I’ve been working in a corporate setting for almost 18 years at this point and over the course of my career, I’ve had the opportunity to engage at varying levels of difficult decisions. I’ve witnessed them (and possibly critiqued them) at a distance, participated in discussions as a contributor/party that advocates for a particular outcome around difficult decisions, and I have been the ultimate decision-maker.
Defining the Problem
What is a difficult decision? I’m defining it for the context of this post as a decision that has a negative impact, potentially a positive impact but generally no clear-cut ‘net positive’ path forward. This could mean making a choice that either ‘the least negative foreseeable outcomes’ is what you strive for or working for potentially a tiny positive outcome based on sacrifices elsewhere. It’s one of the most difficult aspects of leadership, and an area I have seen broadly done well or remarkably poorly.
Key Factors to Consider
There are some key factors I’ve noticed that play into outcomes from tough decisions that are made. I’ve noticed some strategic decisions seem to be made entirely in a vacuum or with an incredibly small audience (sometimes of 1) while others are attempted by committee. Some decisions are dictates (i.e. your budget has moved from 2M to 1M for this project, get it done with quality) while others are more nebulous concepts (i.e. increase stakeholder satisfaction) that you must try to support and balance across all other needs. Whether it’s a question of who to promote when you only have a budget of X, or you need to decide on a strategic roadmap to positively impact the stakeholders you serve. There are always many ways a person can make the decision that whittles down into behaviors that ultimately decide the success you’ll have for moving forward, though you have to know the answers to a few key questions first. I’ve found the answers to these questions can help guide me to a conclusion directly or take reasonable next steps toward a conclusion.
- Have you been able to establish trust in those impacted by the decision (i.e. your stakeholders, leadership, peers, management team and contributors who work for you) to give a sense of who you are and what you care about? This will heavily influence the outcome long term of the decision you make, as long as it aligns with your integrity and past behaviors.
- What does your transparency and communication style look like? This can influence trust as well as a vehicle to explain a decision if you do it well.
- What are the outcomes you personally want out of the decision, and is it in alignment with the ‘hearts and minds’ of those you work with?
- If not – is there a way to win others over to your way of thinking?
- Do you understand the factors that played into this decision being made (i.e. if it’s budgetary, what drove the budget? if it’s weighing improvement initiatives, what and why is the constraint being set?)
- What influence do you have over the factors long term, is there a possibility you can change the choices available ‘next time’ this type of difficult decision comes up?
- Should those impacted by the decision be involved in any way with the decision? Sometimes it seems like a no-brainer ‘yes’ and sometimes it’s a ‘no’ depending on the situation and is worthy to think about.
Answers to the above help guide me personally around difficult decisions.
In the Name of Context – A Little About Me
I work in the Healthcare IT space, specifically, I am responsible for driving the strategic facets of the production of the electronic medical record (EMR). To define scope a little better, my team is responsible for most IT areas of the patient experience from the time a patient books an appointment (i.e. registration) through their care journey to the point where they are billed. These responsibilities range from EMR stability to performance, to function and content enhancements, to routine change management, process improvement, etc. for (as of this writing) over 250 rural hospitals across the United States. While Cerner itself is a large company (over 26,000 employees as of this writing), my group to handle the 50+ EMR solutions we have about 50 associates to tackle how we go about pushing the envelope to deliver the best experience possible to our hospital clients.
Case in Point – Functionality Roadmap
One area of responsibility I mentioned above is tied to functional and content enhancements. What this basically means is that we need to devise and deliver a strategy that improves the tools our clinician users (or back-office users for revenue cycle) leverage for direct patient care. Things we think about are ‘how easy is it to use’ and ‘is the content up to date’. We have an ever-changing landscape we’re up against in the form of regulatory requirements and needs our client base has that we must be agile enough to pivot in order to ensure we’re putting our investments in the right areas. A decision we have to make on a routine basis is ‘where do we invest for improvements vs what can wait’.
A couple of years ago we worked on where we make our investments for clinical improvements. Do we invest in human trafficking prevention and alerting (which is a topic not discussed much, but is a huge problem in rural areas), suicide prevention documentation and alerting (which is another huge issue in rural areas), wound care process and workflows (i.e. what are the most ideal guidelines to follow for specific types of wounds, how to document, etc.), enabling and empowering clients to pass LeapFrog certification guidelines should they choose to invest, etc. Due to the factors at play, we ultimately landed on investing heavily in the human trafficking prevention workflows, Leapfrog certifications and started a multi-year journey in suicide prevention.
Why did we choose those items and how did we choose an emphasis in certain areas? It comes down to taking a hard look at the constraints and factors we are working with. How we’re resourced and how we can make the biggest impact based on resourcing investments we have. CSSRS is the suicide prevention form we based our improvements on and to integrate it in there were key pieces missing (either compliance with broader best practices, coded functionality or resourcing, etc.) which made this a longer-term struggle but still weighed on us from an overhead perspective. We made some great strides in human trafficking prevention workflows. Everyone who worked on these items should be incredibly proud of what they have contributed to patient care on a national stage. Though these decisions on what to engage in are never easy.
We aren’t able to get everything we want to get done completed and we have ongoing conversations throughout the year on weighing out the decisions in case we need to make course corrections. With a stakeholder audience of 250+ hospitals, we are unable to make everyone happy and we have to invest in our communication to showcase and highlight that even though some may not appreciate or agree with the direction we go, we explain the value and thought process around the areas we choose.
In Closing…
The above real-world example is just a small drop in the bucket for the numerous and varied challenges everyone faces, those in leadership positions even more so. I’ve personally found if we can think about the problems in the right way and are coming at it from a solid moral and ethical place – no decision is insurmountable though knowing that doesn’t make the process of making the decision any easier.