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How better decision making can help you and your practice

25 August 2023

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Former practice business manager Gary Hughes describes a step by step process for making decisions that are more effective – and how to manage procrastinators in the team

Theodore Roosevelt, who served as US president, said: ‘In any moment of decision, the best thing you can do is the right thing, the next best thing is the wrong thing and the worst thing you can do is nothing’.

It’s great advice. If you are called on to make a decision, you should always aim to do the right thing, and the worst thing you can do is to make no decision at all.

Some decisions are so simple that you’re barely aware you’re making them, while others are time consuming and high risk. They can involve complicated and unpredictable interpersonal issues and leave you feeling stressed and anxious. Decisions don’t just have an impact on a personal level, they can make or break a project or an entire practice.

Follow a strong decision-making process

Decisions may be made for the right reasons but with a flawed decision-making process they can produce an unintended negative side effect or fail to achieve the intended goal. When the nature and context of the decision to be made is complex, then we need to spend greater time and effort on it, and follow a strong decision-making process like the one outlined below.

1.What is the decision and who is the best person to make it?

The starting point is to make sure you are clear on what you need to decide. When the situation and relationships are complicated it can bring other factors to the fore and obscure the actual decision.

You also need to establish if you are the best person to make the decision. Do you have enough knowledge and understanding? Are you sufficiently impartial? And do you have the capacity to meet all the time requirements in making the decision?

2. Gather all the information and opinions for a thorough assessment

  • Get the evidence and data
  • Encourage discussion and debate
  • Gather feedback and opinion

Anything less than the simplest decision will require time to obtain all the relevant information and opinions. This evidence gathering phase should be thorough, so take time to reflect and evaluate. It’s also important to identify and consider alternatives; and consider the full, broad impact of the decision. I’d also advise that you don’t ignore your intuition – it draws on your past experience and values.

Once you have the evidence, data and opinions you need, set time aside to review and assess everything. When doing this remain focused on the actual decision. Consider all the possible options and the full impact of each of these, bearing in mind some may carry unintended negative consequences unrelated to the main focus of the decision.

3.Make the decision

  • Sense check the decision
  • Make sure you can carry out the decision

At the end of the evaluation, you should be settled on a decision that is clearly the best and the right one to take. Take a step back and do a final sense check. Also make sure the decision can be successfully actioned.

4. Share the decision and follow up

  • Communicate the decision and why, rationale
  • Evaluate and follow up

The final step is to share the decision, it is never good for people affected to find out by accident or at the stage they are directly affected. Make a clear announcement of what has been decided and why, and after an appropriate time make sure you follow-up and evaluate the success of the decision made. It is sometimes the case that decisions made in the right way and for the right reasons appear less positive after a period of time. Never be frightened to admit this and make changes – greater damage is far more likely to be caused by sticking with a bad decision.

Things to avoid when making decisions

Even when following a sound decision-making process it is easy to fall foul of some common pitfalls. To prevent this happening, keep these in mind as you go along:

  • Don’t procrastinate. Don’t hide behind excuses as a reason for not making a decision.
  • Don’t always follow the crowd. Just because someone else has decided something it doesn’t make it the best decision.
  • Don’t ignore other perspectives. Consider the reaction others may have to the decision
  • Don’t only see what you want. Check that you’re not biased towards what’s easy or pleasing.
  • Don’t be blinded by information. Too much info can get in the way and prevent you seeing what matters.
  • Don’t just go for the latest thing, whether it’s information or a solution. The latest thing isn’t necessarily the best.
  • Don’t ignore unintended outcomes. Think through the full impact of the decision and whether there are there any downsides.
How to handle those really tough decisions

Sometimes it can feel like there’s just no right answer. In these situations, rather than endlessly agonising and failing to make a decision, it’s better to accept there isn’t a perfect solution.

Focus on the bigger picture and not the immediate issues. Depending on the nature of the problem a good rule is to always make the decision for one of these two reasons:

  • It’s in the best interests of the practice e.g., financially, legally, strategically or reputationally.
  • It’s the best thing for the team, patients and the wider community.

By taking this approach, however tough the decision is and even if it’s not perfect and possibly unpopular, you can be positive that you will be doing the right thing.

Supporting others to make timely and better decisions

A common problem experienced by practice managers is having to wait for GP partners to make a decision that may be urgent or important and which they then have to action.

Procrastination on the part of others can be a real problem in these situations. However, it can be easily managed by understanding the cause of the indecision and applying and appropriate fix. These may be as follows:  

Lack of interest – explain why making the decision is important.

No urgency – make the decision deadline shorter. For a long- term decision, you could break it down into small meaningful steps and deadlines.

Uncertain about what’s required – provide the information and clarity so they know what’s needed.

Scared of the unknown – explain the impact of no decision and emphasise the benefits a decision could bring

Distracted – remove the distractions and ensure the focus is on one task and decision at a time

Fear of failure – provide reassurance. Demonstrate that the possible risks have been identified and how they’ve been mitigated.

Not enough information – identify which information will be most important.

Too much information – agree what information is really important to avoid conflicting information and allowing them to focus on what’s needed.

Emotional attachments – people are often attached to the status quo, and may find the prospect of change difficult. Explain how the change will be managed.

No emotional attachments – it’s difficult to make a decision when people don’t care one way or the other. Identify the pros and cons of particular actions and the consequences of inaction.

Gary Hughes is the founder / director of Leadership in Practice providing leadership and management development to primary care. He has been a Practice Business Manager and Federation Director and has an MBA and a Post Graduate Certificate in Medical Education.