364
Leadership Lessons: Diagnose Before You Prescribe and Disagree
Respectfully^37
While leaders are involved in many aspects of organizational life, they are judged
based on the effectiveness and quality of decisions made during their tenure as lead-
ers. Research shows that effective leadership practices can promote more effective
decision-making [ 13 ]. Training physicians to lead requires them to do what they
have already been trained to do—diagnose a situation before they seek a solution.
This may be an important connection for surgical leaders. People seem to be hard-
wired to begin strategic thinking by talking about solutions rather than diagnosing
the situation.
The job of the leader is to manage the rational decision-making process by avoid-
ing premature discussion of strategic solutions. When people advocate too quickly
for one alternative, then opinions, assumptions, and uncertainties become indisting-
tuishable from known facts. A clinical leader’s first obligation is to help the team
separate the facts from the assumptions.
Why separate facts from assumptions? The primary source of strategic mistakes
is hidden assumptions [ 21 ]. Hidden assumptions can lead to two types of ineffective
decision processes. If the decision makers have the same assumptions, they will
reach closure very fast without considering the full set of consequences; if they have
different assumptions, the discussion will be neverending and emotionally charged,
at least until the deadlock is broken by abandonment or force (March 1988). In
either case, the quality of the decision making will not be very good.
Strategic thinking shifts the group from premature discussion of solutions to an
exploration and understanding of the problem, the assumptions and the goals, before
deciding on the alternatives. By shifting everyone’s focus from solutions to effective
strategic thinking, the decision makers have a better understanding of what is at
(^37) See [ 13 ].
Relationship behavior
High H1: Anything in NJ, Teterboro?
AT: Yes to the right
H1: Birds
H2: Uh Oh
H1: Hit birds, lost thrust in both
engines... going back to LaGuardia
AT: which engines?
H1: both engines
H1: We are going in the Hudson
H1: My aircraft!
H2: Your Aircraft
H1: GET THE QRH...
H2: I’m starting the APU
Jon Chilingerian 2017
H2: no relight after 30 seconds thrust
engines confirm idle
H1: idle..
H1: Any ideas?
Low
Task behavior
High
Fig. 20.6 Diagnosing
Flight 1549’s Situation and
Adapting Leadership Style
J.A. Chilingerian