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New Book Review! April 14, 2022

It Worked-How I made the Decision to Write this Article Become a Reality.

You have a choice.

It appears without notice and you sometimes only have a fleeting moment before the time to make a decision about that choice is gone.

But you did have a choice. Once. 

Did you notice? Or is your head still swirling, as mine often is, from the past two years of pivoting?

Watch out, there went another decision point. How did you do? What will be the outcome of this decision tomorrow, next quarter, three years from now?

How about those decisions that didn’t turn out as you expected, have you had a chance to reflect on why so that you can make better choices in the future? With so many events outside of our control, this is the perfect opportunity to make a choice to improve our decision-making. And you are in luck.  Once again, Chip Heath and Dan Heath, who brought us such insights about changing when things are hard (Switch) and about how to make your ideas thrive (Made to Stick), have created a timely, easy-to-read book about a critical leadership skill: making decisions.  Their new book is entitled Decisive: How to Make Better Choices in Life and Work decisive: How to Make Better Choices in Life and Work Decisive: How to Make Better Choices in Life and Work

Starting with the four villains of decision making - narrow framing, confirmation bias, short-term emotion, and overconfidence about the future - the authors create an easy-to-follow framework for evaluating and addressing each of these common pitfalls. The examples that they use are relevant to health care and remind us of the importance of bias.

Instead of just reviewing the book, I wanted to show you how reading this book and implementing some of the ideas has helped me with some recent decisions.

For example, in writing this book review, either I will get it done or I will not. However, that is too narrow a focus. According to research included in this book, “whether or not” decisions such as whether or not to keep my commitment to finish this book review would fail 52% of the time and you would not now be reading this. Instead, I widened my options by asking a different question. I asked myself, “How could I make this work?” and “Where in my schedule could I find time to complete this book review?”  I hoped that widening my focus would allow me to meet my commitment and to share these ideas with our community. Unfortunately, when I looked at my calendar, I found what I expected to find.

There was just no time in my schedule to allow me to write this book review!

Bam! Confirmation Bias – the next villain! 

We talked about this a lot at the recent AIAMC in-person meeting in New Orleans, how confirmation bias can limit our recognition of underrepresented minorities, for example.  So, just as we are all working with our Programs to talk about the importance of increasing our diversity in health care to meet the needs of our patients, we also need to be talking about reality testing our assumptions. If the assumption is that test scores and students who come from similar experiences will excel, how do we consider the opposite, by asking ourselves probing questions to spark constructive disagreement within our organizations, to ask disconfirming questions or even force ourselves to consider the opposite of our instincts?

So, I considered the opposite of where would I find time and asked myself, what do I need to do this week in order to get this article done by Wednesday? I am testing this assumption with a deliberate mistake, writing in-between meetings rather than waiting for a perfect, empty afternoon or few days to carefully construct the perfect book review. In addition, I used another tool, looking inside our organization to find one of our “bright spots”. Thank you to Kristina McComas, Medical Education Coordinator at Billings Clinic who loves all things about literature, including avoiding syntax errors.

We both made choices: you to read this review, me to write it. Kristina to edit it. Now we both will live with our decision and prepare to be wrong. Those two sentences contain hints to the last two villains of decision making. Curious? Check out the book, Decisive by Chip Heath and Dan Heath.

That is a decision you will not regret.

Virginia “Ginny” Mohl, MD, PhD, is the DIO and Medical Director of Education, Billings Clinic and Co-Chair AIAMC NI VIII on Justice, Equity, Diversity, Inclusion (JEDI)