• 04 May 2007
  • What Do You Think?

How Do Managers Think?

"Uncertainty sometimes is essential for success" asserts a new book, How Doctors Think. The work of doctors raises intriguing questions about managing, says Jim Heskett, since diagnostics are an important part of managerial decision-making, too. Jim sums up nearly 60 responses from readers around the world, including practicing physicians.
by Jim Heskett

Summing Up

Can managers acquire ways of thinking or ways of learning from doctors?

Managers can learn from an understanding of how doctors think. But whether the lessons are profound or even totally applicable was a matter of discussion among respondents to this month's column. What was intriguing was a suggestion that while managers might have little to learn from doctors about thinking, there might be more important implications for managers in the ways that doctors are trained.

Many similarities were observed between the thinking of medical and management practitioners and the environments in which it is carried out. Joe Schmid observed that "both medical doctors and organizational managers work in cultures that are historically problem definition poor and solution rich. Their individual rewards systems are both driven by 'throughput.'" Joanne Celens opined that "the key success factor—like with doctors … (is) management's willingness to hear … as input in their decision processes." Alberto Souto said, "Both medicine and management are socio-technologies … plus art …. There is still a lot of craftsmanship in these two disciplines."

Richard Kunjawa suggested that "… doctors rush when the illness is serious … managers, when faced with little time and pressure to get things done, fail to think well and so make poor decisions." Itamar Offer, a physician, said that "information is always partial in both professions … there is no substitute for listening to others …." Bill Welter opined that "… the basic cycle that all thinking professionals (doctors and managers alike) should use (is): to sense, to make sense, to decide, and to act …. Unfortunately, too few of us deem 'thinking' to be real work." C.J. Cullinane wrote, "The concept of people, be they patient or employee, holding back information either knowingly or just forgetting, is a problem that can kill a patient or a company."

Others suggested important contrasts that they think make comparisons less relevant. William James Dorman commented, "Interesting to make analogies, but the basics of medical decision making are grounded in scientific fact whereas there is no unified body of knowledge based on science for the manager." As Todd Rhoad put it, "… doctors … are trained troubleshooters. It takes many years to learn to operate using such a scientific method in solving problems …. Managers focus on making decisions with little information, not through a rigorous review of the details." According to Gerald Nanninga, "A big difference between doctors and managers is the fact that the doctor's patients realize they are sick and proactively seek out the doctor …. A good manager needs to get more involved in 'preventative medicine ….'" Akhil Mehta, before observing similarities, pointed out that "… human life is almost never involved in managerial decision making." Siva Subramaniam commented that "the metric for measuring the doctor's work is a near perfect solution while the manager has to deliver the most effective outcome vis-à-vis original plans."

One interesting comment about what managers can learn was offered by Darryl Duncan, who asked, "I wonder if we do a good enough job of educating our employees to recognize symptoms of 'poor health' so that they are able to self-identify themselves to their managers?" And Ulysses U. Pardey said, "(In their training, doctors) are in real contact with what they must understand …. The ways and tools used to teach and understand medicine allow doctors to be hands-on today with what will be their job tomorrow …. Will future managers have the privilege to experience and acquire practical understanding within real-life companies … (as a) complementary device to business school teaching and learning?" What do you think?

Original Article

Ask an artist how she creates a work of art, and chances are she can't tell you in a way that would enable you to do it. Similarly, managers I've observed over the years have great difficulty dissecting how they make tough decisions. Now we have an intriguing book, How Doctors Think, in which a practicing doctor, Jerome Groopman, describes brilliant diagnoses and treatments. The book is of particular interest because our colleagues at Groopman's institution, the Harvard Medical School, have evidenced a long-standing interest in business school-type case method techniques, including the development of an instructional program based on them.

Perhaps most important, Groopman describes how and why doctors sometimes make tragic mistakes. These are mistakes that occur because of miscommunication (the failure to say "tell me again"); too heavy a reliance on pattern recognition; a tendency to draw on stereotypes to make decisions regarding patients; premature closure of problem diagnosis, possibly because of too heavy a reliance on first impressions; framing effects (biases or preconceptions caused by others’ opinions or diagnoses); and availability (judging on the basis of the "ease with which relevant examples come to mind"). In his words, the diagnostic process is even "compromised by positive or negative feelings we have toward another person." Putting it bluntly, research has shown that doctors are more patient when diagnosing people who are not seriously ill, troublesome, or chronic in their complaints. And getting things right takes time, time that many doctors just don't have (or think they don't have).

More successful doctors work hard at something called "patient activation and engagement," primarily by asking open-ended questions whose purpose is to engage patients with the purpose "to wake someone up" and signal that the doctor is inviting a dialogue about a patient's ailments. In fact, Groopman asserts that "how a doctor thinks can first be discerned by how he speaks and how he listens…his attention to the body language of his patient as well as his own body language."

The process proceeds with questions designed to open the exploration of diagnoses that don’t fit usual patterns or preconceptions. Its success may depend on questions posed by the "awakened" patient, questions such as "Can I tell you again about how I feel, how it happened, etc.?" "What else could it be?" "Is there anything that doesn't fit?" And "is it possible I have more than one problem?" The very best doctors are able to say, "I believe you when you say something is wrong, but I haven't figured it out," possibly voluntarily sending you on to another doctor for his opinion. This takes time, and good doctors make time to do it. Does this sound like your doctor?

Even though doctors may sometimes avoid full disclosure to patients for fear of disturbing them, Groopman asserts that "uncertainty sometimes is essential for success." These observations about doctors raise some interesting questions about how we manage. After all, diagnostics are an important part of managerial decision-making, whether or not someone's life is on the line. What, if anything, can managers learn from Dr. Jerome Groopman's findings and hypotheses? To what degree do they help explain how managers think? Can we learn about good diagnostic procedure by observing our medical counterparts? What do you think?

To read more:
Jerome Groopman, How Doctors Think (Boston: Houghton Mifflin Company, 2007).