Ideas For Increased Effectiveness

The secrets of effective decision-making

An area that creates some of the greatest “stuckness” in my work of coaching physicians is that of decision-making.

My own experience of making up my mind has taught me that the period of analysis, fantasy, wishful thinking, and whatever else goes into decision-making, is fraught with anxiety, fear and uncertainty. Once I’ve made my decision, I typically feel like a huge burden has been lifted and I’m ready to face the consequences of my choice.

I experienced this angst earlier this year when it became apparent that my daughter wasn’t thriving at school, and appeared to require a new environment. After a month of torturing ourselves, my husband and I finally made the decision to look for an alternative — and even before we found a great substitute, we started sleeping again. Just the act of deciding to move on was sufficient.

So how does one make a good decision?

Tomes have been written on the topic, and one of the books I found most useful is “How Great Decisions Get Made“(A) by Don Maruska. He identifies 10 steps for reaching agreements together — and since I want to give you the secrets to reaching your own decisions, in this case, “together” may mean you plus your ambivalent self (or you plus your significant other, etc.).

Here the 10 steps from the book (somewhat adapted by me):

  1. Name the decision – “Do I stay in this practice, move to another medical practice, or quit medicine and clinical practice altogether?” or “Do I hire an experienced office manager who might be costly, or do I limp along with my current staff?” or “Do I stay in this dead-end job for the stability of my family or do I uproot us all to move to a new opportunity on the other side of the country?”
  2. Enlist everyone who may be impacted by the decision – this may include your significant other, your medical practice partner(s), your children or your key staff member depending what the decision to be made is
  3. Explore with each of the participants their hopes, with the goal of discovering shared hopes
  4. Uncover the real issues – What is truly at stake here? This may be a tough question to answer, but it’s necessary to persist until root causes are uncovered!
  5. Identify all optionsMind mappingbrainstorming, sleeping on it — these are all tools to getting to what is possible.
  6. Do your homework and gather the correct information. Don’t rely on assumptions, guesswork or perceptions. Try to determine facts, but don’t overlook the power of self-knowledge and intuition.
  7. Put all the cards on the table – wishes, facts, hopes, possibilities.
  8. Select and write down those options that support the majority of shared hopes (it can be self-defeating trying to accommodate everyone’s last need!)
  9. Map out the solutions with the anticipated pros and cons, and be rigorous about anticipating obstacles. Make sure everyone knows that some flexibility will be required.
  10. Focus on forging ahead, secure in the knowledge that we are innately constructed psychologically to justify our decisions once we’ve made them — our brains immediately find all the reasons as to why the decision we just made was an excellent one! There’s no value in playing the “second-guessing game.”

For some extra reading, check out What Do You Want to Say You’ve Done? from the Harvard Business Review Blog last week (I call this the “deathbed” perspective!)

May you be blessed with your great Next Decision!

Philippa Kennealy ran a private family practice, and a hospital, before building her coaching business helping MDs launch and run successful practices and businesses. Visit her online at to learn more.