It is important that healthcare consultants, patient advocates and doctors should learn to adopt an open and curious mindset and use a systematic process, outlined below, for addressing the most complex clinical problems.

From McKinsey , we learn the principles of improving our decision making processes. This is essential for healthcare consultants and patient advocates when working with complex patients.

Seven approaches to improve decision making processes for complex patients.

(1) being curious about every element of a problem; look at every aspect of the problem and put a question mark at the end of every statement?

(2) adopting imperfect solutions at the onset and then refining them over time. And accepting the imperfection without undue harsh criticism but understanding that the decision will mature and deepen with time and effort.

(3)seeing the problem through multiple lenses by forming a team with multiple disciplines on board;

(4) allowing the team to experiment using thought experiments, at the outset, in order to not create harm of any kind with patients. It is important to recognize that effective problem solving involves a lot of trial and error. And it is important to be able to estimate probabilities as a proxy for levels of certainty about possible solutions. This helps to guide the decision making.

(5) accessing the cognitive surplus and collective intelligence of a network of experts in order to invite the smartest persons into the discussion because they are not there at the outset. Experts like to opine about problems in which they have experience and expertise. Many experts like to share their knowledge freely. If they don’t, then don’t invite them into the discussion.

(6) using storytelling to engage the team members emotionally and get their commitment to think deeply about the problem

(7) ensuring psychological safety for the members of the team so that they will actually contribute with some confidence that they won’t be ridiculed or excluded for speaking out.

The challenge in healthcare is that these principles are rarely applied. That is the opportunity.

The hierachy of the most senior clinician’s ideas are adopted. Reasoned discussion or possibly debate are not allowed.

There is little psychological safety in presenting new ideas that seem “out of the box” thinking. And many universities have their own paradigms for solving problems and do not allow contradictory or conflicting paradigms to enter the discussion.

These factors make solving complex problems less effective and end up hurting patients in the process. That is why the error rate for hospitalized patients is 25-30%.

The fact of harm to patients have led Raymond Rupert, patient advociate, and his team at RCM Health Consultancy into introducing the following 7 principles into their problem solving process when addressing patient complexity every day of the week and every week of the year.

This decision making process at RCM Health Consultancy now has a 25 year legacy of creating positive impacts for patients. We will be pleased to share it with any hospital or clinic group interested in learning more.

Raymond Rupert, patient advocate and healthcare consultant.

Reference: Charles Conn and Robert McLean are the authors of Bulletproof Problem Solving: The One Skill That Changes Everything (Wiley, 2018).