The meta-decision framework
To the best of our knowledge, no similar discussion has been done in the healthcare literature. Although it is beyond the scope of this study to describe how the concepts of decision-making were developed and how different frameworks 11, 15,18, 20, 17,19 relate to each other, the focus is a simplified adaptation and applicability of this framework to healthcare that stimulates reflection and learning.
As shown in Figure 1, the concept of meta-decision generally follows three distinct steps: identification, development, and evaluation. Through the introduction of these steps, two examples will be used to apply the meta-decision concept in detail—one at the patient care level and the other at policy level. Additional examples are listed to further clarify the concept in Figure 2 and 3.
Identification
In the identification step, there is either a need for a decision or a perceived value of a decision (opportunity). A need has a performance gap, measuring how far one is from deciding, which helps in planning the decision-making. With an opportunity, there is already a decision to consider. Mintzberg et al. 11 states, “Perhaps opportunities do not require much investigation there is nothing to correct, only something to improve.” The application of this step necessitates an understanding of the environment, mainly, the timeframe, context, and population.