Clinical decisions vs. business decisions

Ever heard, “He’s a great physician, but doesn’t get the business side of it?”

Some physicians have a reputation for being great at patient care, but poor at managing the “business side” of their practice.  This could be for a variety of reasons… not enough formal business education, not enough experience in managing people, not enough passion for “the business side”, etc.

What about the way decisions are made in the practice?  Do the decision making processes used to diagnosis and treat patients – which are second nature to physicians – not result in success when the same processes are used to make decisions about the “business side” of the practice?

One of the best articles I have read from Harvard Business Review, The Seasoned Executive’s Decision – Making Style (Feb 2006), highlights a study looking at the decision-making styles of more than 200,000 executives.  The researchers identified 4 distinct ways in which successful business leaders make decisions.  With predictability, the more successful executives evolved their decision-making process as they assumed roles of greater responsibility and influence. Â The four styles were identified to be…

1.  Decisive. People using the decisive style value action, speed, efficiency, and consistency. Once a plan is in place, they stick to it and move on to the next decision. In dealing with other people, they value honesty, clarity, loyalty, and, especially, brevity. Time is precious in this mode.  This type of process was most often used by first level managers and directors.

2.  Flexible. Like the decisive style, the flexible style focuses on speed, but here the emphasis is on adaptability.  Faced with a problem, a person working in the flexible  mode will get just enough data to choose a line of attack– and quickly change course if need be.

3.  Hierarchic. People in the hierarchic mode do not rush to judgment. Instead, they analyze a great deal of information and expect others to contribute – and will readily challenge others’ views, analyses, and decisions. From the hierarchic perspective, decisions should stand the test of time.  This type of process has been identified when long term management decisions are made within a business by upper levels of management.

4. Integrative. People using the integrative style don’t necessarily look for a single best solution. Their tendency is to frame any situation very broadly, taking into account multiple elements that may overlap with other, related situations. Consequently, they make decisions that are broadly defined and consist of multiple courses of action. When working with others, integrative decision makers like lots of input and are happy to explore a wide range of viewpoints, including those that conflict with their own, before arriving at any conclusion. Decision making for the integrative is not an event, but a process. This type of process is most often used by CEO’s and leaders in higher positions within an organization.

Applying these four distinctive processes to physicians and clinicians, it could be argued that patient care is often managed using the “Decisive” level of decision making.  Clinicians may have difficulty shifting out of this mode to the other modes when making decisions about their practice, especially considering that the research supports successful business decisions being made through “Integrative” and “Hierarchic” processes.  These processes may not be as intuitive, and therefore business decisions for the practice are made using the same process used to make decisions about patient care. Â Most physicians are probably unaware that there is a difference in decision-making processes, despite the evidence provided in the research.  Does difference in business decisions vs. clinical decisions matter?  I think it might.

[Front-page photo courtesy of Flickr user PhotoDu.de]