Introduction
A successful organization of today is aware that the work processes are changing at a much faster pace these days, and it has to face the challenges of rapidly changing technology and globalization uncertainty and unpredictability. Nevertheless, most people are not prepared to change their thinking because they lack the willingness to take risks and are opposed to change [1].
Managers are tasked with balancing responsibilities toward management, staff, and patients. Making a decision is one of these responsibilities. For effective decision-making, requiring dependence on self-confidence, individuality, and values to make up-to-date decisions [2]. There is no doubt that the quality of decisions made has a significant impact on the performance of institutions, regardless of the type of organization [3].
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In health care organization, there are three functional levels in nursing management – first line at the unit level, middle at the department level, and top at the organizational level [4], and each manager adopted one or more style of decision making when intent to take a decision. Bavolar et al., [5] defined decision-making styles as habitual patterns of reactions to situations.
Scott and Bruce [6] developed five major decision-making styles that were used in this study: spontaneous, avoidant, dependent, intuitive, and rational. spontaneous describes the effort to make decisions as quickly as possible; avoidant is the tendency to avoid making decisions whenever possible; dependent is the tendency to rely on others when making decisions; intuitive is the reliance on feelings and instincts; and rational is the thorough search and logical evaluation of alternatives, cited in [5].
Previous studies have identified that decision-making styles associated with various decisions outcomes [7]. To overcome challenges and achieve intended outcomes, these decisions must be put into practice [8]. Flores-Garcia et al. [9] reported that rational decision-making requires clear, objective, well-defined information and a logical, systematic investigation. It is regularly applied by enterprises and frequently yields favorable outcomes [10].
Although people often use a combination of decision-making styles, the relationships between these types highlight those people who have a dominant style. Al-Rayes and Mohammed [11] found that the majority of nursing managers tend to make decisions on their own. Even though they are confident in their abilities, expert nurses may not always make appropriate judgements [12]. Especially when intuitive decision-making could be the only solution when they are under time constraints, there is evidence that the intuitive style is advantageous [8]. Rational and intuitive decision-making techniques can be used together to help managers come to sound choices [13]. People with a higher level of this style are expected to have higher scores in desirability, attainability, commitment, and intention to persist as they weigh up the various features of the selected goals before deciding to pursue them [5].
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Clemen cited in [14] states that creativity plays an important role in decision making because it can be more than just an activity that generates new alternatives that define the boundaries of a decision. An active decision maker seeks out decision opportunities and tries to create them whenever possible, looking for new and better alternatives. In healthcare organizations, nursing managers are required to thinking creatively and outside the box to find the necessary balance between knowledge, novelty, and creativity to carry out managerial responsibilities and reach a sound decision.
Managerial creativity can be defined as the ability of nursing managers to generate their own new, useful, and understandable ideas by drawing on the managerial creativity elements of originality, intellectual fluency, flexibility, problem sensitivity, analysis ability, and risk taking [15]. According to Edward de Pono, “creative thinking is not a talent; it is a skill that can be learned. Creativity is critical for the success of the organization and maintaining its competitive advantage, as well as in its survival management.
it is essential to have the capacity to fit in a novel idea to frequently handle administrative difficulties [16]. Such as staffing and scheduling, answering to executives, crises, and work-related stress that can profoundly impact decision-making, which can lead to impulsive decisions or decision avoidance [17]. Hossny [18], and Hossny et al. [19] asserts that creative thinking and solutions are required to address challenges of crises. Also, managers can choose appropriate strategies to reduce time lost at work and advance sustainability. It has a motivating effect; it will encourage nurse managers to become autonomous and enrich them with experience [15].
Managerial creativity in a hospital setting will improve efficiency and dedication while alleviating stress and unnecessary red tape. Creativity will heighten the cohesion and productivity of a team, as well as ease time management. So, studying the relationship between dominant decision-making styles and managerial creativity is crucial for future nursing and management to help decision-makers and policymakers determine the appropriate style that can be adopted and congruent with creative thinking to select a creative alternative for a sound decision. To this end, this study was conducted.
Study aim
To study the relationship between dominant decision-making styles and the creativity of nursing managers.
Research question
What are the dominant styles of decision making?
(1) What are the dominant styles of decision making?
(2) What is the level of managerial creativity of nursing managers?
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(3) Is there a relationship between managerial creativity and dominant decision-making styles?
Methods
Design of the study
The present investigation was conducted using a cross-sectional study design. This study conducted in four university hospitals; main university hospital, women health hospital, Rajhi liver hospital, and neuralgic hospital. The questionnaire was accompanied by a cover letter that explained the study’s goals, assured participants that their participation was optional, and assured them that their data would be kept private.
Sample and sampling technique
In this study, 229 nurse managers (13 directors, 99 supervisors, and 117 head nurses) were chosen as participants, with inclusion criteria; the participants must be in the three managerial levels and they have experience in management positions not less than three years. In order to achieve the study main goal, this study employed a purposive sampling technique in which the nurse managers were chosen by the researchers and to get an in-depth understanding. In order to participate, the participants were selected from diverse four hospitals and requested to complete the questionnaires. One researcher communicated directly with each nursing director of each hospital under study to get their help in this regard.
The researchers employed “Epi Info” to estimate the intended sample size. Epi Info is a software tool for sample size calculation for use by researchers and public health specialists developed by the United States Centers for Disease Control and Prevention. The criteria used for calculation are as follows: Z = confidence level (95%); d = error proportion (0.05). This yielded a sample size of 229 to achieve a study power of 0.80.
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Operational definition
Nursing manager: in this study, it is meant as one of those in one of the three levels of management, either the director/assistant director, the superintendent (supervisor), or the lead nurse (head nurse). Director/assistant director: manages the nursing team in a hospital, long-term care facility or other healthcare institution. They hire and train staff, create schedules and conduct employee evaluations; supervisor: a person who is responsible for two or more units in hospital and links hospital management and clinical care; head nurse: a person who is responsible for one unit in hospital, directs the nursing staff and serves as the primary point of communication between the nurses and the supervisors.
Tools and data collection
General decision-making style questionnaire (GDMSQ)
This questionnaire is to assess the decision-making styles of nursing managers, total of 25 items divided into five styles: rational 5 (items), dependent 5 (items), avoidant 5 (items), intuitive 5 (items), and finally, spontaneous 5 (items). Using a 5-point Likert scale, responses were rated from 1 (strongly disagree) to 5 (strongly agree). Examples of items are I double-check my information sources to be sure I have the right facts before making decisions (rational), I generally make decisions which feel right to me (intuitive), I rarely make important decisions without consulting other people (dependent), I postpone decision-making whenever possible (avoidant), and I often make impulsive decisions (spontaneous).
Each of the five general decision-making styles had individual element scores added together to produce values ranging from 5 to 25 for each pattern. Each nurse manager’s score has been converted to a percentage. High was defined as a percent score equal to or greater than 75%; The modest level was defined as a score of 60–75%; and a low was defined as a degree of less than 60%. Previous reliability for the general decision-making styles scale was (= 0.724) [21].
Managerial creativity tool
Two components make up the managerial creativity tool. Obtaining sociodemographic information is the initial section. Information like age, gender, marital status, educational background, management level, and years of experience are included. The managerial creativity survey is the second component. To measure the innovation of nursing managers, Tawfiq [20] developed this scale. It has 35 components that are broken down into 7 subscales: Originality (5 things), for instance, I carry out the tasks given to me creatively and refrain from copying other people’s methods for resolving labor issues. I can think of quick answers to work-related challenges, for example, which is one of my five intellectual fluency items. Flexibility (5 things), for instance, allows me to present fresh concepts to develop the task quickly and easily. Sensitivity to problems (5 items), for example, allows me to anticipate work-related issues before they arise. For instance, I pay the most attention to my work tasks than anyone else when maintaining direction and concentration of attention (5 things). Taking a chance (5 items), for instance, I welcome criticism from others. Last but not least, synthesis and analysis (5 things), for example, I am able to arrange my thoughts. A 5-point Likert scale, with 1 representing “strongly disagree” and 5 representing “strongly agree,” was used to score the items. The closer an answer is to 5, the more strongly an individual agrees with the question. 35 and 175 are the lowest and highest scores, respectively. The outcomes are then divided into the following categories: Creativity is regarded as being below average (low) from 35 to 74; from 75 to 125 is considered average creativity (moderate); and from 126 to 175 is considered very creative (high). Previous reliability for the management creativity scale was (= 0.903) (A AlAmer, 2023).
Validity and reliability
Final review of the instruments for content, clarity, length, wording, overall appearance, and format was conducted by one professor and two associate professors of nursing. Pilot research was undertaken to evaluate the tool’s understandability, clarity, and applicability; to determine how long the study would take; to identify any potential problems that might emerge during data collecting; and more. 10% of the total sample (n = 23) were subjected to the pilot study. The data were analyzed, and not changed. Using a Cronbach’s alpha-coefficient test, the research instruments’ reliability was assessed. The results showed scores of 0.89 on the management creativity scale and 0.73 on the general decision-making style scale. It was therefore clear that the study instruments are quite trustworthy.
Procedure of the study
The evaluation of the literature that was already accessible on the study’s topic was conducted during this phase, which lasted roughly three months, from January to March 2023. Additionally, a research proposal was submitted to the authorization committee for ethical approval. Then the nursing managers received the questionnaire. One researcher communicated directly with each nursing director of each hospital under study to get their help in this regard. Informed consent was obtained with full knowledge prior to data collection. The tools were distributed by researchers to participants according to their schedule and time arrangement and collected promptly as finished. The completed questionnaire and signed informed consent form were then requested to be returned by the respondents promptly as finished. Each participant spent around 20 min to complete the questions. In May 2023, actual data collecting took place.
Statistical analysis
Statistical Package for the Social Sciences, version 22.0 (IBM Corp., Armonk, NY, USA), was used for data entry and statistical analysis. Prior to doing any statistical analysis, the statistics were checked for homogeneity and normality using the Anderson-Darling test. Frequencies, percentages, averages, standard deviations, ranges, chi-square, and multivariate linear regression were used to present the data using descriptive statistics. The interrelationships among quantitative variables were evaluated using a Pearson correlation analysis. At a P-value of 0.05, statistical is significance.
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Ethical approval
The Institutional Review Board of the Ethics Committee of the Faculty of Nursing, Assiut University, provided ethical approval under number (232/15/2021) at the end of 2021. Informed consent was obtained from all participants, and they were informed of the purpose and objective of the study before starting data collection. The confidentiality of their information was ensured. The study participants were informed of their right to privacy and that they could participate or withdraw at any moment. Their permission was then obtained, which confirmed their free and voluntary consent.
Results
Socio-demographics of nursing managers (N = 229)
The distribution of nursing managers is shown based on their sociodemographic information, in Table 1. Nearly half of nursing managers were between the ages of 30 and 40. The majority of them were married, and female, while a small percentage were single. The majority (90.4%) of them had bachelor’s degrees in nursing. About half of them (51.1%) worked in first level management, followed by 43.2% in middle level management and 5.7% in top level management. More than two fifths of them had expertise covering more than 10 years.
Table 1
Distribution of socio-demographic data for study nursing managers (N = 229)
Socio-demographic data | (n) | (%) |
|---|---|---|
Age group | ||
Less than 30 | 99 | 42.0 |
30–40 | 106 | 46.9 |
More than 40 | 24 | 11.0 |
M ± SD (range) | 33.67 ± 6.12(25–56) | |
Gender | ||
Male | 6 | 2.6 |
Female | 223 | 97.4 |
Marital Status | ||
Single | 34 | 14.8 |
Married | 192 | 83.8 |
Divorce | 3 | 1.3 |
Education Level | ||
Nursing bachelor | 207 | 90.4 |
Postgraduate | 22 | 9.6 |
Management Level | ||
Top Level | 13 | 5.7 |
Middle Level | 99 | 43.2 |
First Level | 117 | 51.1 |
Years of Experience | ||
Less than 5 years | 46 | 20.1 |
5–10 years | 85 | 37.1 |
More than 10 years | 98 | 42.8 |
M ± SD (range) | 11.05 ± 6.16 (2–33) | |
Means and standard deviations of study variables
Regarding decision-making styles, Table 2 showed that the rational style had the highest average score (most dominant), followed by the dependent style, then the intuitive. While the lowest average score was related to avoidance and spontaneity. Regarding managerial creativity, managerial creativity was generally high. Regarding its sub-domains, synthesis and analysis had the highest average score, followed by maintaining direction and focus, then risk-taking, and the lowest average score related to originality and flexibility.
Table 2
Mean and standard deviations of decision-making styles and managerial creativity of the studied managers (N = 229)
Main study variables | M ± SD (%) | Achieved Points (%) |
|---|---|---|
Decision-making styles | ||
Rational | 21.05 ± 2.03 | 84.1 |
Dependent | 16.91 ± 2.8 | 67.9 |
Intuitive | 16.54 ± 2.84 | 65.9 |
Spontaneous | 14.23 ± 3.09 | 56.9 |
Avoidant | 12.81 ± 2.88 | 51.2 |
Managerial creativity subdomains | ||
Originality | 21.04 ± 1.79 | 84.16 |
Intellectual fluency | 21.59 ± 2.17 | 86.38 |
Flexibility | 21.19 ± 2.18 | 84.75 |
Sensitivity to problems | 21.31 ± 2.29 | 85.22 |
Keep direction and focus of attention | 21.74 ± 2.05 | 86.95 |
Risk taking | 21.62 ± 1.88 | 86.46 |
Synthesis and analysis | 22.54 ± 2.19 | 90.15 |
Overall managerial creativity | 151.02 ± 10.26 | 86.30 |
Correlation coefficient between dominant style and subdomains of creativity
Table 3 shows that there is a significant positive association between the rational style (dominant style) and administrative creativity in general as well as all its subdomains. This table also shows that the dependent decision-making style is negatively and statistically significantly associated with administrative creativity in general as well as all its subdomains. Finally, the intuitive approach is negatively and statistically insignificantly associated with administrative creativity in general as well as all its subdomains.
Table 3
Correlation between dominant decision-making styles and managerial creativity subdomains
MC D-Ms | Rational | Dependent | Intuitive | |||
|---|---|---|---|---|---|---|
r | P | r | P | r | P | |
Originality | 0.135 | 0.034* | -0.132 | 0.039* | 0.049 | 0.44 |
Intellectual fluency | 0.314 | 0.001** | -0.250 | 0.001** | 0.008 | 0.91 |
Flexibility | 0.264 | 0.001** | -0.133 | 0.038* | -0.071 | 0.27 |
Sensitivity to problems | 0.397 | 0.001** | -0.311 | 0.001** | -0.026 | 0.68 |
Keep direction and focus of attention | 0.457 | 0.001** | -0.193 | 0.002** | -0.020 | 0.75 |
Risk taking | 0.402 | 0.001** | -0.255 | 0.001** | -0.109 | 0.09 |
Synthesis and analysis | 0.363 | 0.001** | -0.236 | 0.001** | 0.012 | 0.86 |
Overall (MC) | 0.478 | 0.001** | -0.310 | 0.001** | -0.032 | 0.62 |
Regression analysis between two study variables
According to Table 4, three decision-making approaches had a significant impact on nursing managers’ creativity. The rational approach had the greatest impact on administrative creativity and was positive, followed by the dependent approach and then the avoidant approach, which had a negative impact on administrative creativity.
Table 4
Multivariate linear regression between decision-making styles and creativity
Managerial creativity | 95.0% CI for B | |||||
|---|---|---|---|---|---|---|
Decision-Making Style | B | β | t | P. value | Lower bound | Upper bound |
Rational | 1.950 | 0.388 | 6.007 | 0.001** | 0.823 | 1.664 |
Intuitive | 0.341 | 0.095 | 1.570 | 0.118 | -1.273 | 0.141 |
Avoidant | -0.664 | -0.188 | -2.391 | 0.018* | -0.915 | -0.073 |
Dependent | -0.913 | -0.251 | -4.249 | 0.001** | -0.762 | -0.075 |
Spontaneous | 0.367 | 0.111 | 1.440 | 0.151 | -0.056 | 0.503 |
F | 21.33 | |||||
pvalue | 0.000** | |||||
R-Squared | 0.309 | |||||
Levels of managerial creativity
The majority of nurse managers had high level of creativity, as seen in Fig. 1. However, no one had low creativity, and just 4.1% of them displayed moderate creativity.
Fig. 1
levels of managerial creativity
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Discussion
This study aims to investigate the relationship between the dominant decision-making style and creativity among nursing managers. The results of our study showed that the three dominant decision-making styles are rational, dependent, and intuitive, respectively. The majority of nursing managers are highly creative. The rational style was positively and significantly associated with overall creativity, but the dependent was negatively and significantly associated with it, and there was no association between the intuitive style and overall creativity. The rational decision-making style has the greatest positive effect on creativity. While the dependent and intuitive styles ranked second and had a negative effect on creativity.
The result of this study revealed that the majority of participants had a bachelor’s nursing degree with experience spanning more than ten years. According to Manlangit et al., [22], the success of decision-making was strongly correlated with experience. The mean age of participants was 33 years. The majority of participants were female.
Our study revealed that the most dominant decision-making styles were rational, dependent, and intuitive. This is in line with the findings of Ali and Elhakem [23], who discovered that office executives from diverse departments demonstrated a high level of inventiveness and that directors in administration-related disciplines are most likely to utilize the rational method when making decisions. According to what Riaz [24] concluded that, when they get to a conclusion, individuals who take rational approach immediately act on it. Additionally, the deliberate increase in the use of the rational style strongly agrees with the findings of Lamba and Ozdasli [25].
Also, this could be back to the statistic that the widely held of nursing managers had a bachelor’s degree, and more than two-fifths of them had more than ten years’ experience. This is in line with the study results conducted by [21]. As well, Al Shra’ah [26], stated that styles of decision-making for any organization or manager rest on capability and education progressions.
Regarding to managerial creativity, regarding overall creativity level, the current study showed that majority of nurses’ manger had high level of administrative creativity. This result was agreement with Olsson et al., [27] who found that majority of nursing mangers had high level of administrative creativity level. In difference, this result was matching Hassi cited in [15] who found that more than half of nursing mangers had low level of administrative creativity.
The mean score for overall creativity was high. When assessed in descending order by nursing managers, the highest mean score regarding creativity subdomains were related first to synthesis and analysis, then keep direction and focus attention, and then risk-taking, intellectual fluency, sensitivity to problems, flexibility, and lastly, originality. This finding is in agreement with [21], who found the same ranking. Also, somewhat in line with that of Ali and Elhakem [23], who found that the most crucial managerial creativity skills available to managers in Sudanese institutions were, in descending order, synthesis and analysis, maintaining direction, risk taking, flexibility, originality, intellectual fluency, and problem sensitivity.
From this we can say that creativity especially this related to synthesis and analysis that according to Khalid et al., [28] it is the ability of managers to redefinition of problem after getting rid of old pattern of thinking, keeping direction and focusing attention. A high level of creative thinking was also discovered by Panatik [29] in their study of Malaysian research officers. Moreover, Massada et al. [30] in their study on the Jordanian Ministry of Education found that administrative creativity has impact on service quality.
Moreover, the findings found that the dominant rational style was positively and significantly associated with overall creativity and the only positive and highest effect on creativity of nursing managers is come from using rational style of decision-making. From the researcher point of view, nursing managers who adopt rational style of decision making mainly used analytical and synthesis in collecting facts and details so together the rational style congruent with creativity.
Furthermore, there is a significant inverse relationship of avoidance style, dependency style, and spontaneity style with managerial creativity. This finding is in line with a study conducted by [21] on nursing managers in Saudi Arabia. According to Scott and Bruce [6], avoidant style is characterized by delay and denial, which is not in line with the nature of creativity. The dependent style was negatively and statistically significant associated with all elements of creativity, and it had the next effect on the creativity of nursing managers in a negative as shown in the analysis of regression.
Limitations
Some limitations are included in this study, as it is based on a cross-sectional survey. Most of the participants are female and very few are male. This is due to the fact that most of the nursing leaders in Egypt are females, because the entry of male education into nursing is relatively recent, and its graduates have not yet reached administrative positions, except for a few of them. Moreover, there was a one-year gap before actually starting work on the research paper due to time pressures the researchers faced.
Conclusions and recommendations
We can conclude that the three dominant decision-making styles are rational, dependent, and intuitive, respectively. The majority of nursing managers are highly creative. The rational style was positively and significantly associated with overall creativity, but the dependent was negatively and significantly associated with it, and there was no association between the intuitive style and overall creativity. The rational decision-making style has the greatest positive effect on creativity. While the dependent and intuitive styles ranked second and had a negative effect on creativity.
Based on this finding, the researchers recommended periodically assessment of the administrative creativity for nurse managers and providing them with training program about different decision-making styles as well as administrative creativity. Moreover, reviewing rules and polices of health care organization to improve nurse managers administrative creativity.
Acknowledgements
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“Not applicable”.
Declarations
Ethics approval and consent to participate
The Institutional Review Board of the Ethics Committee of the Faculty of Nursing, Assiut University, provided ethical approval under number (232/15/2021) at the end of 2021. Informed consent was obtained from all participants, and they were informed of the purpose and objective of the study before starting data collection. The confidentiality of their information was ensured. The study participants were informed of their right to privacy and that they could participate or withdraw at any moment. Their permission was then obtained, which confirmed their free and voluntary consent. All methods were carried out in accordance with relevant guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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