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Do Your Students Know How to Analyze a Case—Really?

Explore more.

• Case Teaching
• Student Engagement

J ust as actors, athletes, and musicians spend thousands of hours practicing their craft, business students benefit from practicing their critical-thinking and decision-making skills. Students, however, often have limited exposure to real-world problem-solving scenarios; they need more opportunities to practice tackling tough business problems and deciding on—and executing—the best solutions.

To ensure students have ample opportunity to develop these critical-thinking and decision-making skills, we believe business faculty should shift from teaching mostly principles and ideas to mostly applications and practices. And in doing so, they should emphasize the case method, which simulates real-world management challenges and opportunities for students.

To help educators facilitate this shift and help students get the most out of case-based learning, we have developed a framework for analyzing cases. We call it PACADI (Problem, Alternatives, Criteria, Analysis, Decision, Implementation); it can improve learning outcomes by helping students better solve and analyze business problems, make decisions, and develop and implement strategy. Here, we’ll explain why we developed this framework, how it works, and what makes it an effective learning tool.

The Case for Cases: Helping Students Think Critically

Business students must develop critical-thinking and analytical skills, which are essential to their ability to make good decisions in functional areas such as marketing, finance, operations, and information technology, as well as to understand the relationships among these functions. For example, the decisions a marketing manager must make include strategic planning (segments, products, and channels); execution (digital messaging, media, branding, budgets, and pricing); and operations (integrated communications and technologies), as well as how to implement decisions across functional areas.

Faculty can use many types of cases to help students develop these skills. These include the prototypical “paper cases”; live cases , which feature guest lecturers such as entrepreneurs or corporate leaders and on-site visits; and multimedia cases , which immerse students into real situations. Most cases feature an explicit or implicit decision that a protagonist—whether it is an individual, a group, or an organization—must make.

For students new to learning by the case method—and even for those with case experience—some common issues can emerge; these issues can sometimes be a barrier for educators looking to ensure the best possible outcomes in their case classrooms. Unsure of how to dig into case analysis on their own, students may turn to the internet or rely on former students for “answers” to assigned cases. Or, when assigned to provide answers to assignment questions in teams, students might take a divide-and-conquer approach but not take the time to regroup and provide answers that are consistent with one other.

To help address these issues, which we commonly experienced in our classes, we wanted to provide our students with a more structured approach for how they analyze cases—and to really think about making decisions from the protagonists’ point of view. We developed the PACADI framework to address this need.

PACADI: A Six-Step Decision-Making Approach

The PACADI framework is a six-step decision-making approach that can be used in lieu of traditional end-of-case questions. It offers a structured, integrated, and iterative process that requires students to analyze case information, apply business concepts to derive valuable insights, and develop recommendations based on these insights.

Prior to beginning a PACADI assessment, which we’ll outline here, students should first prepare a two-paragraph summary—a situation analysis—that highlights the key case facts. Then, we task students with providing a five-page PACADI case analysis (excluding appendices) based on the following six steps.

Step 1: Problem definition. What is the major challenge, problem, opportunity, or decision that has to be made? If there is more than one problem, choose the most important one. Often when solving the key problem, other issues will surface and be addressed. The problem statement may be framed as a question; for example, How can brand X improve market share among millennials in Canada? Usually the problem statement has to be re-written several times during the analysis of a case as students peel back the layers of symptoms or causation.

Step 2: Alternatives. Identify in detail the strategic alternatives to address the problem; three to five options generally work best. Alternatives should be mutually exclusive, realistic, creative, and feasible given the constraints of the situation. Doing nothing or delaying the decision to a later date are not considered acceptable alternatives.

Step 3: Criteria. What are the key decision criteria that will guide decision-making? In a marketing course, for example, these may include relevant marketing criteria such as segmentation, positioning, advertising and sales, distribution, and pricing. Financial criteria useful in evaluating the alternatives should be included—for example, income statement variables, customer lifetime value, payback, etc. Students must discuss their rationale for selecting the decision criteria and the weights and importance for each factor.

Step 4: Analysis. Provide an in-depth analysis of each alternative based on the criteria chosen in step three. Decision tables using criteria as columns and alternatives as rows can be helpful. The pros and cons of the various choices as well as the short- and long-term implications of each may be evaluated. Best, worst, and most likely scenarios can also be insightful.

Step 5: Decision. Students propose their solution to the problem. This decision is justified based on an in-depth analysis. Explain why the recommendation made is the best fit for the criteria.

Step 6: Implementation plan. Sound business decisions may fail due to poor execution. To enhance the likeliness of a successful project outcome, students describe the key steps (activities) to implement the recommendation, timetable, projected costs, expected competitive reaction, success metrics, and risks in the plan.

“Students note that using the PACADI framework yields ‘aha moments’—they learned something surprising in the case that led them to think differently about the problem and their proposed solution.”

PACADI’s Benefits: Meaningfully and Thoughtfully Applying Business Concepts

The PACADI framework covers all of the major elements of business decision-making, including implementation, which is often overlooked. By stepping through the whole framework, students apply relevant business concepts and solve management problems via a systematic, comprehensive approach; they’re far less likely to surface piecemeal responses.

As students explore each part of the framework, they may realize that they need to make changes to a previous step. For instance, when working on implementation, students may realize that the alternative they selected cannot be executed or will not be profitable, and thus need to rethink their decision. Or, they may discover that the criteria need to be revised since the list of decision factors they identified is incomplete (for example, the factors may explain key marketing concerns but fail to address relevant financial considerations) or is unrealistic (for example, they suggest a 25 percent increase in revenues without proposing an increased promotional budget).

In addition, the PACADI framework can be used alongside quantitative assignments, in-class exercises, and business and management simulations. The structured, multi-step decision framework encourages careful and sequential analysis to solve business problems. Incorporating PACADI as an overarching decision-making method across different projects will ultimately help students achieve desired learning outcomes. As a practical “beyond-the-classroom” tool, the PACADI framework is not a contrived course assignment; it reflects the decision-making approach that managers, executives, and entrepreneurs exercise daily. Case analysis introduces students to the real-world process of making business decisions quickly and correctly, often with limited information. This framework supplies an organized and disciplined process that students can readily defend in writing and in class discussions.

PACADI in Action: An Example

Here’s an example of how students used the PACADI framework for a recent case analysis on CVS, a large North American drugstore chain.

The CVS Prescription for Customer Value*

PACADI Stage

Summary Response

How should CVS Health evolve from the “drugstore of your neighborhood” to the “drugstore of your future”?

Alternatives

A1. Kaizen (continuous improvement)

A2. Product development

A3. Market development

A4. Personalization (micro-targeting)

Criteria (include weights)

C1. Customer value: service, quality, image, and price (40%)

C2. Customer obsession (20%)

C3. Growth through related businesses (20%)

C4. Customer retention and customer lifetime value (20%)

Each alternative was analyzed by each criterion using a Customer Value Assessment Tool

Alternative 4 (A4): Personalization was selected. This is operationalized via: segmentation—move toward segment-of-1 marketing; geodemographics and lifestyle emphasis; predictive data analysis; relationship marketing; people, principles, and supply chain management; and exceptional customer service.

Implementation

Partner with leading medical school

Curbside pick-up

Pet pharmacy

E-newsletter for customers and employees

Employee incentive program

CVS beauty days

Expand to Latin America and Caribbean

Healthier/happier corner

Holiday toy drives/community outreach

*Source: A. Weinstein, Y. Rodriguez, K. Sims, R. Vergara, “The CVS Prescription for Superior Customer Value—A Case Study,” Back to the Future: Revisiting the Foundations of Marketing from Society for Marketing Advances, West Palm Beach, FL (November 2, 2018).

Results of Using the PACADI Framework

When faculty members at our respective institutions at Nova Southeastern University (NSU) and the University of North Carolina Wilmington have used the PACADI framework, our classes have been more structured and engaging. Students vigorously debate each element of their decision and note that this framework yields an “aha moment”—they learned something surprising in the case that led them to think differently about the problem and their proposed solution.

These lively discussions enhance individual and collective learning. As one external metric of this improvement, we have observed a 2.5 percent increase in student case grade performance at NSU since this framework was introduced.

Tips to Get Started

The PACADI approach works well in in-person, online, and hybrid courses. This is particularly important as more universities have moved to remote learning options. Because students have varied educational and cultural backgrounds, work experience, and familiarity with case analysis, we recommend that faculty members have students work on their first case using this new framework in small teams (two or three students). Additional analyses should then be solo efforts.

To use PACADI effectively in your classroom, we suggest the following:

Advise your students that your course will stress critical thinking and decision-making skills, not just course concepts and theory.

Use a varied mix of case studies. As marketing professors, we often address consumer and business markets; goods, services, and digital commerce; domestic and global business; and small and large companies in a single MBA course.

As a starting point, provide a short explanation (about 20 to 30 minutes) of the PACADI framework with a focus on the conceptual elements. You can deliver this face to face or through videoconferencing.

Give students an opportunity to practice the case analysis methodology via an ungraded sample case study. Designate groups of five to seven students to discuss the case and the six steps in breakout sessions (in class or via Zoom).

Ensure case analyses are weighted heavily as a grading component. We suggest 30–50 percent of the overall course grade.

Once cases are graded, debrief with the class on what they did right and areas needing improvement (30- to 40-minute in-person or Zoom session).

Encourage faculty teams that teach common courses to build appropriate instructional materials, grading rubrics, videos, sample cases, and teaching notes.

When selecting case studies, we have found that the best ones for PACADI analyses are about 15 pages long and revolve around a focal management decision. This length provides adequate depth yet is not protracted. Some of our tested and favorite marketing cases include Brand W , Hubspot , Kraft Foods Canada , TRSB(A) , and Whiskey & Cheddar .

Art Weinstein , Ph.D., is a professor of marketing at Nova Southeastern University, Fort Lauderdale, Florida. He has published more than 80 scholarly articles and papers and eight books on customer-focused marketing strategy. His latest book is Superior Customer Value—Finding and Keeping Customers in the Now Economy . Dr. Weinstein has consulted for many leading technology and service companies.

Herbert V. Brotspies , D.B.A., is an adjunct professor of marketing at Nova Southeastern University. He has over 30 years’ experience as a vice president in marketing, strategic planning, and acquisitions for Fortune 50 consumer products companies working in the United States and internationally. His research interests include return on marketing investment, consumer behavior, business-to-business strategy, and strategic planning.

John T. Gironda , Ph.D., is an assistant professor of marketing at the University of North Carolina Wilmington. His research has been published in Industrial Marketing Management, Psychology & Marketing , and Journal of Marketing Management . He has also presented at major marketing conferences including the American Marketing Association, Academy of Marketing Science, and Society for Marketing Advances.

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Case Study Application of an Ethical Decision-Making Process for a Fragility Hip Fracture Patient

In Canada, up to 32,000 older adults experience a fragility hip fracture. In Ontario, the Ministry of Health and Long Term Care has implemented strategies to reduce surgical wait times and improve outcomes in target areas. These best practice standards advocate for immediate surgical repair, within 48 hours of admission, in order to achieve optimal recovery outcomes. The majority of patients are good candidates for surgical repair; however, for some patients, given the risks of anesthetic and trauma of the operative procedure, surgery may not be the best choice. Patients and families face a difficult and hurried decision, often with no time to voice their concerns, or with little-to-no information on which to guide their choice. Similarly, health-care providers may experience moral distress or hesitancy to articulate other options, such as palliative care. Is every fragility fracture a candidate for surgery, no matter what the outcome? When is it right to discuss other options with the patient? This article examines a case study via an application of a framework for ethical decision-making.

INTRODUCTION

Every year, over 30,000 Canadian older adults experience a fragility hip fracture. The Ministry of Health and Long Term Care of Ontario has promoted best practice recommendations which advocate for immediate surgical repair, within 48 hours of admission, in order to achieve optimal recovery outcomes. ( 1 , 2 ) The majority of patients are good candidates for surgical repair; however, given the risks of anesthetic and trauma of the operative procedure, surgery may not be the best choice for all. The patients at higher risk of poor outcomes perioperatively deserve the opportunity to explore options and articulate their values. Unfortunately, as a short pre-operative interval predicts the best outcomes, patients and families face a difficult and hurried decision, potentially with limited time to voice their concerns, and little to no information on which to guide their decision.

From a systems perspective, quality of care and health outcomes have not always incorporated the patient-centred perspective. ( 3 ) Patient-centred care is “a moral concept and philosophy, considering it to be the right thing to do when designing and delivering respectful, humane, and ethical care”. ( 4 , 5 ) Patients and families have reported in the past that they feel left out of crucial conversations and decisions surrounding care, ( 6 ) and that relevant information is not always provided. ( 7 )

To better understand the underlying ethical complexities which arise from critical decisions in the acute care setting, this paper will examine a case study to demonstrate application of the Corey et al . ( 8 ) 8-step framework (see Appendix A ) for ethical decision-making.

Ms. Jones is 93 years old and lives in a Long Term Care residence. She was admitted to hospital with a fragility hip fracture after being found on the floor in the middle of the night. Ms. Jones has dementia and is unable to make her own decisions. She has limited mobility, previously used a walker. Her two daughters are at her bedside. They state her health has been declining over the last few weeks, with increasing confusion and she now rarely leaves her room.

On admission, the team discovered a pleural effusion, taking up much of her right lung. Her pre-operative assessment also revealed a heart murmur; the resulting echocardiogram demonstrated a heart in very poor condition, with significant valve issues. Between her cardiac and pulmonary function, the surgery poses an increased risk of perioperative complications—she may never survive the surgery, or come off of the ventilator once she is intubated.

Interprofessional teams (surgery, anesthesia, nursing) are of differing opinions. The issue at hand is very difficult. The family is informed that the risk of not having surgery will likely result in death, yet in this patient’s case, proceeding with surgery carries its own risk. The family is left with an hour to think things over. Should they pursue the palliative care route or proceed with surgery?

Step 1. Identify the Problem or Dilemma

In our case study, 93 year old Ms. Jones is admitted to hospital with a fragility hip fracture. As a first step, we must recognize that there is actually an ethical dilemma; in this case, the dilemma is whether the patient should proceed with surgery or not, given her underlying medical conditions and potential for perioperative complications. We also need to acknowledge that there is an underlying assumption from all involved (staff, Ms. Jones’ family) that surgery will occur, and that health-care providers (HCPs) may not clearly articulate the option of ‘no surgical intervention’. The stakeholders who are required to proceed through the decision-making process include the patient and family, the surgical team, anesthesia, nursing staff, social work, and potentially the palliative care team and bioethics team.

Step 2. Identify the Potential Issues Involved

There are several assumptions made when a patient presents to the hospital with a fragility hip fracture: a) the fracture will be repaired; b) the patient will recover; and c) the patient will eventually go home or to rehabilitation. With a critically ill, frail, and/or previously compromised patient, this standard trajectory should be questioned. Barry and Edgman-Levitan ( 9 ) promote an ideology of patient-centredness, with the argument that an intervention should only be considered standard if there is ‘virtual unanimity amongst patients about the overall desirability… of the outcomes’.

The first potential issue is the ‘standard’ intervention of surgical repair—the assumption to proceed with the surgery, as directed by best practice recommendations. Is this standard intervention appropriate in all patients with a fragility hip fracture? A second potential issue arises with the patient and their family—the presumption that the acute medical issue will be resolved and the patient will eventually return home. Given her underlying health, this concept is in jeopardy. To add to the complexity, Ms. Jones is likely not able to articulate her wishes and values, as she has dementia. Finally, there is the potential issue of moral distress experienced by health-care providers (HCPs) who feel uncomfortable with the expectant surgical trajectory of this patient, and may feel they are not empowered to advocate for the wishes of the patient.

As health-care professionals, we are guided by moral principles in our decision-making process, namely, autonomy, non-malfeasance, beneficence, justice, fidelity, and veracity. ( 10 ) A focused examination and application of the principles to the case study will help to support potential resolutions for the identified issues.

The spirit of ‘patient-centred care’ endorses that patients should be involved at their level of choice to make an autonomous decision. ( 11 ) However, it is important to recognize that no decision is made in isolation. ( 12 ) The decision at hand is not a simple or straightforward one; literature demonstrates that patients and families have a difficult time with making decisions at time of a critical illness, identifying fear, worthlessness, and a lack of autonomy within the hospital system. ( 7 ) Differing levels of patient and family participation requires an individualized approach to convey meaningful, accurate, and timely information. ( 8 ) Older adult patients tend to take a ‘non-participative’ stance in their care. They often have limited participation in the process for decision-making for a variety of reasons, thereby increasing the risk of their inability to understand or find value within the end decision. ( 6 , 7 , 13 )

Non-malfeasance

Hospitalization can cause the patient to experience “needless mental and physical suffering” ( 14 ) in any number of ways (i.e., pain, waiting for surgery, uncertainty of outcomes, patient/family relationship stress). Evidence indicates that the number of different HCPs involved causes immense anxiety to the family, especially when they do not hear the same message from all members of the team. ( 13 , 15 ) HCPs must ensure that they are not withholding information, or are untruthful as to the options in order to expedite a decision. A study by Ekdahl, Andersson, and Friedrichsen ( 13 ) found that physicians perceive they are ‘too short’ of time for patients to participate in the decision making process, that decisions were ‘too complex’ and ‘time consuming’ to fit into the schedule. Ekdahl et al. ( 13 ) also found that physicians feel frustration with the ‘health-care production machine’, especially in those older adult patients with multiple co-morbidities.

Beneficence

Beneficence promotes wellbeing; or is an action that is carried out to benefit another. ( 8 ) The hospitalization ‘process’ promotes assessment of a patient, treatment of the illness, followed by a physical approach to recovery (allowing recovery to be measured against specific milestones), and discharge in a timely manner. ( 15 , 16 ) This ‘process’ may promote beneficence in an overarching global perspective of the system; however, on an individual level, it often falls short. On an individual level, key actions that have been found to be beneficial and meaningful are open communication and sharing of information. ( 6 , 7 , 14 , 17 )

“Practitioners have a responsibility to provide appropriate services to all clients”. ( 8 ) Older adult patients may not receive information about options available, especially if the HCPs feel that it would take too much time to thoroughly explain, or if HCPs assume that patients are too ill to participate in the decision-making process, ( 13 ) or if the assumption is made that all patients want to proceed with surgery. Focusing on each older adult’s individual health goals is time-consuming—in this case, the patient has dementia, and a family meeting would be required. The concept of patient-centred care revolves around patient and HCP partnerships, yet older adult patients face unique problems with hospitalization—a slower communication process, a decreased level of functioning, and a degree of family involvement. ( 14 ) Can we provide this type of relationship and communication effort equally for every patient? Or only for those patients who may be at higher risk of negative outcomes?

Fidelity and Veracity

Fidelity involves fulfilling ones’ professional roles, creating a trusting relationship, and veracity ensures that we are truthful and honest to the patients. How do we ensure that as a HCP we are providing an unbiased opinion? Do we take the same amount of time to present patients with the option of conservative, non-surgical treatment, including palliative care, as we take to advocate for surgery? The HCP team assumes that patients will commit to surgery; however, a patient often displays a suboptimal understanding of the risks and benefits of surgery. ( 18 ) Similarly, there is the very real risk of bias towards an argument of palliative care in those frail patients or those with dementia. HCPs must return to the voice of the patient through their family, to understand that patients’ identity, their meaning of life, and desired goals which emphasize the patients’ dignity. ( 12 )

It is important to acknowledge assumptions that the patient and family may have made upon admission to hospital—that surgery will occur and the patient will recover. Have we presented the patient and their family with as much information as they need to make a decision in a clear format (without medical jargon)? In addition to understanding risks of surgery, it is paramount that the family understands the non-surgical option may result in death or decreased function (if any functional ability returns). It is in an acute situation such as this that families require truthful and open communication with physicians, nurses, and other members of the health-care team. ( 11 )

Self Care (HCPs)

Can we consistently provide care that prioritizes a patient’s values? HCPs are not always able to preserve all of the values and interests at stake. ( 19 ) We know that the most common cause of moral distress in nursing is prolonged, aggressive treatment which we do not believe will be likely to have a positive outcome. ( 20 ) As a HCP, we must look to root causes operating within the larger system, to prevent and/or respond to feelings of moral distress. ( 19 )

From a systems perspective, does the hospital provide an avenue for exploration of patient values within a timely fashion? Is there a framework in place to enhance the HCP’s understanding of moral distress and provide strategies for coping with situations such as these (i.e., an opportunity for a team debriefing with the entire team, or opportunities for learning how to deal with situations that may cause moral distress)?

Step 3. Review the Relevant Ethics Codes

The philosophy of patient-centred care within the hospital encourages active listening, respect, and an attempt to understand individuals. The Canadian Medical Association (CMA) supports “practicing the profession of medicine in a manner that treats the patient with dignity and as a person worthy of respect”. ( 21 ) The College of Nurses of Ontario (CNO) supports the view that nurses “must use the client’s views as a starting point”. ( 22 ) Across all HCPs is the similarity of the need to listen, understand, support, and advocate for a respect of patients’ values with the expected course of treatment.

The importance of collaboration with the patient and respecting a patient’s values are highlighted within similar statements: ”…it is the patient who ultimately must make informed choices about the care he or she will receive”. ( 21 )

Step 4. Know the Applicable Laws and Regulations

In Ontario, legislation and common law require that the wishes of patients or substitute decision-makers be respected. ( 22 ) However, in many systems, health care is not truly patient-centred; rather, patients are required to adapt to the system. ( 11 ) A number of initiatives have been undertaken in the last few years in an attempt to improve the focus of patient-centredness, with the principle assertion that patients should be involved at the level of their choice. ( 11 )

Step 5. Obtain Consultation

It is important to realize that we bring our own biases to the decision-making process, making it difficult to view the current patient/family’s situation objectively. As an individual HCP, our previous experiences will have an impact on the messaging that we provide. From a systems perspective, we are likely to pose a ‘knowledge’ bias towards meeting treatment based outcomes—for example, surgery within 48 hours, immediate post-operative mobility, and the expected length of stay for this type of patient.

Inter-disciplinary consultations with patients and their families ensure review of unbiased information about the risks and benefits of proceeding with surgery, allowing for a fully informed decision. In addition to discussing the operative plan with the surgical team, there is an opportunity to provide Ms. Jones’ family with other options that may be available to her. Consultation with extended family members, clergy, social workers, or an ethics team may help the family to reflect on the patient values; what this illness means to them as a family unit, and how best to proceed. A discussion with palliative care may help the family to better understand what symptom management consists of for their mother. Social work may also be able help explore community services available to the family in this situation—for example, is the patient able to return to home with the future of wheelchair dependence? Are there any other options which may be available to this patient and her family that were not originally considered? How do we, as HCPs, ensure that the family is afforded the opportunity to obtain all the necessary information from differing disciplines to make an informed choice?

Step 6. Consider Possible and Probable Courses of Action

In order to fully understand the options, it is helpful to outline all the possible and probable courses of action that are open to Ms. Jones and her family.

• Surgical team offers a ‘purposeful pause’ to discover Ms. Jones’ core values; to discuss the consequences of a) delaying surgery, b) proceeding with surgery, and c) the non-surgical intervention. From an ethical and legal perspective, this may meet the concept of patient-centred care, but does not likely provide the patient and her family with all the information they need to make an informed choice. They may have more questions that the surgical team may not be able to answer, or they may request more time to consider. Additionally, the patient and her family would still be expected to adapt to the system in place in order to make a decision within the proposed wait time frame (admission to surgery less than 48 hours).
• Advocate for a family meeting with the primary nurse, social work, palliative care team, clergy, internal medicine, in addition to the surgical (surgeon, anesthesia) team, to fully explore both options, and to explore what the ‘non-surgical’ option would mean. From a legal and ethical perspective this embodies the concept of patient-centred care, with as many members of the health-care team at the table to help Ms. Jones’ family fully explore their options.
• Apply the current standard of care recommendations to Ms. Jones’ situation, without consideration of the patient’s needs, values, or preferences. From an ethical and legal perspective, this approach does not represent patient-centred care.

Step 7. Enumerate the Consequences of Various Decisions

With the first option, the surgical team takes a ‘purposeful pause’ to discover the patient’s core values and discusses pros and cons of a surgical intervention. Often, this may be most ‘efficient’ way to deal with the situation at hand. It may also be the preference of the patient; some patients have reported that they value this limited level of involvement—“I get a description of what is going to happen”. ( 13 ) As a consequence, there will be a number of patients who will want to have a greater sense of involvement other than a simple description of planned events. The first option does recognize the principle of autonomy, but does not follow the principle of justice; practitioners have the responsibility to provide information about other options which may be available. The principles of beneficence and non-maleficence are not completely met, as the team approaches the solution primarily to benefit the system (i.e., efficiency). The principles of fidelity and veracity are also partially met, as the surgical team provides an honest perspective, although it may be biased towards proceeding with surgery.

The second option, offering the patient and her family a meeting with all stakeholders, strongly aligns with the fidelity and veracity principles. The information offered is truthful and complete, and is in Ms. Jones’ best interest, as it attempts to discover her values that will affect the family’s final decision. Principles of beneficence and autonomy would be met with patient empowerment through information sharing, and secondly, by allowing the patient and family to arrive at their own decision with that information. As a consequence, taking the time to arrange for a family meeting with all stakeholders may not be possible for all patients, and the principles of justice and non-maleficence are brought to the forefront for future patients. A potential consequence could be harm to the patient, as the time it takes to arrange a meeting could push the time to surgery beyond the recommended 48 hours post-admission, placing the patient at greater risk of negative post-operative outcomes.

The third option is one of passive action, with a lack of communication and recognition of patient-centred care values. Ms. Jones would be placed on the operating room list, and the surgical repair will occur. Consent must legally be obtained for the surgery; however, the family may not think of key questions to ask that may be relevant in this situation. The onus remains on the HCP to provide a full explanation of all options to the family. The only benefit would be to the system, as the procedure will be carried out in a timely manner. Ms. Jones may benefit from the surgery; we cannot assume that surgery is a negative option. As a consequence of this option, HCPs do not explore patient values, and this option is against almost all of the ethical principles. Additionally, this option is likely to cause the highest moral distress amongst staff, as they are unable to meet the unique needs of Ms. Jones and her family.

Step 8. Choose what Appears to be the Best Course of Action

Virtue ethics asks us if we are doing the best action for our patients, and compels us to be conscious of our behaviours. ( 8 ) We need to take the necessary time to discover the patient’s values within the unique situation they are now experiencing. Simply stated, we need to remember that they are a person, with feelings, emotions, past experiences, future hopes/plans, and usually an element of fear and anxiety. The goal is to work with Ms. Jones and her family to decide together on the current care plan and the best plan for action (or inaction), a plan that truly aligns with the patient’s values.

From an ethical perspective, the best course of action is to hold a family meeting with all stakeholders to discover Ms. Jones’ values about a meaningful life and a meaningful death, and come to a consensus as to what the right decision is for this patient. ( 12 ) The team must ensure that the patient and the family have all the necessary tools in which to make this decision. Have we provided them with all the information required? Do they understand the information? Do they understand the consequences of their decision? From a systems perspective, we need to continue to strive towards engaging patients and family members more fully and consistently in care and decision-making processes. ( 6 ) Dissemination of lessons learned from assisting patients and families through difficult decision-making may be helpful to other health-care teams experiencing similar moral conflicts.

As a next step, the HCP team may consider development of an educational reference for future patients to assist with similar decisions, including promotion of an advanced care plan to help communicate goals and concerns to HCPs. ( 12 , 18 ) Additionally, decision aids, such as videos and brochures, can help deliver information to patients and their families. ( 9 ) The use of readily available technology, such as iPads and cellphones, means that families are better able to access these materials at any time of day. A recent Cochrane Review demonstrated that, in comparison to usual care, decision aids can increase knowledge, resulting in a higher proportion of patients choosing the option which most aligns with their values. ( 23 ) Providing patients with information that outlines potential options with risks and benefits clearly explained can also meet many of the ethical principles that are to be considered with ethical decision-making.

The in-depth review of the case study has helped us to examine the underlying issues that come into play when helping this patient and her family to make a critical decision. Although each patient is an individual, literature tells us that many perceive the concept of patient-centredness to represent an ‘involvement in their care’. The level of involvement may vary from person to person, but all patients want the care they receive to reflect their values and preferences, and to make them feel that they have been treated as a whole person. ( 24 )

Clinicians also like to believe that they deliver patient-centred care, yet the characterization of the concept will vary with the health-care provider, their relationship with the patient, and the circumstances surrounding the admission to hospital. Recognizing that there is potential for an ethical dilemma when patients present with a critical illness is important to ensure that we continue to act upon the key concept of understanding a patients’ values and proceeding to align provision of care with those values.

ACKNOWLEDGEMENTS

The author wishes to acknowledge Dr. Tracy Trothen (Queen’s University) for her time and expertise as a ‘practical ethicist’.

Appendix AFramework for Ethical Decision-Making (Corey et al ., 2014)

• Identify the problem or dilemma
• Identify the potential issues involved
• Review the relevant ethics codes
• Know the applicable laws and regulations
• Obtain consultation
• Consider possible and probable courses of action
• Enumerate the consequences of various decisions
• Choose what appears to be the best course of action

CONFLICT OF INTEREST DISCLOSURES

The author declares that no conflicts of interest exist.

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Organizational decision making

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From Prediction to Transformation

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To See the Way Forward, Look Back

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Problems of Matrix Organizations

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People May Be More Trusting of AI When They Can’t See How It Works

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When Autonomy Helps Team Performance — and When It Doesn’t

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• December 01, 2021

How to Make Peace with a Company Decision You Don't Like

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An Organization-Wide Approach to Good Decision Making

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• May 27, 2015

What AI-Driven Decision Making Looks Like

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La Esperanza: Beyond Automation

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Four Steps to Effective Decisions

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Note on Organizational Structure

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Effective Decision-Making: A Case Study

Effective decision-making:, leading an organization through timely and impactful action.

Senior leaders at a top New England insurance provider need to develop the skills and behaviors for better, faster decision-making. This virtually delivered program spans four half-day sessions and includes individual assignments, facilitator-led presentations, and simulation decision-making. Over the past two months, this program touched over 100 leaders, providing them with actionable models and frameworks to use back on the job.

For one of New England’s most iconic insurers, senior leaders are challenged to make timely, effective decisions. These leaders face decisions on three levels: ones they translate to their teams, ones they make themselves, and ones they influence. But in a quickly changing, highly regulated market, risk aversion can lead to slow and ineffective decisions. How can senior leaders practice in a safe environment the quick, yet informed, decision-making necessary for the job while simultaneously learning new models and techniques — and without the learning experience burdening their precious time?

The Effective Decision-Making program was artfully designed to immerse senior leaders in 16 hours of hands-on experience, including reflection and feedback activities, applicable exercises, supporting content, and participation in a business simulation to practice the core content of the program. Participants work together in small groups to complete these activities within a limited time frame, replicating the work environment in which these leaders must succeed. Continuous reflection and group discussion around results create real-time learning for leaders. Application exercises then facilitate the simulation experience and their work back on the job. The program employs a variety of learning methodologies, including:

• Individual assignments that incorporate content and frameworks designed to develop effective decision-making skills.
• Guided reflection activities to encourage self-awareness and commitments for action.
• Large group conversations — live discussions focused on peer input around key learning points.
• Small group activities, including virtual role plays designed to build critical interpersonal and leadership skills.
• A dynamic business simulation in which participants are charged with translating, making, and influencing difficult decisions.
• Facilitator-led discussions and presentations.

Learning Objectives

Participants develop and improve skills to:

• Cultivate a leadership mindset that empowers, inspires, and challenges others.
• Translate decisions for stronger team alignment and performance.
• Make better decisions under pressure.
• Influence individuals across the organization.
• Better understand how one’s leadership actions impact business results

Design Highlights

Program agenda.

As a result of the COVID-19 pandemic and the need for social distancing, this program was delivered virtually. However, this didn't preclude the need to give leaders an opportunity to connect with, and learn from, one another. In response to those needs, Insight Experience developed a fully remote, yet highly interactive, offering delivered over four half-day sessions.

Interactive Virtual Learning Format

Effective Decision-Making was designed to promote both individual and group activities and reflection. Participants access the program via a video-conferencing platform that allows them to work together both in large and small groups. Learning content and group discussions are done as one large group, enabling consistency in learning and opportunities to hear from all participants. The business simulation decision-making and reflection activities are conducted in small groups, allowing teams to develop deeper connections and conversations.

Simulation Overview

Participants assume the role of a General Manager for InfoMaster, a message management provider. Their leadership challenge as the GM is to translate the broader IIC organizational goals into strategy for their business, support that strategy though the development of organizational capabilities and product offerings, manage multiple divisions and stakeholders, and consider their contribution and responsibility to the broader organization of which they are a part. 

Success in the simulation is based on how well teams:

• Understand and translate organizational strategy into goals and plans for their business unit.
• Align organizational initiatives and product development with broader strategies.
• Develop employee capabilities required to execute strategic goals.
• Hold stakeholders accountable to commitments and results.
• Communicate with stakeholders and involve others in plans and decision-making.
• Develop their network and their influence within IIC to help support initiatives for the organization

History and Results

Effective Decision-Making was developed in 2020 as an experience for senior-level leaders. After a successful pilot, the program was then rolled out to two more cohorts in 2021 and 2022. The senior-level leaders who participated in the program then requested we offer the same program to their direct reports. After some small adjustments to make the program more appropriate for director-level leaders, the program was launched in 2022 for approximately 100 directors.

Here is what some participants have said about this program:

• “ One of the better programs we've done here at [our organization]. Pace was very quick but content was excellent and approach made it fun .”
• “ Loved the content and the flow. Very nicely organized and managed. Thank you! ”
• “ Really enjoyed the collaborative nature of the simulation.”
• “ It was wonderful and I felt it is a great opportunity. Learnt and reinforced leadership training and what it would take to be successful.”
• “One of the best I've experienced — especially appreciated how the reality of [our organization] was incorporated and it was with similarly situated peers.”
• “This program was great! It gave good insight into how to enhance my skills as leader by adopting the leadership mindset.”
• “Loved the fast pace, having a sim group that had various backgrounds in the company and seeing the results of our decisions at the corporate level.”
• “Great program — I love the concepts highlighted during these sessions.”

Looking for results like these?

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Decision-making process

The basic idea, theory, meet practice.

TDL is an applied research consultancy. In our work, we leverage the insights of diverse fields—from psychology and economics to machine learning and behavioral data science—to sculpt targeted solutions to nuanced problems.

Which do you prefer, hamburgers or pizza? 

You probably came up with the answer to that question quickly — unless you’re really torn between those two delicious meals. Yet, whenever we are making a choice between two or more things, our brains go through a decision-making process.

When we are presented with a choice, we first have to identify the decision. For the hamburger vs. pizza question, that’s an easy step — you immediately know that the decision is between two food items. Next, we have to gather the relevant information. You think of hamburgers and pizzas and their respective tastes. Then, you identify alternatives. Are there any other options? Maybe a secret taco stash laying around? No.

Now that you know the parameters of the decision, it’s time to weigh the evidence. Since it’s based on personal preference, you only have to conjure up your own experience eating both. Which one have you preferred in the past? And finally: you’re ready to make the choice. 1

If the question was to require an action, such as “Do you want to go get hamburgers or pizza?”, after making the choice, you would implement the action and order one or the other. The last step is to reflect on that decision. As you sit thedown with your slice of pizza, are you content? You evaluate your outcome so that in the future, you can improve your choices. 2

A decision-making process is the cognitive process where you weigh alternatives to achieve a desired result. 3

It doesn’t matter which side of the fence you get off on sometimes. What matters most is getting off. You cannot make progress without making decisions. - American entrepreneur and motivational speaker Jim Rohn. 4

Problem Solving: while problem solving and decision making are related, they are not the same. Problem solving is an analytical process used to identify the possible solutions to a situation at hand and is sometimes a part of the decision-making process. However, sometimes you make a decision without identifying all possible solutions to the problem. 5

Analysis Paralysis: the inability to decide because of over-thinking. People usually get stuck in the stage where they consider all the alternatives and can be overwhelmed by choice (known as the choice overload bias ), preventing them from picking a choice. 6

Boundary conditions: constraints necessary for the solution of a decision. 7 The boundary conditions determine what the objective of the decision is and therefore what solutions will be suitable. 8

Maximizing: a decision-making process in which an individual employs optimization, where they gain all the necessary data on alternatives to make the best decision. 9

Bounded rationality : decision-making processes where individuals satisfice instead of optimize. 

Decision-making processes are one of the facets that make humans unique. There are definitely similarities between the ways that humans and animals make decisions (in fact, we wrote a whole article about it: “ Decision-Making Parallels Between Humans and Animals ”). But humans are thought to engage in more complex decision-making processes - our actions are less governed by instinct than animals.  

Since decision-making processes are an integral part of humanity, it’s impossible to pinpoint a time where they were first an object of research, as we have been interested in how humans make decisions as long as we have existed! In research, decision-making processes are usually examined as either group decision-making, or individual decision-making. 

In group decision-making, multiple individuals work together to analyze a question or problem, consider alternative choices, and make a choice. An obvious difference between group decision-making and individual decision-making is that the former process is usually more formal and occurs outside of internal thought processes. Being in a group also has quite impactful effects on the types of decisions we come to. For example, groupthink is a phenomenon borne from our desire to achieve consensus - individuals ignore evidence or neglect to speak out if their thoughts contradict the majority opinion. It is a form of group conformity that hinders critical thinking and can lead to suboptimal decisions. Additionally, groups tend to make riskier decisions than individuals. 10

Yet, sometimes group decision-making processes are advantageous because there are a greater number of perspectives which can reduce the personal biases that come into play with individual decision-making. Groups can usually come up with a greater number of alternatives, because they have more time and resources. Oftentimes, individuals have to employ the satisficing technique, where they make a choice that is satisfactory rather than optimal. When satisficing, individuals don’t engage in problem-solving, but pick the first choice they come across that adheres to the boundary conditions, because it requires too much time, effort, and resources to gather all the necessary evidence and alternative options. 

Various research has gone into trying to outline the steps involved in the decision-making process. One of the earlier processes,developed by Australian psychologist Leon Mann in the 1980s, is known as the GOFER process. It was based on a theory Mann had previously proposed alongside psychologist Irvin Janis, the conflict theory of decision making, which suggests decision-makers must choose from a set of alternatives that each have positive and negative outcomes. 11 GOFER represents an acronym for five decision-making steps:

• G oal clarification. In this step, the decision-maker must determine what their goal is and what they are trying to achieve with their decision.
• O ptions generation. The decision-maker conjures up different options that are available to them and that would help them achieve their goals.
• F acts-finding. During this stage, the decision-maker examines what evidence they have on each alternative and what information they are missing that could help them make their decision. 
• E ffects. The decision-maker considers the positive and negative outcomes of each alternative.
• R eview. Now that a decision has been arrived at, the decision-maker considers how it will be implemented. 12

Another popular decision-making process model is the DECIDE model, developed in 2008 by Hawaiian educator, Kristina Guo. It has similar steps as the GOFER model and Guo developed it to help healthcare managers make better decisions. The acronym stands for:

• D efine the problem.
• E stablish the criteria.
• C onsider the alternatives.
• I dentify the best alternative.
• D evelop a plan and implement the plan of action.
• E valuate and monitor the solution and feedback. 10

While the first five steps are similar to the GOFER model, the DECIDE model has an additional step, evaluate, which is crucial for improving decision-making processes in the long run, as evaluating your choice will help you learn how successful it was and whether you should make the same decision in the future.

Consequences

Although we usually make decisions quickly, following decision-making models can help us make thoughtful decisions. By outlining the decision-making process, you can ensure that you are going through each step, considering the alternatives, and making an informed decision, which should lead to better outcomes. When it comes to group settings, being transparent about the decision-making process can also help other people understand why you’re making the choices you are. After all, wasn’t it irritating when your parents told you that the answer was no ‘because they said so’? 

Controversies

Oftentimes, people assume that decision-making processes are rational. Many models assume that individuals will make choices that maximize utility while minimizing costs. They also assume people have all of the information required to make the optimal choice — all of the models include a stage where the decision-maker analyzes various alternatives. 

But consider how many decisions you have made today. Is it really possible to go through each stage of the decision-making process, weigh out all the advantages and disadvantages of each alternative, and then come to a clear decision? Humans are thought to make around 35,000 choices per day, which makes it impossible for us to have the time, resources, or brain capacity to have all the information necessary to make a perfectly rational decision. 13

That’s why many people criticize decision-making models for being unrealistic, and instead suggest that decision-making processes actually adhere to bounded rationality , where decision-makers satisfice instead of optimize. 

Effectiveness of the GOFER Decision-Making Process

Giving teens the tools to make better, more thought-out decisions can help improve outcomes. In 1988, Leon Mann and his colleagues from The Flinders University of South Australia conducted a study to determine how effective teaching students the GOFER decision-making process was. 14  

Mann and his colleagues developed and ran a GOFER course to teach teens generalized decision-making skills that would enable the students to apply the decision skills to a range of problems even beyond the school context. They delivered the course over the span of a year with the aid of two principal texts. The first book outlined decision-making processes and the GOFER technique, while the second applied the principles of GOFER to five areas: decision-making in groups, friendships and decision-making, subject choices, money, and finally, the GOFER technique employed in various different professions. 14  

Mann et al. compared the students in South Australia who had taken the GOFER course with a control group of high school students who had not taken the course. They gave all students a questionnaire that asked them to reflect on their decision self-esteem, their vigilance with decisions, panic measures they might be prone to, cop out tendencies they use to avoid making decisions, and complacency. They filled out another questionnaire that examined their performance on decision-making across the five areas taught by the course, and a third questionnaire that asked them general information about decision-making, with questions like, “What makes a good decision maker?” 14

Mann found that the students who had been trained in the GOFER method during the course had much higher reports of self-esteem as a decision-maker, and better habits when it came to making decisions (fewer panic, cop-out, and complacency tendencies). Mann et al. concluded that the GOFER decision-making process helped improve student knowledge on decision-making, raise their confidence, and improved their habits. 14 

Decision-making styles

Just as there are various different decision-making models, there are different decision-making styles. Each style has different advantages and disadvantages, and can be categorized into four main types: directive, conceptual, analytical, and behavioral. 15

Directive: Individuals with directive decision-making styles rely on rationality, but the decision-maker usually relies solely on their own knowledge without taking into account other opinions. 15

Conceptual: The conceptual decision-maker likes to approach problems from every angle. They like to brainstorm potential alternatives, gather insights from other people, and try to come up with creative solutions to problems. This style of decision-making can be time-consuming as a result. 15

Analytical: Similar to the conceptual decision makers, analytical decision-makers like to gather a lot of information before they make a decision. While the conceptual decision-maker is keen to come up with creative solutions, the analytical decision-maker wants to find data and facts that will support their decision. At times, this can prevent innovative choices, but it means that choices are well-informed and objective. 16

Behavioral: Individuals with a behavioral decision-making style are group-oriented. However, instead of leaving the process open-ended, they will provide groups with potential options and alternatives and use the group sessions to discuss potential pros and cons. To be effective, this style needs a decisive leader who can listen to the pros and cons and execute a decision, or else discussion could go on forever. 16 

Related Content

Group Decision Making: How to Be Effective and Efficient

Groupthink can be an obstacle to group decision-making processes, but so can it’s opposite. You’ve probably heard of the phrase ‘too many cooks in the kitchen.’ When many people are involved in the decision-making process, too much time can be spent debating between alternatives which can lead to a standstill or a delay in making a decision. While opposite issues, both of these phenomena are common challenges in group decision-making. To discover some principles that can help groups make more effective and efficient decisions, read this article by our contributor, Yasmine Kalkstein.

The Power of Narratives in Decision Making

Decision-making processes are usually outlined as a series of steps or stages. Humans like to categorize things in that way, because we tend to process the world around us as narratives that have a sequence: a beginning (a cause), a middle, and an end (an effect). That is known as the theory of narrative thought, which this article explores. In the article, contributor Constantin Huet explores why it is that we think in terms of stories, and what effects stories have on our consumer decisions. 

• 7 steps of the decision-making process . (2020, May 18). Lucidchart. https://www.lucidchart.com/blog/decision-making-process-steps
• Decision-making process . (2016, September 23). University of Massachusetts Dartmouth. https://www.umassd.edu/fycm/decision-making/process/
• Lunenburg, F. C. (2010). The Decision Making Process. National Forum of Educational Administration and Supervision Journal , 27 (4). http://www.nationalforum.com/Electronic%20Journal%20Volumes/Lunenburg,%20Fred%20C.%20The%20Decision%20Making%20Process%20NFEASJ%20
• Sweatt, L. (2016, October 6). 13 Quotes About Making Life Choices . SUCCESS. https://www.success.com/13-quotes-about-making-life-choices/
• Problem solving vs decision making – what is the difference? (2019, July 30). Changeboard. https://www.changeboard.com/article-details/16960/problem-solving-vs-decision-making-what-is-the-difference-
• Chen, J. (2021, July 2). Analysis Paralysis . Investopedia. https://www.investopedia.com/terms/a/analysisparalysis.asp
• What Are Boundary Conditions? (2021, September 3). SimScale. https://www.simscale.com/docs/simwiki/numerics-background/what-are-boundary-conditions/
• Drucker, P. F. (1967, January 1). The Effective Decision . Harvard Business Review. https://hbr.org/1967/01/the-effective-decision
• Satisficing . (2021, October 7). The Decision Lab. https://thedecisionlab.com/reference-guide/psychology/satisficing/
• Belovicz, M. W., Finch, F. E., & Jones, H. (2017). Do Groups Make Riskier Decisions Than Individuals. https://doi.org/10.5465/ambpp.1968.4980628
• Loneck, B. M., & Kola, L. A. (2010). Using the Conflict-Theory Model of Decision Making to Predict Outcome in the Alcoholism Intervention. https://doi.org/10.1300/J020V05N03_09
• GOFER Process for Decision Making. Tools and Techniques to make Better Choices . (October 6). Briquinex. Retrieved January 18, 2022, from https://briquinex.blogspot.com/2020/10/gofer-process-for-decision-making-tools.html
• Krockow, E. M. (2018, September 27). How Many Decisions Do We Make Each Day? Psychology Today. https://www.psychologytoday.com/ca/blog/stretching-theory/201809/how-many-decisions-do-we-make-each-day
• Mann, L., Power, C., Harmoni, R., Beswick, G., & Ormond, C. (1988). Effectiveness of the GOFER course in decision making for high school students. Journal of Behavioral Decision Making , 1 (3), 159-168. https://www.academia.edu/18668639/Effectiveness_of_the_GOFER_course_in_decision_making_for_high_school_students
• Lombardo, J. (2013, July 24). Decision Making Styles: Directive, Analytical, Conceptual and Behavioral . Study.com. https://study.com/academy/lesson/decision-making-styles-directive-analytical-conceptual-and-behavioral.html
• Malhotra, S. (2018, July 27). 4 styles of decision-making: A leader's guide . The Enterprisers Project. https://enterprisersproject.com/article/2018/7/4-styles-decision-making-leaders-guide?page=0%2C1

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Teaching Resources Library

Case studies.

The teaching business case studies available here are narratives that facilitate class discussion about a particular business or management issue. Teaching cases are meant to spur debate among students rather than promote a particular point of view or steer students in a specific direction.  Some of the case studies in this collection highlight the decision-making process in a business or management setting. Other cases are descriptive or demonstrative in nature, showcasing something that has happened or is happening in a particular business or management environment. Whether decision-based or demonstrative, case studies give students the chance to be in the shoes of a protagonist. With the help of context and detailed data, students can analyze what they would and would not do in a particular situation, why, and how.

Case Studies By Category

Top 40 Most Popular Case Studies of 2021

Two cases about Hertz claimed top spots in 2021's Top 40 Most Popular Case Studies

Two cases on the uses of debt and equity at Hertz claimed top spots in the CRDT’s (Case Research and Development Team) 2021 top 40 review of cases.

Hertz (A) took the top spot. The case details the financial structure of the rental car company through the end of 2019. Hertz (B), which ranked third in CRDT’s list, describes the company’s struggles during the early part of the COVID pandemic and its eventual need to enter Chapter 11 bankruptcy. 

The success of the Hertz cases was unprecedented for the top 40 list. Usually, cases take a number of years to gain popularity, but the Hertz cases claimed top spots in their first year of release. Hertz (A) also became the first ‘cooked’ case to top the annual review, as all of the other winners had been web-based ‘raw’ cases.

Besides introducing students to the complicated financing required to maintain an enormous fleet of cars, the Hertz cases also expanded the diversity of case protagonists. Kathyrn Marinello was the CEO of Hertz during this period and the CFO, Jamere Jackson is black.

Sandwiched between the two Hertz cases, Coffee 2016, a perennial best seller, finished second. “Glory, Glory, Man United!” a case about an English football team’s IPO made a surprise move to number four.  Cases on search fund boards, the future of malls,  Norway’s Sovereign Wealth fund, Prodigy Finance, the Mayo Clinic, and Cadbury rounded out the top ten.

Other year-end data for 2021 showed:

• Online “raw” case usage remained steady as compared to 2020 with over 35K users from 170 countries and all 50 U.S. states interacting with 196 cases.
• Fifty four percent of raw case users came from outside the U.S..
• The Yale School of Management (SOM) case study directory pages received over 160K page views from 177 countries with approximately a third originating in India followed by the U.S. and the Philippines.
• Twenty-six of the cases in the list are raw cases.
• A third of the cases feature a woman protagonist.
• Orders for Yale SOM case studies increased by almost 50% compared to 2020.
• The top 40 cases were supervised by 19 different Yale SOM faculty members, several supervising multiple cases.

CRDT compiled the Top 40 list by combining data from its case store, Google Analytics, and other measures of interest and adoption.

All of this year’s Top 40 cases are available for purchase from the Yale Management Media store .

And the Top 40 cases studies of 2021 are:

1.   Hertz Global Holdings (A): Uses of Debt and Equity

2.   Coffee 2016

3.   Hertz Global Holdings (B): Uses of Debt and Equity 2020

4.   Glory, Glory Man United!

5.   Search Fund Company Boards: How CEOs Can Build Boards to Help Them Thrive

6.   The Future of Malls: Was Decline Inevitable?

7.   Strategy for Norway's Pension Fund Global

8.   Prodigy Finance

9.   Design at Mayo

10. Cadbury

11. City Hospital Emergency Room

13. Volkswagen

14. Marina Bay Sands

15. Shake Shack IPO

16. Mastercard

17. Netflix

18. Ant Financial

19. AXA: Creating the New CR Metrics

20. IBM Corporate Service Corps

21. Business Leadership in South Africa's 1994 Reforms

22. Alternative Meat Industry

23. Children's Premier

24. Khalil Tawil and Umi (A)

25. Palm Oil 2016

26. Teach For All: Designing a Global Network

27. What's Next? Search Fund Entrepreneurs Reflect on Life After Exit

28. Searching for a Search Fund Structure: A Student Takes a Tour of Various Options

30. Project Sammaan

31. Commonfund ESG

32. Polaroid

33. Connecticut Green Bank 2018: After the Raid

34. FieldFresh Foods

35. The Alibaba Group

36. 360 State Street: Real Options

37. Herman Miller

38. AgBiome

39. Nathan Cummings Foundation

40. Toyota 2010

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Case Studies

More than 70 cases pair ethics concepts with real world situations. From journalism, performing arts, and scientific research to sports, law, and business, these case studies explore current and historic ethical dilemmas, their motivating biases, and their consequences. Each case includes discussion questions, related videos, and a bibliography.

A Million Little Pieces

James Frey’s popular memoir stirred controversy and media attention after it was revealed to contain numerous exaggerations and fabrications.

Abramoff: Lobbying Congress

Super-lobbyist Abramoff was caught in a scheme to lobby against his own clients. Was a corrupt individual or a corrupt system – or both – to blame?

Apple Suppliers & Labor Practices

Is tech company Apple, Inc. ethically obligated to oversee the questionable working conditions of other companies further down their supply chain?

Approaching the Presidency: Roosevelt & Taft

Some presidents view their responsibilities in strictly legal terms, others according to duty. Roosevelt and Taft took two extreme approaches.

Appropriating “Hope”

Fairey’s portrait of Barack Obama raised debate over the extent to which an artist can use and modify another’s artistic work, yet still call it one’s own.

Arctic Offshore Drilling

Competing groups frame the debate over oil drilling off Alaska’s coast in varying ways depending on their environmental and economic interests.

Banning Burkas: Freedom or Discrimination?

The French law banning women from wearing burkas in public sparked debate about discrimination and freedom of religion.

Birthing Vaccine Skepticism

Wakefield published an article riddled with inaccuracies and conflicts of interest that created significant vaccine hesitancy regarding the MMR vaccine.

Blurred Lines of Copyright

Marvin Gaye’s Estate won a lawsuit against Robin Thicke and Pharrell Williams for the hit song “Blurred Lines,” which had a similar feel to one of his songs.

Bullfighting: Art or Not?

Bullfighting has been a prominent cultural and artistic event for centuries, but in recent decades it has faced increasing criticism for animal rights’ abuse.

Buying Green: Consumer Behavior

Do purchasing green products, such as organic foods and electric cars, give consumers the moral license to indulge in unethical behavior?

Cadavers in Car Safety Research

Engineers at Heidelberg University insist that the use of human cadavers in car safety research is ethical because their research can save lives.

Cardinals’ Computer Hacking

St. Louis Cardinals scouting director Chris Correa hacked into the Houston Astros’ webmail system, leading to legal repercussions and a lifetime ban from MLB.

Cheating: Atlanta’s School Scandal

Teachers and administrators at Parks Middle School adjust struggling students’ test scores in an effort to save their school from closure.

Cheating: Sign-Stealing in MLB

The Houston Astros’ sign-stealing scheme rocked the baseball world, leading to a game-changing MLB investigation and fallout.

Cheating: UNC’s Academic Fraud

UNC’s academic fraud scandal uncovered an 18-year scheme of unchecked coursework and fraudulent classes that enabled student-athletes to play sports.

Cheney v. U.S. District Court

A controversial case focuses on Justice Scalia’s personal friendship with Vice President Cheney and the possible conflict of interest it poses to the case.

Christina Fallin: “Appropriate Culturation?”

After Fallin posted a picture of herself wearing a Plain’s headdress on social media, uproar emerged over cultural appropriation and Fallin’s intentions.

Climate Change & the Paris Deal

While climate change poses many abstract problems, the actions (or inactions) of today’s populations will have tangible effects on future generations.

Cover-Up on Campus

While the Baylor University football team was winning on the field, university officials failed to take action when allegations of sexual assault by student athletes emerged.

Covering Female Athletes

Sports Illustrated stirs controversy when their cover photo of an Olympic skier seems to focus more on her physical appearance than her athletic abilities.

Covering Yourself? Journalists and the Bowl Championship

Can news outlets covering the Bowl Championship Series fairly report sports news if their own polls were used to create the news?

Cyber Harassment

After a student defames a middle school teacher on social media, the teacher confronts the student in class and posts a video of the confrontation online.

Defending Freedom of Tweets?

Running back Rashard Mendenhall receives backlash from fans after criticizing the celebration of the assassination of Osama Bin Laden in a tweet.

Dennis Kozlowski: Living Large

Dennis Kozlowski was an effective leader for Tyco in his first few years as CEO, but eventually faced criminal charges over his use of company assets.

Digital Downloads

File-sharing program Napster sparked debate over the legal and ethical dimensions of downloading unauthorized copies of copyrighted music.

Dr. V’s Magical Putter

Journalist Caleb Hannan outed Dr. V as a trans woman, sparking debate over the ethics of Hannan’s reporting, as well its role in Dr. V’s suicide.

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Edward Snowden: Traitor or Hero?

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A heated debate ensues over whether or not the Confederate flag should be removed from the South Carolina State House grounds.

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Gaming the System: The VA Scandal

The Veterans Administration’s incentives were meant to spur more efficient and productive healthcare, but not all administrators complied as intended.

German Police Battalion 101

During the Holocaust, ordinary Germans became willing killers even though they could have opted out from murdering their Jewish neighbors.

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American football is a rough and dangerous game and its impact on the players’ brain health has sparked a hotly contested debate.

Healthcare Obligations: Personal vs. Institutional

A medical doctor must make a difficult decision when informing patients of the effectiveness of flu shots while upholding institutional recommendations.

High Stakes Testing

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Krogh & the Watergate Scandal

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Limbaugh on Drug Addiction

Radio talk show host Rush Limbaugh argued that drug abuse was a choice, not a disease. He later became addicted to painkillers.

U.S. Olympic swimmer Ryan Lochte’s “over-exaggeration” of an incident at the 2016 Rio Olympics led to very real consequences.

Meet Me at Starbucks

Two black men were arrested after an employee called the police on them, prompting Starbucks to implement “racial-bias” training across all its stores.

Myanmar Amber

Buying amber could potentially fund an ethnic civil war, but refraining allows collectors to acquire important specimens that could be used for research.

Negotiating Bankruptcy

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Pardoning Nixon

One month after Richard Nixon resigned from the presidency, Gerald Ford made the controversial decision to issue Nixon a full pardon.

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Nursing staff and family members struggle with informed consent when taking care of a patient who has been deemed legally incompetent.

Prenatal Diagnosis & Parental Choice

Debate has emerged over the ethics of prenatal diagnosis and reproductive freedom in instances where testing has revealed genetic abnormalities.

Reporting on Robin Williams

After Robin Williams took his own life, news media covered the story in great detail, leading many to argue that such reporting violated the family’s privacy.

Responding to Child Migration

An influx of children migrants posed logistical and ethical dilemmas for U.S. authorities while intensifying ongoing debate about immigration.

Retracting Research: The Case of Chandok v. Klessig

A researcher makes the difficult decision to retract a published, peer-reviewed article after the original research results cannot be reproduced.

Sacking Social Media in College Sports

In the wake of questionable social media use by college athletes, the head coach at University of South Carolina bans his players from using Twitter.

Selling Enron

Following the deregulation of electricity markets in California, private energy company Enron profited greatly, but at a dire cost.

Snyder v. Phelps

Freedom of speech was put on trial in a case involving the Westboro Baptist Church and their protesting at the funeral of U.S. Marine Matthew Snyder.

Something Fishy at the Paralympics

Rampant cheating has plagued the Paralympics over the years, compromising the credibility and sportsmanship of Paralympian athletes.

Sports Blogs: The Wild West of Sports Journalism?

Deadspin pays an anonymous source for information related to NFL star Brett Favre, sparking debate over the ethics of “checkbook journalism.”

Stangl & the Holocaust

Franz Stangl was the most effective Nazi administrator in Poland, killing nearly one million Jews at Treblinka, but he claimed he was simply following orders.

Teaching Blackface: A Lesson on Stereotypes

A teacher was put on leave for showing a blackface video during a lesson on racial segregation, sparking discussion over how to teach about stereotypes.

The Astros’ Sign-Stealing Scandal

The Houston Astros rode a wave of success, culminating in a World Series win, but it all came crashing down when their sign-stealing scheme was revealed.

The Central Park Five

Despite the indisputable and overwhelming evidence of the innocence of the Central Park Five, some involved in the case refuse to believe it.

The CIA Leak

Legal and political fallout follows from the leak of classified information that led to the identification of CIA agent Valerie Plame.

The Collapse of Barings Bank

When faced with growing losses, investment banker Nick Leeson took big risks in an attempt to get out from under the losses. He lost.

The Costco Model

How can companies promote positive treatment of employees and benefit from leading with the best practices? Costco offers a model.

The FBI & Apple Security vs. Privacy

How can tech companies and government organizations strike a balance between maintaining national security and protecting user privacy?

The Miss Saigon Controversy

When a white actor was cast for the half-French, half-Vietnamese character in the Broadway production of Miss Saigon , debate ensued.

The Sandusky Scandal

Following the conviction of assistant coach Jerry Sandusky for sexual abuse, debate continues on how much university officials and head coach Joe Paterno knew of the crimes.

The Varsity Blues Scandal

A college admissions prep advisor told wealthy parents that while there were front doors into universities and back doors, he had created a side door that was worth exploring.

Providing radiation therapy to cancer patients, Therac-25 had malfunctions that resulted in 6 deaths. Who is accountable when technology causes harm?

Welfare Reform

The Welfare Reform Act changed how welfare operated, intensifying debate over the government’s role in supporting the poor through direct aid.

Wells Fargo and Moral Emotions

In a settlement with regulators, Wells Fargo Bank admitted that it had created as many as two million accounts for customers without their permission.

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Decision-Making: An Applied Case of Problem-Analysis and Solutions Finding

Written by Borbala Pentek on January 18, 2019 . Posted in Articles , Strategy

Collecting data on organizational decisions, analyzing it and checking it for accuracy will bring insights into the performance of a business, however this does not guarantee adequate decision-making .

Therefore, to ensure that these insights are effectively transformed into actions, one should be familiar with the main steps of the decision-making process, as well as the most commonly used decision-making techniques.

Figure 1: Decision-Making process

1. assess the current situation.

The first step of the decision-making process would be to assess the current situation based on the available data. Data analysis helps pinpoint the most crucial organizational issues drilling down into the performance of internal processes as well.

On the one hand, defining the problem correctly will save decision-makers time and money. On the other hand, confusion about the problem at hand will lead to lack of focus and efficiency in actions taken, based on data analysis.

Let’s take the example of a company operating in the telecommunications industry, which is looking into the following dashboard for its Customer Service Department.

Figure 2: Organizational Dashboard

The target for # Customer complaints received being 210, there is clearly a problem with the company’s operations that leads to an increased number of customer complaints. The problem therefore needs to be identified and adequate solutions provided.

2. Search for solutions

After correctly stating the problem, one needs to search for solutions and come up with ideas to solve it. This implies analyzing the stated problem, considering all the variables and data available at hand (time, financial data, frequency of occurrence, etc.).

By making use of brainstorming sessions, preferably conducted with the participation of the organization’s main stakeholders – possibly during the performance review meeting, decision-makers should list more than one solution for the problem at hand.

In the case of the aforementioned telecommunications company, the purpose of the performance review meeting would be to find out the cause of the increasing number of customer complaints, after which they would suggest and evaluate solutions.

Moreover, they’d have to also focus on developing initiatives to improve the results of # Customer complaints received, as it is nonetheless an indicator of customer dissatisfaction with the company’s products or services.

As a first step, the problem needs to be defined correctly. In order to do this, managers must learn to distinguish between problems and symptoms. Using root cause analysis tools, such as the Fishbone (Ishikawa) Diagram and problem analysis techniques such as the 5 Whys, can help with identifying the causes that lie at the heart of the issues.

The high number of customer complaints in this case may most likely be a symptom of a deeper conundrum; therefore, we use the 5 Why Method to determine why this indicator is not meeting its target.

Figure 3: 5 Why’s Technique

According to the 5 Whys Root Cause analysis, the cause for complaints is dissatisfaction due to unexpectedly high bills, or bill-shock. However, the issue is not related to incorrect charging, but in most cases, unexpected charges while being abroad.

This means that customers don’t have adequate information regarding their monthly allowance and international charges, which leads to unrealistic expectations in many of the cases.

What is interesting about this is the fact that even though most of the time the high number of complaints are directly associated with the Customer Service department, in this case asking the question Why? five times points to a different direction regarding the root cause of the issue.

In order to go even deeper into the causes of the problem, a Fishbone Diagram is used to identify other possible factors that are contributing to the increase in customer complaints.

In order to develop the Fishbone Diagram, several facts should be gathered during a preliminary investigation of the problem. This diagram is valuable because it allows us to dig deeper and get a better understanding of what lies behind the organization’s systems and what processes are causing the problem.

Figure 4: Fishbone (Ishikawa) Diagram

Clustering or cluster analysis, in its simplest form, is a highly useful technique as far as classifying problems is concerned.

If we were to perform a simple cluster analysis on the information identified through the Ishikawa Diagram, for our telecommunications company, we’d see that this tool would prove extremely useful when it comes to narrowing down the main areas/activities that the organization should further look into.

Figure 5: Cluster analysis

3. evaluate alternatives.

Choosing the most suitable solution for the problem at hand implies that advantages and disadvantages are presented for every solution identified during the performance review meeting or alternate problem-solving sessions.

This is defined as the evaluation phase. The best alternative will be the one that minimizes risks and costs, and maximizes benefits. Some techniques, such as cost-benefit analysis or stakeholder analysis can help managers identify the best solution the organization can consider for future application.

Getting back to our telecommunications company, after having identified that the main contributing factor for their high number of customer complaints is the poor quality of information offered, and finding out the main causes behind this problem, the next step is to propose solutions.

Figure 6: Evaluating alternatives

When it comes to customer support, a solution with a high return on investment would be to implement an E-mail Customer Service System.

As far as the area of information/communication is concerned, redesigning the company’s website would be conducive towards greater transparency and raise awareness on international tariffs.

Since the organizational budget allows for only one of these initiatives to be implemented, they must be evaluated and only the most viable one maintained.

4. Select the proper alternative

A technique as simple as Pros/Cons enables a useful comparison analysis between two alternative solutions proposed for solving the problem of our telecommunications company.

Table 1: Pro/Cons Technique

Once the most beneficial alternative has been identified, managers must make sure that the decision is implemented correctly . This can be achieved through the constant monitoring of resources, timeline, objectives and stakeholders.

Furthermore, setting regular monitoring intervals (daily, weekly, monthly etc.) is useful for finding the perfect balance between excessive and insufficient monitoring.

During this phase, data collection becomes important and valuable again, given that the last step, evaluating impact , is based on the analysis of data previously collected.

5. Evaluate impact

Due to budgetary constraints and the fact that, while implementing a new website could bring many additional benefits, it is more expensive, the problem at hand is believed to be solved more efficiently through e-mail customer support.

Therefore, the telecommunications company we have been following up on throughout this article decides to implement the first idea, an E-mail Customer Support System.

Now comes the last step in their decision-making process – evaluating impact. It implies making use of the lessons learnt by tackling the problem it has identified and assessing the effectiveness of its chosen solution.

This step enables an organization to make better decisions in the future, based on past experiences. You can generate real impact by turning improvement ideas into initiatives and managing such initiatives for the ultimate benefit of boosting organizational results.

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Tags: Decision making , Strategic Management , strategic planning

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Case Study – Continue to Fight? Patient Decision-Making Changes

By Ryan Pferdehirt, D.Bioethics, HEC-C

January 2021

Patient Decision-Making Bioethics Case Study

Sarah is a 73-year-old individual who identifies as female and is suffering from metastatic colon cancer. While an inpatient, she is cared for by her longtime oncologist, hospitalists, and ultimately a critical care team. Initially Sarah has decision-making capacity, Sarah makes decisions with her family (husband and two adult children).

When discussing treatment options and goals of care, Sarah inconsistently makes decisions based on who is present in the room. When the patient is by herself, she says that she knows she is very sick and is tired; and at this point, all she cares about is being comfortable. But when her family, particularly her husband, is in the room, Sarah will default to saying that she wants to “continue to fight.”

Multiple physicians have noticed the difference between what their patient says in private and when family is present. Family discussion centers on those militaristic notions of “fighting” the cancer. “Mom, you don’t want to give up, do you?” and “Let’s just keep fighting a little more, Honey.” Then when Sarah is alone with her providers, she says, “I really just want to make sure that I am comfortable and not in pain.” During the night shift, Sarah coded and was resuscitated per her Full Code status. She was transferred to the Medical ICU and seems now to have more pain and discomfort than previously. Her decisional capacity is unclear, and transient at best due to sedation and possibly anoxic injury. A family meeting is scheduled to discuss decisions to be made, including code status going forward.

ICU physicians, residents in particular, state a perspective that attempting resuscitation again would be “futile” and it is time to move to comfort measures only. The attending oncologist believes that it is too early to stop aggressive treatment and “withdraw care.” She wants to keep Sarah Full Code and obtain consent for at least another round of chemotherapy.

Both teams have requested that Ethics join the family meeting.

Organizational culture, compensation systems, decision-making, and efficiency of public higher education institutions: case study of the University of Sfax

• Research Article
• Published: 04 April 2024

Cite this article

• Wahiba Ben Fradj Nasrallah   ORCID: orcid.org/0000-0001-7116-8052 1 &
• Ghazi Zouari 1  

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In this research, we examined the mediating effect (decision-making) between governance mechanisms captured by organizational culture and compensation systems (local and/or national criteria bonuses) of public higher education institutions and their efficiency, through an empirical study based on correlational investigation. To identify the relationship between governance mechanisms: organizational culture and compensation systems (local and/or national criteria bonuses), decision-making, and efficiency of public higher education institutions, we selected a sample of 19 public higher education institutions in Sfax for the periods 2017–2020 and 2020–2023. The obtained results revealed that the attribute of organizational culture (captured by student life) and compensation systems (local and/or national criteria bonuses) indirectly affect the efficiency of university institutions through decision-making.

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All data generated or analyzed during this study are included in this published article (and its supplementary information files).

The treatment of mediating variables should follow the approach outlined by Baron and Kenny ( 1986 ). This approach, aimed at testing the mediating effect, is performed using hierarchical multiple regression. This analysis involves assessing the total (cumulative) effect of explanatory variables on a criterion. The method consists of several steps: (1) testing the effect of the predictor (independent variable) on the criterion (dependent variable), (2) testing the effect of the predictor (independent variable) on the mediator using partial and simple regressions, and (3) testing the other relationship (predictor and mediator on the criterion). In this case, hierarchical multiple regression is used. It involves gradually entering explanatory variables into the regression equation, starting with the predictors and control variables (1st step), and then the mediating variable (2nd step). If there is an increase in the adjusted R-squared after entering the mediator, we can infer the effect of this mediator in the relationship between the predictor and the criterion (Zouari and Zouari-Hadiji 2014 ).

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Nasrallah, W.B.F., Zouari, G. Organizational culture, compensation systems, decision-making, and efficiency of public higher education institutions: case study of the University of Sfax. Decision (2024). https://doi.org/10.1007/s40622-024-00377-0

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