Better Decision Making in Practice

Every day in general practice, we make decisions.

Most are small and made quickly, sometimes without us even thinking about them. Others are much bigger and involve money, people, risk or the future of the practice and can have consequences for years. Making decisions is simply part of running a business.

But that doesn’t mean we always do it well. Decisions can take too long. Too many people can become involved, and sometimes nobody is quite sure who has the authority to decide.

At other times, we gather more and more information when we already have enough. Occasionally, we even avoid making the decision altogether.

The result of these can be frustration, lost opportunities and a practice that moves more slowly than it needs to. Poor decision-making can also erode the credibility and the confidence in the leadership of the practice.

So how can we improve and make better decisions?

Start by being clear about the decision.

This might sound obvious, but it is surprisingly easy to start discussing a problem without being clear about the decision that actually needs to be made. Strip away the history, opinions and emotion and ask:

What exactly are we deciding?

Then ask:

Why do we need to make this decision?

For example, rather than discussing whether the practice needs to improve its finances, the decision might be:

Do we need to introduce regular monthly financial reporting?

The reason might be that there currently isn’t enough information about income, expenditure and profit to confidently make informed financial decisions. Understanding the reason for the decision gives something specific to decide, and that clarity becomes even more important when several people are involved.

Who should make the decision?

One of the biggest causes of slow decision making is every decision go to the same people.

I have worked with practices where the partners make almost every decision. It adds to their workload, slows the practice down and can leave managers feeling they have responsibility without the authority they need to do their jobs.

I’ve also experienced the opposite, where the manager becomes the person everyone turns to, creating another bottleneck.

The person with the most senior job title isn’t automatically the best person to make every decision.

Think about two things: scope and impact.

Scope is the size of the decision. How much money, time, people or resource is involved?

Impact is about the consequences. What happens if we get it right? More importantly, what happens if we get it wrong?

A decision with limited scope and low impact can often be delegated. As scope or potential impact increases, greater management or partner involvement may be appropriate.

Practices can set their own boundaries, and it’s an exercise I often help partners and managers with. Doing this gives people permission to make decisions, removing bottlenecks and smoothing workload, while maintaining appropriate controls.

DIAGRAM 1: Scope and Impact decision making matrix

Not every decision needs the same amount of attention.

Some decisions deserve careful consideration, but others don’t. A useful way of separating them is to think about one-way and two-way decisions, an idea attributed to Jeff Bezos.

A one-way decision is not reversible. If you get it wrong, you can’t easily go back. These decisions deserve more information, consultation and consideration.

A two-way decision is reversible. You can try something and, if it doesn’t work, change it or go back. These decisions can usually be made much more quickly.

This distinction matters because practices can spend far too much time treating every decision as a one-way decision, trying to remove every possible risk from decisions that are easily reversible. If you can try something for three months, measure the results and change it if necessary, do you really need six months of discussion before trying it?

Use enough information, not all the information.

We rightly want evidence to support important decisions, but more information doesn’t automatically lead to a better decision. Too little information can leave us guessing. Too much can make it impossible to see what really matters.

It’s better to decide what information you actually need. That could include:

• Facts and data

• Relevant context

• Opinions from people affected

• An assessment of the likely impact

Then stop gathering information when you have enough to make the decision.

There will also be occasions when the evidence simply isn’t available. This is where experience and intuition matter. Intuition isn’t just a feeling that should be easily dismissed. It is an accumulation of years of knowledge and experience allowing you to recognise something before you can necessarily evidence it.

Good leaders know when they need more evidence and when they already know enough to act.

Use a process for the difficult decisions.

You don’t need a framework every time somebody wants to order a new chair, but for bigger, more complicated decisions, a consistent decision-making process can be extremely helpful.

My DECIDE framework asks seven simple questions:

• What is the decision?

• Why are we making this decision?

• Is it a one-way or two-way decision?

• Who needs to make this decision?

• Do we have the information we need?

• Does it align with our goals, purpose and vision?

• Does the benefit outweigh what we need to put in?

Used together, these questions take you from defining the decision through to deciding whether it is actually worth doing.

DIAGRAM 2: DECIDE Decision Making Process

And when the decision is really difficult?

Some decisions don’t have a perfect answer. They might involve a valued member of staff, significant financial consequences or competing priorities. Whatever you decide, someone may be unhappy, and these are the decisions we can agonise over.

When I faced those situations in practice, one question repeatedly helped me:

What is best for the business?

It takes you away from emotions, personalities, individual preferences and the easiest short-term answer. You can take that further by asking whether the decision is in the best interests of the practice financially, legally, strategically or reputationally, and whether it is the right thing for the team, patients and wider community.

The answer still might not be comfortable but using that question as your decision-making anchor can make the right decision clearer.

Make the decision and get moving.

Better decision making isn’t about creating more processes and system, it should do the opposite. It should help the practice make the right decisions at the right level, with enough information and at the right speed.

So perhaps there are two questions worth remembering the next time you’re stuck on a decision:

What is best for the business?

And:

Do we really need to delay this decision?

Because while making the wrong decision can have consequences, continually failing to decide has consequences too. Sometimes the best thing you can do for your practice is simply make the decision and get moving.

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About Gary Hughes, MBA, PGCMDE

Gary Hughes has spent nearly 20 years in primary care, leading, supporting and strengthening general practice as a Practice Manager, consultant, educator and facilitator. Through Leadership in Practice, he helps practices become stronger, more effective businesses.

Gary developed the Business Strength Model, a practical framework that enables practices to assess the strength of their business across seven key areas. He also designs and delivers workshops and education programmes, speaks at industry events, and hosts the Leadership in Practice podcast.

If you would like to understand the strength of your business and identify opportunities for improvement, contact Gary here to arrange a free Business Foundations Health Check.

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About us

THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network management and the creator of The Business of Healthcare. With over 20 years in the industry, we have supported more than 300 PCNs through interim management, training and consultancy.

Our expertise spans project management and business development across both primary and public sectors. Our work has been published in the London Journal of Primary Care, and we have authored over 250 blog posts sharing insights on primary care networks.

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