Organizational behavior in the Health Service : a comparison of local resource allocation.
Decision theory suggests two general ways to study decisions: t e process y
lich the decision was made or the attributes of the decision itself.
Within the process branch, Allison (1971) and Allen (1979) analyzed a single
~cision using the Rational model, the Organizational Process model, and the
Jreaucratic Politics model, each of which contributed to explaining the decision.
Llison and Allen also argued for how their findings could be applied more
enerally. Aharoni (1966) and Heclo and Wildavsky (1974) used a second approach t
:udy pieces of many decisions. The emphasis was on understanding the whole proces
ather than on explaining any particular decision. This approach is largely free
f decision models and describes important factors within the process.
One set of attributes comes from Cooke and Slack (1984) who suggested that
!cisions can be analyzed by three related pairs of variables: Operational -
:rategic, Independent - Dependent, and Structured - Unstructured. To these, the
esearcher added Relative Importance and Innovation.
This paper uses both the process and attribute approaches to analyze eleven cas
~udies of local capital allocation decisions in two health districts in northern
ngland. Some of the cases were chosen to allow direct comparison between
rganizations, circumstances, and individuals. Like Allison or Allen, each decisio
as examined through each model (Hypothesis 1: Each decision model helps explain
ach decision). Following Aharoni or Heclo and Wildavsky. the examination of many
ecisions allows delineation of important factors within the process (Hypothesis 2
here are specific factors which are important to explain the process). Finally,
ach decision is also classified using Cooke and Slack's decision attributes
Hypothesis 3: Decisions can be explained using the various decision attributes).
Information was gathered through interviews with participants and examination 0
elevant documents. Some of the decisions were concurrent with the researcher's
tay and could be watched as they happened. However, most events occurred before
Part way into the study, it became clear that each district had an
rganizational process for the kinds of decisions in the study. This process was
ased on three elements: the rules and regulations within the NHS which prescribe
hat is acceptable and how it is to be done; past events and personalities within
he health district itself which influenced current processes; and events outside
he NHS which established the climate within which all of this took place.
etailing this process became the basis for Part II.
Because an organizational process describes the overall approach, the Organizaional
Process model should also best explain the case study decisions (Hypothesis
). This alternative to Hypothesis 1 was tested in Part III, where each case stud
S described and analyzed. However, the results show that the Bureaucratic Politic
~del is also important in explaining the decisions, with the Rational model less
,aeful. Thus, neither Hypothesis 1 nor Hypothesis 4 is totally supported.
As expected in Hypothesis 2, many factors affected decisions (see Part IV), som
pecific to the setting and some with broader applicability. The more interesting
nes are Staff and Patient Welfare, the Availability of Money, and the Threshhold
:ffect. Also in Part IV, the results from Part III are combined in a matrix, with
eciaion models on one axis and decision attributes on the other, to analyze how
:he two approaches are related. The results show some of the expected relationship
letween models and attributes on a broad basis but not on a detailed basis.
Significance: This study broadens decision theory by taking a first step in
:ombining the attribute and process approaches. It also illuminates the need for
:urther study by showing how incompatible the results of the twosaPDrQaches are.
ee "Notes on reverse