Wednesday, September 30, 2009

How to Make Better Decisions About Healthcare Reform

Debatej0301320jpg The outcome of the healthcare “debate” (more of a shouting match really) will be flawed because the process of decision making is flawed. A solid structure built on a soft foundation will not stand. So, unless “we the people” take a stand by insisting that “they the politicians” change their polarized, decision-making process, healthcare reform is moribund.

We must demand that our politicians frame the healthcare debate around four fundamental questions that will improve the decision-making process. Each of these questions is associated with one of the four leadership styles of the eXpansive Leadership Method (XLM) seen below. The XLM cannot tell us what to do; it can frame the process of how to think about what to do (i.e., the decision-making process).


1. VISIONARY QUESTIONS -- begin by asking, "What would be an eXtraordinary outcome?" Visionary thinking invites contemplation of a broad perspective, strategic implications, and long-term considerations. When dealing with a difficult challenge, such as healthcare reform, probe deeper by answering visionary questions, such as…

How does this challenge relate to our nations priorities? (What about two wars, the economy, energy dependence, the environment, atrocious k-12 educational performance…?)

Is this a problem worth investing resources to solve at this time? (Can you say debt?)

What might be the downstream negative and positive consequences?

Are we too invested in the status quo? (Why is everyone talking about the British and Canadian systems? What lessons can we adapt from Germany and some of the Asian countries?)

2. RATIONAL QUESTIONS – explore how we know what we know. We therefore ask, "What are the facts and expectations of those affected?" Rational thinking helps us monitor our environment and be in touch with the facts, without the irrational hype we see night after night on television. In deciding how to address a complex challenge, this means being aware of the external and internal context of our decision by asking...

Do we have the correct information about quality, cost, and access? (Americans spend twice as much on entertainment as we do on out-of-pocket healthcare expenses. 50% of the US hospitals are losing money.)

What assumptions we making? (Can we really fix a nonexistent system? Healthcare “system” is an oxymoron. Healthcare in the U.S. is a fragmented cottage industry.)

How will we monitor the implementation of this decision?

How can we make this process of deciding transparent?

3. EMPOWERING QUESTIONS -- concerns themselves with the moral code and values we use. We begin by asking, "What's the right thing to do, especially for others?" This is an empowering question because it focuses our attention on serving those whom we lead. When we’re dealing with thorny issues, consider asking…

If everyone in the world had to do exactly what we are contemplating doing, what type of world would we have?

What is the right thing to do for the greatest number of people without violating individual rights? (Is it right for people who choose to smoke, drink, and eat poorly to pay the same healthcare expenses as those who exercise, practice prevention, and maintain their weight via healthy eating?)

What is the most honest and fair thing to do?

Is what we are deciding to do consistent with who I aspire to be?

4. COMMANDING QUESTIONS -- remind us that human beings have free will and therefore are responsible for their actions. It leads us to the question, “What are the consequences of our options?" This commanding question compels us to refuse victim thinking and accept responsibility for our choices. Eventually you must choose what to do or not to do. (That is the question!) Here are a few more questions that will help you think expansively as you access your free will responsibly:

Have we solicited the opinions of those with whom we often disagree?

How risky are the alternatives?

Can we test the alternatives on a small scale before we decide?

What are our best options based on the answers to all of these questions?

Peter Drucker reminds us that while leadership used to be about having answers, it is now about asking questions. The best approach to meeting daunting challenges and solving perplexing problems is therefore, to use a consistent methodology that helps us ask expansive questions. The XLM doesn’t tell us what type of healthcare system we need, it does show us how to frame the conversation.

What other questions should we be asking in the healthcare debate?

Keep eXpanding,

P.S. The web-based eXpansive Leadership Method (XLM) assessment measures 4 fundamental leadership styles, 16 core competencies, and 8 essential leadership skills. Within minutes of completing your assessment (which takes less than 20 minutes to fill out), you can download your highly personalized profile - a comprehensive, 21 + page report and customized action plan in PDF format. Go to to learn more.

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