Multi-Stage Decision Making

Wharton, in “Wharton on Decision Making” describes a multi-stage process for decision making and offers a few questions one can ask themselves to enhance the likelihood of a desired outcome (John Wiley & Sons Inc, 2001). The questions are fairly handy and since I work in mental health, and my job is directing patients towards their own best outcomes they good tools that I can use to give a patient the ability to reflect. They are:

1) Am I being myopic?

2) How appropriate is the starting analogy I am using to solve the problem?

3) What are penalties for making an error?

4) What am I learning from the feedback I am receiving?

Taken in order these are fantastic “self-checks” one can use to slow down a decision making process. One of the biggest barriers that I encounter when attempting to decide the best course of action to take with a given patient is myopia. I work in addiction, homelessness, and with the severely mentally ill. It is normal to look at patient’s past behavior and attempt to draw conclusions about their future behavior. Addiction recovery is a process that is often shot-through with failure. Not only are the organic changes in the brain difficult to revert but the thinking errors that arise lead addicts to repeat a series of bad choices. It becomes a bit of a self-directed spiral; thinking errors lead to relapse which undue any organic brain recovery which then leads to more thinking errors.

As for myopia, it is easy for a provider to not see past the information directly in front of them. We often tend to ignore possible factors “down the line” as we know patients typically can only handle one hurdle at a time. However, this a trap. If a provider does not have supports in place for a patient that does move ahead the patient can be left in a bit of a lurch.

However there is a flaw in this process; it assumes that a patient is thinking rationally, or even a manager for that matter. People in addiction rarely demonstrate clear thinking and the sufferers of a severe mental illness face immense hurdles in apply a clear process to any decision. There are managerial techniques such as developing one’s own emotional intelligence that allow for a manager to begin to set aside some of their bias and prejudices but once again it comes back to the capability of a given manager to apply these tools.

For me, decision making professionally is often based more on intuition and how I’m reading a patient’s ability to commit to a process. At the risk of sounding like I am discounting the text, which I am not, this skill cannot be based on equations or applying a set model. One has to read a chart, engage with the patient, and learn to use active listening and motivational interviewing to get a feel for where a patient is at in their minds. And of course, patients are not always honest so a great deal of intuition is required.

In any other aspect of my decision making, from personal life, to managing a program itself, the multi-stage process is quite handy! It allows for a methodical approach to looking at an issue and provides a foundation of assurance that you’ve covered options while approaching a decision.