen et al., 2011 in his article, a great proportion of the influence on the clinical decision making is based on the competency and comfort level of the health care professional, if a particular health care professional is not comfortable with a treatment procedure, statistics indicates that he or she will more likely abstain from making that clinical decision which will require him or her to engage in that particular activity, although this factor is only applicable while the safety and wellbeing of the patient is not being threatened majorly (MacLean et al., 2012).

The last significant sector of factors that are responsible for the influence on the clinical decision making is by the rules and regulation of the health care facility, according to the authors, the particular set of regulations in the hospital often restricts the clinical decision maker from taking the adequate decisions (Croskerry 2013). In most cases the medical managers with the responsibility of managing and organizing the entire health care facility are under the task for maintaining the rules and regulations of the health care facilities. Their understanding although are non medical but this nonmedical influence on the clinical decision making is known to make the most substantial impact on the entre process (Tsai et al. 2016).

First and foremost it will need to be addressed, that the medical managers all managers of Healthcare facilities have the responsibility of maintaining the rules and regulations of the facility, organized and maintained the billing system, management of the treatment procedures in accordance to the socio economic status of the patient, package payment system associated with insurance coverage and government relief packages, and maintaining the quality and competency of the staff (Peek et al. 2016). It needs to be mentioned that the socio economic status of the patient often interferes with the adequate clinical decision making, and the medical manager is insurance on correlating the socio- economic status of the patient and the health care package that he can afford is the most substantial one (Croskerry 2017). Along with that the management policies that the Healthcare facilities has in place provide a tremendous pressure on the hospitals, administration, care team and the insurance companies, twin corporate all the regulatory management policies into the treatment packages. Hence the management decisions often differ from the need of clinical decision making that the patient might be under, administrative practices interfere with the adequate decision making. Now it has to be understood that are administrative department of the Healthcare facility will not understand the clinical needs and requirements of the patient with that magnitudes that a care professional or medical practitioner would (Thomson et al. 2017). According to Richter Sundberg, Garvare & Nyström 2016, the impact of non medical insurance on the clinical decision making mostly is detrimental on the health and safety of the patients (Richter Sundberg, Garvare & Nyström 2016). The patients often need to suffer the consequences of the Labs in clinical judgment due to a particular regulatory policy of the healthcare facility, on a particular care coverage that the patient was under, and the blame mostly is bestowed on the health care team assigned to him.

Impact of Non-Medical Managers on Clinical Decision Making

The McIntosh et al. 2016 in the article have discussed that the medical managers are the non clinical administrative staff never take into account the critical Health Care needs and requirements of the patient into consideration when dividing the care packages and billings, and the payment package system of healthcare delivery mandates the clinical decision makers to refrain from taking adequate clinical decision which will prioritize the patient’s health and safety (McIntosh et al. 2016). MacLean et al., 2012 have opined in their article that the importance of the clinical decision making is pivotal in the pattern health care follows in the current age, hence the need for reducing the impact of nonmedical influence has emerged a major concern for the health care regulatory authorities worldwide (MacLean et al. 2012).

In order to evaluate the findings of this literature review we have to consider a few key points that were discovered. First and foremost, in order for the literature review to start the need for understanding and exploring what clinical; decision making was had been extremely important. This is what the article by Bright explained to us, the next requirement for this literature review to explain had been explore and describe the impact of clinical decision making in the healthcare sector, and the role that this aspect of the health care plays. Two articles by Croskerry and Elwyn helped us understand the impact of clinical decision making and the how it benefits the healthcare industry. The next sector for this literature review explored the different influential factor for the clinical decision making and a number of different articles helped in exploring each of the factors, such as the patient preferences, the physician’s understanding of the patient needs and their competency, the infrastructure of the health care facility and most importantly the regulatory guidelines. Lastly the literature review explored the insurance the non medical factors associated with him cynical settings on the clinical decision making, for instance the administrative factors and the non medical managers (Evans et al. 2015). A number of different articles have provided valid and relatable data and information regarding the impact non-medical managers’ impact on the clinical decision making. There are also different factors associated with the influence that the non medical managers have on clinical decision making, the payment package for different patients, the socioeconomic status of the patient, the insurance cover, the infrastructure of the facility and the regulatory guidelines of the facility (MacLean et al. 2012).


Hence it can be stated that the literature review had been successful in exploring all the different aspects associated with clinical decision making and the kind of influence that nonmedical interference can have. However, in order to validate the need for this literature review can be defined by the fact that the interference of the non medical managers on the clinical decision making is detrimental for the health and safety of the patients, and the recovery status of the patient bears the burn for this interference (Park 2016). There have not been enough data on the internet available to understand the impact of this administrative or non medical influence and this literature review bridges the gap left behind in the literature.


On a concluding note it can be said that the impact of nonmedical influence on the clinical decision making is alarming; however there is no initiative from the health care authorities to address this frightening condition in health care. This literature review puts together al the available analytical studies and attempts to attract the attention of global and national authorities so that more in depth statistical studies are conducted on this issue and adequate actions are taken so that the patient do not need to suffer the consequences of lapse clinical judgment due to nonmedical influence.


Allen, L.A., Stevenson, L.W., Grady, K.L., Goldstein, N.E., Matlock, D.D., Arnold, R.M., Cook, N.R., Felker, G.M., finance, G.S., Hauptman, P.J. & Havranek, E.P., 2012. Decision making in advanced heart failure. Circulation, 125(15), pp.1928-1952.

Bright, T.J., Wong, A., Dhurjati, R., Bristow, E., Bastian, L., Coeytaux, R.R., Samsa, G., Hasselblad, V., Williams, J.W., Musty, M.D. & Wing, L., 2012. Effect of clinical decision-support systemsa systematic review. Annals of internal management, 157(1), pp.29-43.

Croskerry, P., 2013. From mindless to mindful practice—cognitive bias and clinical decision making. N Engl J Med, 368(26), pp.2445-8.

Croskerry, P., 2017. Individual variability in clinical decision making and diagnosis. Diagnosis: Interpreting the Shadows. Oxford, UK: CRC Press, Taylor Francis Group.

Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cording, E., Tomson, D., Dodd, C., Rollnick, S. & Edwards, A., 2012. Shared decision making: a model for clinical practice. Journal of general internal medicine, 27(10), pp.1361-1367.

Evans, S.C., Roberts, M.C., Keeley, J.W., Blossom, J.B., Amaro, C.M., Garcia, A.M., Stough, C.O., Canter, K.S., Robles, R. and Reed, G.M., 2015. Vignette methodologies for studying clinicians’ decision-making: validity, utility, and application in ICD-11 field studies. International Journal of Clinical and Health Psychology, 15(2), pp.160-170.

Jansen, J.P., Fleurence, R., Devine, B., Itzler, R., Barrett, A., Hawkins, N., Lee, K., Boersma, C., Annemans, L. & Cappelleri, J.C., 2011. Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value in Health, 14(4), pp.417-428.

MacLean, S., Mulla, S., Akl, E.A., Jankowski, M., Vandvik, P.O., Ebrahim, S., McLeod, S., Bhatnagar, N. & Guyatt, G.H., 2012. Patient values and preferences in decision making for antithrombotic therapy: a systematic review: Antithrombotic Therapy and Prevention of Thrombosis: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST Journal, 141(2_suppl), pp.e1S-e23S.

McIntosh, T., Stewart, D., Forbes-McKay, K., McCaig, D. and Cunningham, S., 2016. Influences on prescribing decision-making among non-medical prescribers in the United Kingdom: systematic review. Family practice, 33(6), pp.572-579.

Park, I.H., 2016. More options, more considerations: how new treatment options influence clinical decision marketing. Journal of thoracic disease, 8(10), p.E1408.

Peek, M.E., Lopez, F.Y., Williams, H.S., Xu, L.J., McNulty, M.C., Acree, M.E. & Schneider, J.A., 2016. Development of a conceptual framework for understanding shared decision making among African-American LGBT patients and their clinicians. Journal of general internal medicine, 31(6), pp.677-687.

Richter Sundberg, L., Garvare, R. & Nyström, M.E., 2016. Reaching beyond the review of research evidence: A qualitative study of decision-making during clinical guideline development.

Thomson, R.G., De Brún, A., Flynn, D., Ternent, L., Price, C.I., Rodgers, H., Ford, G.A., Rudd, M., Lancsar, E., Simpson, S. & Teah, J., 2017. Factors that influence variation in clinical decision-making about thrombolysis in the treatment of acute ischaemic stroke: results of a discrete choice experiment.

Tsai, K.H., Moskowitz, A.L., Brown, T.E., Park, A.L. & Chorpita, B.F., 2016. Interpreting progress feedback to guide clinical decision-making in children’s mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 43(2), pp.199-206.