There’s an old story that in pursuit of a pen that would work for keeping notes during space missions, the Americans spent millions of dollars to invent just such an item. It worked and was a brilliantly created pen that served its purpose. The Russians, on the other hand, came up with a different solution. If you follow this article through to the end, you’ll find out what that was.

Making tough decisions in private practice is essentially the same as making them in any other business, or indeed in your life generally. Here we set out what I think are the key steps to making tough decisions.


Step 1. Identify the problem

It’s important to clearly understand what the true issue that you’re looking to solve is. It helps to write it down and try to condense the issue to one clear sentence. This is not the time to record all the ways the problem is affecting the business. This is simply the time to identify the core problem you want to resolve.


Step 2. Identify the true cause

Often, when we react to seeing a problem or issue in our private practice, we can jump to a conclusion about the cause. If a particular report is generated with consistently inaccurate data then we may decide the problem is the team member that generates that report. However, when we investigate with greater depth (and less emotion) what we may well discover is that the problem sits with data collection, recording or some other unseen aspect.

Because of this, it is important to properly investigate what the true cause of the issue is. If not we can easily end up fixing a symptom or by-product of the real problem.


Step 3. Identify the possible solutions

Once we know both the problem and the true cause, we can set about designing possible solutions. Let’s not overdo this step though. Most private practice owners hit a roadblock with this step, mainly due to overthinking both the number of possible solutions and the complexity of those solutions. It’s a good time to re-read the opening paragraph of this blog as this step is a pretty strong clue to the solution the Russians came up with.

As with step 1, write down the solutions. Use a bullet point list to keep it tight and simple.


Step 4. Weigh the possible solutions for effect and impact

Using the bullet point list created in the previous step, grade each solution for effect (effectiveness in solving the problem) and impact (impact to the business, the team, and process of running the practice).

Narrow your list to two or three solutions and put together a summary page capturing a simple explanation of the problem, what the true cause is and finally what the three main possible solutions are.


Step 5. Get advice

With your summary page, it’s time to find a trusted sounding board. If you have a consultant then call them. If you have an advisor or business partner then now is the time to bring them in. Remember at this point you have identified the problem, the true cause, and some possible solutions. Be open to the idea that your advisors may have other solutions you haven’t yet considered.


Step 6. Decide and implement

This a good time to note that the best solutions are not always expensive. It does not always require a big upheaval for you or your team and it certainly doesn’t have to be disruptive. Having designed the possible solutions and taken appropriate advice, it is simply a case of deciding what the best road is and putting it into place.


Step 7. Debrief and review

This is a step that often gets missed, and yet it is so important to the overall process. Reflecting on the decision that was made and the process of implementing will help for next time. Equally, reviewing how effective the decision was once implemented will also help the next time you have to make a tough decision.


So in summary, making a tough decision is really the same as making any other decision. If you have a clear understanding of what you need to change and clear process for working out what you want to achieve, then it becomes less daunting. The most effective solutions are not always complex or expensive and sometimes when you think it through logically, the solutions are right there in front of you all along.

The Russians took a pencil.