Making Choices As A Physician In Management

Physicians in management and leadership roles can use a strategic choice framework to improve the quality of their decisions.

Problem solving and decision-making are important skills for all physicians, in business and in life. Problem-solving often involves decision-making, and decision-making is especially important for management and leadership. There are processes and techniques to improve decision-making and the quality of decisions. Decision-making may be more natural for some personalities, so these physicians should focus more on improving the quality of their decisions. Physicians that are less natural decision-makers are often able to make quality assessments, but then need to be more decisive in acting upon the assessments made.

Too often, the process of making a decision is cumbersome and unfocused.  

Making Choices: The Traditional Approach

• Study lots of things  --  Broad, ambiguous direction to work team                           
• Review findings  --  Binders of unconnected bits of data and ideas                   
• Develop options  --  Pressure to converge on workable options  
• Seek alignment with key managers  --  Lots of time spent in meetings before the meeting
• Polish the presentation  --  Usually over and over again              
• Seek approval by senior management  --   Try to get in and get out with your plan intact       

With this approach, decision-makers often end up delegating the complexity away.  There is no time to think.  Insufficient consideration is given to the art of defining “what’s doable.” Too much emphasis is given to an elaborate “buy-in” process.  And the outcomes involve inspecting quality at the end and incremental choices at best. 

Making tough decisions—whether at the executive committee level or in the course of a physician manager’s day-to-day work—can consume high levels of resources but still produce unsatisfactory outcomes. 

Challenges of the Traditional Approach

• Choices do not get made.  Example: Unable to reach consensus on core segments.
• Choices appear to get made, but fall apart.  Example: Management selects a path forward, but their staff does not implement the choice into activities.
• Choices get made, but action is not timely.  Example: Valuable partnership opportunity is missed due to slow decision-making process.
• Choices are not robust.  Example: Poor acquisition decision based on unreliable data and faulty analysis of implications. 

Overview of Strategic Choice Framework

The Choice Framework optimizes the decision-making process by identifying critical; issues up front and converting them to discrete choices, allowing more time for focused, deeper analysis to overcome major uncertainties.

• Frame choice  --  Convert issues into at least two mutually independent options that might resolve the issue
• Brainstorm potential options  --  Broaden the list of options to ensure consideration of an inclusive list of options
• Specify “what we must believe” --  For each option, specify conditions that must hold true for the   option to be a good strategic move
• Identify barriers to choice  --  Determine which of the conditions you feel least confident are true
• Conduct analysis  --  Test the conditions with the lowest confidence first
• Make choice  --  Review analysis against key conditions and make informed choices

Advantages of the Choice Framework

• Focuses on decisions to be made in a particular planning situation, whatever their timescale and whatever their substance
• Highlights the subtle judgments involved in agreeing on how to handle the uncertainties which surround the decision to be addressed
• The approach is interactive, designed not for use by experts in a board room setting, but as a framework for communication and collaboration between people with different backgrounds and skills