Saturday, 27 April 2013

How I Make Decisions

Decisions are constant, but the intention to make a good one might not be. There are roughly five steps I take to getting the most out of a big decision.

Lately my life has centred around how to make good decisions. It’s one of the reasons I have gone with “Big Decisions” as a theme for this blog, and also appears to be an area where there is ongoing potential for improvement. Working in healthcare has provided exposure to the result of decisions made by individuals, managers, executive, and politicians.

Australia is still adapting to significant health reforms which started in 2010 under the then Prime Minister Kevin Rudd [1]. One of the key outcomes of those reforms (and one I strongly support) is the intention that health consumers have a greater say about the services they receive not just when they are unwell, but also in the planning and implementation stages for service design.

My role in 2012 was to assist a rural NSW health district meet that value [2]. It involved spending a fair amount of time deconstructing how to make a decision, so that a system could be built where the wider community can be involved in the process. Based on my experience as a workshop facilitator, assisting with the development of a strategic plan for the organisation, and also previously as a clinician I ended up with a basic structure for decision making as outlined below:

1)     Define the problem
What is the reason for a decision to be made? This is a good way to scope out the exact issue that you hope to address by making a decision. Talking to others is one way to get perspective on how motivated you should be to take the decision on. It can also identify who else might be affected or need to be involved which helps with the next step.

2)     Create possible solutions
Pull together information and resources including the people affected to find out what all the options are. This is where people who are divergent thinkers, or are good at working with others to get ideas will excel. There is evidence that having at least more than 2 possibilities is a good starting point to make a good decision [3]. Jesse from Breaking Bad gave a great example of Divergent Decision Making in season 2, episode 9 [4].

3)     Weigh up each option
If the decision is just for you, then simply scoring how well each option addresses the initial problem may be all that is needed. If the outcome can potentially affect many other people, this is where things get interesting. The process of working with people to give weight to their concerns is a challenge faced by families, organisations, and ultimately politicians.

4)     Choose the best outcome
If the decision is not that easy, or includes other people, give it time [5]. Otherwise for the smaller ones try flipping a coin to decide and see how the outcome makes you feel [6]. The real divergent decisions makers, myself included, can potentially get stuck here. Sometimes you just need to jump in and make a decision, which is better than the alternative [7].

5)     Did you fix the problem?
Once the impact of the decision can be measured it is time to ask: did it solve the problem? Also were all of the expected benefits from that choice realised? If not it is time to start all over again!

Reading the steps above makes decision making look easy, but I am constantly surprised how many people don’t follow anything resembling this process when making a choice. And not just for discretionary items, but for the big ticket things like their house, car, career, relationships, travel and family planning.

From my experience I have found that writing it all out and talking to others is essential to make a good choice. I expect to be exploring this strategy further though to review the level of need and challenges to good decision making in different scenarios.

Does this reflect how you make decisions, both big and small? Are there times when it works best, and others when it is not needed at all?


[4] Breaking Bad wiki (spoiler alert)
”Jesse rattles off things Walt could create with their lab supplies — a robot, a homing device, a dune buggy — until one idea clicks with Walt: Walt realizes he can make a mercury battery using chemicals, coins, and galvanized metal.”

[5] Allow time for shared decision making

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