Meta-Decision: History and Applicability in Healthcare
Several studies have examined the concept of meta-decision.9–11 Wang 9 defined it as “the
decision on how to make the practical decisions required throughout the
whole decision process.” Mintzberg 11 called it
program control, an overall process of planning and switching in
decision-making, and acknowledged the difficulty of the process stating
that “decision control activities are difficult to study because they
tend to be implicit and informal, taking place in the mind of the
decision-maker and to leave little trace of themselves.”
The meta-decision concept was used more in non-healthcare models, but
despite its importance, the literature on this subject is limited and
dispersed over time. 12 13, 14 Thus,
it is worthwhile to conceptualize and propose its implementation in
healthcare, and acknowledge that it is based on successful experiences
in non-healthcare literature. 15, 16They identified distinct steps for decision-making, which are very
similar but differ in number of steps and terminology.11, 15, 17
The meta-decision steps include rationality as an important concept. It
strongly relates to Simon’s bounded rationality theory, which indicates
that rationality is limited when individuals make decisions based on the
tractability of the decision problem, cognitive limitations of the mind,
and available time . Decision-makers, in this view, act as satisfiers,
seeking a satisfactory rather than an optimal solution.3 17–19
In this study, the meta-decision will be supported with examples from
patient care and policy levels. It is followed by expanded discussions
on value and bias, fundamental concepts within this framework.