Should our decisions be rational or emotionally driven?

Yesterday I was engaged in an interesting discussion over prioritisation of competing needs for a fixed amount of money. We had received an unrestricted grant for improvement of services in our rural clinic. Two important options are on the table. 

(1) Paying regular salaries for the clinic staff for a year 

(2) Setting up an upgraded basic laboratory facility in the clinic

We were discussing which of these must be prioritised. I am reflecting on this discussion because, it helped me think through some issues that I think are important. 

To provide some context, we are a non-governmental organisation providing basic level primary health care services including services for diabetes and hypertension in the local rural community. We are a low cost, fair quality service, which many locals prefer because of the calm, quiet, non-threatening and respectful ambience. Currently due to the poor finances we are able to run the clinic only on three days a week, and pay the staff only for those days. The basic lab facility that we used to have has become defunct because of old and out-dated equipment and non-availability of a lab technician since the past 2 years. We are unable to recruit lab-technicians because they are either not familiar with using the old equipment or are not interested. 

The local community has trust in the clinic and on an average at least 100 patients visit the clinic each day on the days the clinic is open. People from far away also visit the clinic having heard about the low cost, high quality services through word of mouth. Therefore, we understand that there is a felt need for continuing to provide good quality clinical services in this clinic. To fulfil these needs, we wrote a fund-raising proposal and shared it with a few people. Yesterday we received a grant from a good hearted donor and we are in the process of planning how to use this money. 

If we use it for paying salaries for staff for a year, it raises the issue of sustainability. We will provide regular salaries for a 6 day work-week this year and keep the clinic open. What about next year and the years after? Will we be able to raise the same fund year after year to sustain keeping the clinic open? This question bothered us. Alternatively, if we set up the laboratory facility, and if we do a thorough costing exercise and charge a nominal fee for the tests that we offer, we may be able to continue running the lab facility through the revenue generated from the lab. We were discussing back and forth on this issue. 

When I was reflecting on this last night, one of the things that occurred to me was whether we should make this decision rationally based on numbers and economic considerations, or whether emotions and empathy should drive this decision. The staff are currently suffering because they are receiving very low salary. Their motivation levels are at an all time low. They are pushing themselves to the edge to come to work and make ends meet at their homes. Would a one year respite in the financial situation by giving regular salary lead to improved morale and work satisfaction? And who is to say, that we may not be able to raise funds again to sustain the salary next year? Our emotions and empathy make us want to give salaries this year, while maintaining the efforts to raise money again next year. But the rational brain which is looking at the number of people who will benefit from the new laboratory services, the ability to create a sustainable revenue based model of lab services makes us want to establish the lab services. 

I think emphasis on rational decisions driven by objective evidence and numbers is over hyped. An emotional decision driven by empathy, can be as important and meaningful as a rational one or maybe even more. Firstly emotions and empathy bring in the human element to the administrative decision making. Secondly, not all needs and metrics of effectiveness can be measured. Hundred people may vote that they want a good lab facility. But how is that different from five families of staff suffering because of low salaries? How does one place an objective comparison between these? After all, our empathy and emotions are also driven by our perceptions of the life of people around us. If a situation makes us feel that we need to do something to correct the situation (empathy), then I think we should trust that instinct and act on it. I don't know what we will ultimately decide about the method of spending the money. But this thought exercise has opened an interesting like of thinking for me and I wanted to share it.