Life With Mayo
Contemplations on The Nature of
Decisions
I have a colleague who is working on a book with a bunch of doctors on a subject that more of us should know more about but would rather not. That could mean a lot of different topics, but in this case it’s prostate cancer. When the book comes out, I’ll let you know.
Anyway, she sent me a note the other day in which she mentioned that she had just gotten off the phone with a doctor from the Mayo clinic. This led me to recall an experience I had a number of years ago that had something to do with the Mayo clinic. There’s a point to this so bear with me.
The story goes like this:
Back in 1980, I had the opportunity along with a friend to move from Rochester NY to Honolulu, HI to start a coffee company. Most normal people would have thought to get on a plane and fly there. For reasons that seemed to make a lot of sense at the time, we decided to drive. Lest you think me completely daft, the actual plan was to drive to Los Angeles via as many interesting places as we could find (including a then much, much smaller Starbucks where we had a nice visit) from whence we would ship the car and board a plane.
But back to the road trip. A very long Day 1 got us as far as Chicago. It was stupid late on Day 2 and we found ourselves going through Rochester MN (home of the Mayo clinic) with headlights that didn’t work too well and a serious need for sleep. We were in desperate need of a hotel room.
It was then that I saw signs for the “Clinic View Hotel.” Honest to goodness I didn’t make the connection. It seemed like a lousy name for a hotel, but whatever. It was late, we were tired, we saw the sign . . . you know how it goes.
After some missed turns we finally find the place, pull up, and walk in. It looks like a hospital for goodness sake. Big wide halls. Tile everywhere. Railings on the walls. We still don’t make the connection. It seemed like a really strange way to decorate a hotel, but whatever.
Keep in mind that it’s really late. Like Night Clerk Mike late. We get up to the front desk and start to check in. Finally I had to ask.
“So, why do they call it the Clinic View Hotel? Seems like a funny name for a hotel.”
The guy looked at me like I just flew in from the planet Rewanhango.
“Because it looks out over the clinic” says he.
“What clinic?” says I.
Now he really thinks I’m whacked and is probably thinking about calling security.
“The Mayo Clinic?”
Well my friend and I looked at each other and got the heck out of there as fast as we could. For some reason, the idea of staying in a place called "The Clinic View Hotel" right across from you know where suddenly seemed incredibly unappealing. We drove about 90 mph out of town until we finally found a Motel 5 or 4 or whatever and stayed there, safe in the knowledge that there wasn’t a clinic in sight.
There's a point here, and it's coming.
Lately I’ve become obsessed with the idea of decision quality. Another colleague of mine, Clint Korver the founder of Outcome Software, is the one that got me started on this topic. It's his fault.
To understand the idea of a quality decision, you first have to make the distinction between quality decisions and quality outcomes. You could drink like a fish, get in your car at 3:00 in the morning and make it home safe and sound. That would be a quality outcome, I guess, but certainly not a quality decision.
A quality decision begins as a conscious choice to make a decision. As Clint says, "it’s like driving a wedge between the normal stimulus/response of living". That intention forms the basis of what should become what Clint calls “an irrevocable allocation of resources.” Anything less doesn’t qualify as a quality decision.
Beyond that intention is the actual process of making a decision—a process with these six dimensions:
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An appropriately framed decision. What are you deciding and why? What shouldn’t you be deciding and why?
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Creative, doable alternatives. Are they real alternatives or just the same old, same old? This is where you want to raise constructive conflict.
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Meaningful and reliable information. What you want is insight that will be meaningful and relevant in judging alternatives.
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Clear values and tradeoffs. Values define our preferences among outcomes. Values can be expressed by “attributes.” Attributes are characteristics of the outcomes that we find desirable or undesirable. They typically occur over time and may have some degree of uncertainty associated with them. These are the standards by which you’re going to resolve the conflicts.
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Correct Reasoning. Reasoning is how you combine your alternatives, information, and values to arrive at a decision. Good reasoning requires an explanation, or rationale. This is where you actually resolve the conflicts.
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Commitment to Action. A decision without action is futile. Commitment to action means that you are set to act and have the ability to direct your action in a purposeful manner. This is where you want no conflict.
Which brings me back to the story of Mayo Clinic. Why didn’t I put it together? It’s not like I’d never heard of the Mayo Clinic because I had. It’s not that I didn’t know it was in Rochester, Minnesota, because I did. Growing up in Rochester, New York, you kind of had a sense of what was in the only other Rochester that people on this side of the Atlantic have ever heard of.
It’s possible that I have and had a deep seated mental block about the Clinic. I think a better explanation, and the one that I’m going with here, is that my framework at the time was all about sleeping and getting on down the road to Hawaii, and not about medical care. With that framework, all the information in the world wasn’t going to compute as I considered what at the time seemed the only possible alternative. It was, in fact, more stimulus/response than it was an actual decision.
Word to the wise: if you want to make better decisions, start by recognizing that a decision is required (vs. stimulus/response) and then take some care in framing the problem you’re actually trying to solve. Once the frame is set, once the problem space is defined, you’re much further towards a decision than the one out of six factors implies.
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Last modified:
05/03/06