A Decisive Model

As an athletic trainer, you make countless decisions every day that affect your athletes. Ever thought about how you make those decisions, and if there might be a better way?

By Dr. Tim Laurent

Tim Laurent, EdD, ATC, CSCS, is Program Coordinator for Athletic Training and Exercise Physiology at Lynchburg College.

Training & Conditioning, 12.7, October 2002, http://www.momentummedia.com/articles/tc/tc1207/model.htm

As athletic trainers, we perform a variety of tasks in a variety of settings. We prevent injuries. We evaluate injuries. We provide immediate care. We design and conduct rehabilitation programs. We perform a variety of administrative functions such as ordering supplies.

But we do not mindlessly perform these tasks. Instead, we decide when and how to evaluate, treat, and prevent injuries.

Athletic trainers make big and small decisions every day. This decision-making process is repeated so often that many of us forget that we are actually making decisions. Yet these decisions are important, and many of them have far-reaching consequences. For example, an athletic trainer’s decision about what to include in an athlete’s rehabilitation program on Monday may determine that athlete’s playing status on Saturday. Therefore, in order to succeed at our jobs, we need to make good decisions.

Fortunately, decision making is a skill that is learned and it improves with practice. One helpful method for learning to make better decisions is to examine basic decision-making models that outline the process of arriving at a conclusion.

Many decision-making models exist, but they can be divided into two broad categories: group decision making and individual decision making. Group models describe how organizations, such as the NCAA or the government, make decisions. Individual models describe how people make decisions. This article addresses six individual decision-making models: scientific, ethical, economic, political, experience, and habitual.

These are not the only individual decision-making models, nor are they complete in their presentation. They do, however, provide a framework to evaluate your own decision-making approach. As you read the description of each model, think about the one that most closely resembles you and in what situations you are likely to use each approach.

In using the scientific, also called the knowledge-based, model of decision-making, a person attempts to gather all the information about a subject or issue. It is a detective approach. Once all the facts are in and analyzed, the decision is made.

This type of decision making is very useful for determining what modality or treatment to use. For example, the scientific approach would be used when determining what angle the athlete’s knee should be flexed when performing the Lachman’s test.

For a scientific-based decision to be a good decision, we need to be thorough in gathering information. We do this by following a prescribed method. First, the problem is identified and analyzed. Pertinent information is collected. Alternative actions are identified and evaluated. Finally, the preferred decision is implemented.

This model is very linear in nature. Evidence adds up and leads to a single answer. The advantages of scientific decision making are that it strives to remove subjectivity from decision-making, and it provides a prescribed order to a potentially disordered process. In this way, we can review our methods to determine if we made a mistake along the way. We can also repeat our process if necessary.

The disadvantage to this approach is that the decision maker can never gather all the information. Since the athletic trainer cannot know or learn everything, he or she cannot evaluate all possible alternatives. Also, decisions can be slow to arrive at because more information and additional analyses are sought. This process does not lend itself well when there is more than one correct answer to a particular problem.

Another disadvantage stems from the fact that research is the base for decisions made using the scientific decision-making model. Research helps us to extend past our personal experience to objectively determine the best solution, but because we work with people, not every problem can be framed in a fact-gathering manner. Therefore, we need other models to guide our decision making. In some situations, we will even employ more than one model.

While the scientific decision-maker is concerned with gathering information, the ethical decision-maker is concerned with doing the right thing. Ethical decisions are based on a personal, professional, or religious code that distinguishes right from wrong. Ethical decision making is also called value-driven or moral decision making. In other words, the bigger picture of “is it fair and appropriate?” is analyzed.

An example of a situation where an athletic trainer might be faced with an ethical decision could be in determining which ankle brace to have the athletes wear. At first, the problem appears to be one for a scientific, knowledge-based decision. That is, which is the better brace? But extenuating circumstances may make this an ethical problem for the athletic trainer.

If the athletic trainer has potential financial gain by offering one brace over another, the decision on which brace to offer the athletes may become an ethical one. By asking, “What is the right thing to do regardless of any percentage I make on the sale?” the athletic trainer is employing the ethical model to determine which brace to use.

When using the ethical model, the decision-making process is simpler than in other models because the only concern is for doing the right thing. Evidence is not stacked up as in the scientific model, because there is less need for evidence.

The advantage of this model is that it paints the complicated world in dichotomous right and wrong terms. But that also underscores this model’s drawback. Problems often come with more options than a single right or wrong solution. Sometimes there is not an ethically correct answer. Thus there is room for other considerations—and the applications of other decision-making models.

When the economic model is employed, the decision maker thinks of net gain. The gain is often, but not exclusively, financial. A person uses the economic model when he or she needs to weigh effort against results. The decision maker may have a short-term or long-term orientation. Therefore, two people may come to different decisions using this model.

An example of a typical application is purchasing supplies. One athletic trainer may choose to purchase less expensive tape because her rationale is that this leaves more money in her limited budget for other items. Another athletic trainer with the same budget may purchase more expensive tape by rationalizing that, since he tapes so many people, it is better to have the best tape available. Both of these athletic trainers are using an economic model. They have both weighed the cost of tape against the benefit of that purchase and have arrived at different interpretations of the benefits.

Economic decisions do not have to be exclusively about money. Cost is also measured in terms of effort or input. For example, we may consider the cost and benefit of teaching students how to perform evaluations. The cost is the time and effort it takes to explain, demonstrate, and assess the components of an injury evaluation. The benefit is the student has some knowledge and the ability to assist the athletic trainer, allowing that athletic trainer to accomplish multiple tasks at once.

However, some athletic trainers work in an environment where the stakes are too high to rely on a student’s knowledge and skill. Since time is precious when we are treating several patients and since accuracy is often critical, the athletic trainer may find the cost of having students perform evaluations too great for the benefit.

The advantage to the economic model is that the base for decision making is simple: costs vs. benefits. A disadvantage of using economic decision making is that not all information can be quantified. For example, how much does one athletic trainer’s opinion weigh compared to another athletic trainer’s opinion?

In our ankle braces example, one athletic trainer may think that brace “A” is better because it provides superior resistance to inversion. Another athletic trainer might think that brace “B” is better because it lasts longer. The athletic trainer trying to determine which brace to purchase may be left with one opinion versus another opinion. Since a cost/benefit analysis may leave unanswered questions, the athletic trainer may have to use other decision-making models to arrive at a conclusion.

The objective of the political decision maker is to come up with a decision that is palatable to most of the people concerned. Therefore, other people’s opinions are carefully considered.

While scientific, ethical, and economic models attempt to be objective, political decisions are subjective because there is an overriding concern for what others think. The political decision maker is less concerned with the specific information that is used to make the decision and more concerned with the result of the decision itself. An athletic trainer may consider knowledge, ethics, and economics as evidence-gathering perspectives, but he or she really wants to know how others will perceive that particular decision.

The political decision-making model may be beneficial when an athletic trainer is deciding which athletes to tape for practice. Economically, the budget may not allow for taping every athlete every day. Scientific research may not show that taping is necessary for every athlete every day. Ethics dictates that athletic trainers do everything within reason to prevent injuries. The prior decision-making models may not help the athletic trainer in this situation. But the athletic trainer still needs to decide which athletes to tape.

One compromise could include taping only those athletes with a history of ankle sprains. Another compromise may include taping athletes who play certain sports or positions. Or, an athletic trainer may decide to brace some athletes while taping others. Any of these solutions may or may not work depending on the specifics of a given situation. The key is that the athletic trainer is taking others’ perceptions into account to make a decision.

The advantage of the political model is that by considering others’ reactions and opinions, the compromised solution is likely to be more acceptable. However, the disadvantage of the political approach is that if each circumstance is considered unique, then one decision may contradict a prior decision. This inconsistency may be very frustrating to others and the athletic trainer may be viewed as untrustworthy. While this process of considering other people’s perspectives has merit, a person who always uses this model never develops his or her own perspective.

Experience-based decision making allows us to use our previous experiences to determine how to best act in the present situation. By using experience, we minimize the need to search for facts, determine right from wrong, or debate all options. The background work has been done so that past experiences guide present decisions.

Many of the decisions athletic trainers make are experience based because familiarity is comfortable. The results may not be ideal, but if we are making decisions based on experience, at least we have some idea of the outcome. In other words, our ability to predict the consequences of our actions is important.

Experience-based decisions can be combined with scientific-based decisions to make a very strong decision-making approach. For example, we know that 20 to 30 degrees is the appropriate knee flexion angle for the Lachman’s test. However, the athletic trainer still must decide how best to perform the test. Some athletic trainers hold the femur with one hand while mobilizing the tibia with the other. Other athletic trainers stabilize the femur on the table and flex the knee off the edge of the table. Still others place their thigh under the athlete’s femur to create the desired knee-flexion angle.

So while the scientific decision-making model helped determine the best knee angle, the question of the single best method of performing the Lachman’s test remains. The athletic trainer who has successfully performed the Lachman’s test by placing a leg under the patient’s thigh is likely to repeat this method. Experience has determined the best way for that particular athletic trainer to perform the Lachman’s test.

The advantage of using experience as a basis for making decisions is that decisions can be made quickly. By reflecting on our experiences, we are taking the short cut through all the other models to determine the best solution.

Relying on experience can help avoid problems, but it can also blind the decision-maker to new, exciting, or more effective options. Experience-based decision making also runs into trouble when we repeat bad decisions just because we are comfortable with the process or too lazy to think about a new situation. Experience has turned into habit, which is the final model that we will explore in this article.

Unlike the active decision-making processes presented above, relying on habit is a passive approach. This is not a process in which we weigh pros and cons or stack up evidence against predetermined criteria. This is decision by default. If you ask a habit-based decision maker how a decision is made, the answer will probably be that he or she does not know. The person does not know because he or she has not actively engaged in making the decision.

The habit decision-making model is included not to give any specific example of what athletic trainers should do, but to remind us of what happens when we rely on experience so much that we no longer think. Both experience and habit models view a problem based on what has been done in the past. The difference between them is that when using the experience model we still ask, “What has worked in the past?” Habit removes the element of thought, which automatically removes the element of reflection.

The advantage to using habit in our lives is that it is fast and does not interfere with other conscious thoughts. A veteran athletic trainer can tape one athlete’s ankle while taking the history of another injured athlete. When athletic trainers are attempting to perform multiple tasks, more decisions have to be relegated to habit. The disadvantages are obvious. Without thinking we run the risk of making mistakes and then repeating them.

It is likely that athletic trainers use a blend of these and other models when they make decisions. This background should also help you understand the decisions of athletes, coaches, administrators, and parents with whom you work. What elements of each decision-making model appeal to you? What do you not like about each model? When would you use each model? It’s your decision.

Sidebar: A Quick Exercise
Reflecting on past decisions helps you analyze your decision-making process and better identify which decision-making models apply to particular situations. Here is a quick exercise to help with this analysis:

• Review one of your recent good decisions.
• Review one of your recent bad decisions.

Now, think about which decision-making model most closely resembles the decision-making process you used. Was it the best approach? If you had to do it all over again, what would you change about how you made the decision?