What Medicine Can Teach Us About Decision-Making
The 2008 “HBR List” of “breakthrough ideas” is out in the February issue. Every year I assess the list in terms of the ideas that I think will really take off. Overall, I wasn’t bowled over; there are several negative items about cheating, lying, cybercrime, etc., and I found them a bit depressing. There are also the expected breathless items about how social networks and games are changing the world. But the social networks piece admitted that things hadn’t really gotten better in the area being networked about (the Toronto mass transit system), and I’ve been hearing for a long time that games will change business without seeing much real change.
The idea that did impress me came from Jerome Groopman, a distinguished doctor in Boston and a writer for The New Yorker (and the author of several books, including the recent How Doctors Think). He writes in the list about how the health care industry’s approach to medical error might also inform decision-making in corporations. He notes that many medical errors result from “poor thinking”—incorrect diagnoses, unreliable heuristics, and so forth. He suspects, as I do, that CEO's and other senior executives make similar errors. The difference is that “hospitals convene regular meetings where all faculty and trainees—from the chief to the beginning medical student—revisit cases that had poor outcomes.” Needless to say, such self-examination is rare in the corporate boardroom.
Groopman is only one of the medical leaders who is examining medical decision-making. His New Yorker colleague and fellow Boston physician Atul Gawande (author of the other recent book on medical decision-making, Better) has recently written in The New Yorker about the importance of medical checklists that ensure all the key steps in a medical procedure are acknowledged.
Neither doctor has written about the other major advance in medical decision-making, which involves embedding high-quality clinical knowledge into systems that physicians use for ordering. Such systems help to prevent inappropriate drug prescriptions, useless tests, and ineffective care protocols. Partners Health Care in Boston—Gawande is a surgeon at one of their hospitals—is a leader in the use of this technology. I wrote about it with Partners CIO John Glaser a few years back in HBR . More recently, Dr. Tonya Hongsermeier at Partners has developed an approach to “decision capture”—using groupware to have online discussions with leading physicians on how certain cases should be treated. When a consensus is reached, they build the knowledge into the physician order entry system. It’s just another example of what organizations do when they take decisions seriously.
Groopman is right that the focus on medical decisions should extend into the corporate sector. His “breakthrough idea” gets my vote for the most important one in the 2008 list.
Sign up for the Harvard Business Publishing Weekly Hotlist, a new weekly email roundup featuring the top highlights from HarvardBusiness.org.
- Comments (5)
- Join the Discussion
- Email/Share
Tom Davenport holds the President’s Chair in Information Technology and Management at Babson College, where he also leads the 
Comments
Capturing human knowledge in systems is no doubt a good idea, but it still begs the question of what precisely you do with this information after it is captured. Definition of a better decision requires a clearly defined goal, and a way of evaluating how information impacts that goal. Humans are poor at processing information of any complexity,and poorer at mapping that information to choice values. "Consensus" is a terrible goal, having more to do with group psychology than improving decision-making. It would be better to encode the goal in systems, and allow the systems to evaluate the value of choices given the available information. This is particularly true in business, where (at least for public corporations) the goal is already well defined: maximize shareholder value.
- Posted by Dave Dixon
January 25, 2008 11:23 AM
Pardon my cynical attitude towards a good idea. Capturing lessons learned sounds good, but are the people at the head of large corporations in touch with what is happening at lower levels? If they are, do they care about what is happening at lower levels of their corporation in their pursuit of 'maximizing shareholder value' as Dave Dixon commented?
As part of a large, Dilbert-oriented corporation, where double digit growth outweighs any lessons learned at lower corporation levels, I just don’t see the impetus of reviewing lessons learned from upper levels of management. In fact, if double digit growth is not being achieved, lessons learned become self-tattling exercises that no one would embrace. As long maximizing shareholder value equates to short term earnings objectives, reviews of what happened in the past are just profit burning exercises.
- Posted by Allen Adams
January 25, 2008 3:24 PM
Software, no matter now advanced, is no substitute for human knowledge and reasoning abilities. In fact, over dependence on technology in modern life could often make us use less of our reasoning and creative abilities than our ancestors, whether it is the inability to write a few lines without using spelling or grammar checking software, finding partners using matchmaking software programs on sites such as eHarmony, or even using computer programs to predict elections outcomes or stock prices.
The only way an organization can efficiently function is when company mission, goals and objectives are communicated top down and re-emphasized on a daily basis in very aspect of teamwork in every department and individual job function. Clarity of goals and seamless communication in all direction within the organization is the only rational way for it to exist.
As far as medical organizations are concerned, the lower level staff is usually hard at work trying to save lives while at the top, people are often playing politics and focusing on their department's or company's PR. Or is that true of most organizations?
Raj Bose
Faculty - University of Phoenix
- Posted by Raj Bose
January 27, 2008 7:38 AM
Great arguments for learning from our mistakes -- or successes! But really nothing new: HBS's own David Garvin has been arguing for After-Action Reports (term borrowed from the Army) for ten years (e.g., book Learning in Action from 2000).
Interestingly, the work of some other HBS professors (e.g., Amy Edmondson and Anita Tucker) looks specifically at learning practices in the health care industry, and they have found multiple examples of mistakes not being learned from, or at least not being "taken to the next level" in terms of systems-thinking: making sure that the opportunity to make the same mistake again is removed (whether those systems are IT, as mentioned above, or just how organization operates).
- Posted by Matt A
January 28, 2008 1:16 PM
I don't think that Tom is making a case for 'codifying' lessons learnt into systems and processes as much as he is showing up the stark contrast between the way organizations and hospitals behave. The collective review of a poor outcome shows up clearly the sense of missionary purpose that every worker in a healthcare organization has - it stems from the inherent belief that the institution is greater than the individual. I would guess that the same DNA permeates the military, winning sports teams, and charity organizations e.g. the Red Cross. Most corporate organizations in contrast are psychological battlefields where the larger purpose of the organization is hardly paid any attention to by managers seeking to outshine one another. Is it a surprise therefore that 'passing the buck' and 'furthering one's own career' are the most common lessons that everyone learns fairly early in their careers ?
- Posted by Narayan
January 31, 2008 12:03 AM