Pre-mortems and Decision-making
As this group of 150 primarily radiologists gathered for the first course of the Radiology Leadership Institute, health industry program director at Kellogg School of Management, Joel Shalowitz, MD, MBA, said something that brought a knowing laugh from the room: “In my 25 years of teaching executive management courses, I have never had a group that came back so quickly without prompting.” Yes, radiologists are compliant. Yes, they are disciplined and they know the value of time. They were here, however, for something else: To explore the mysteries of leadership as taught by the cracker-jack faculty of the Kellogg School of Management and shared by a selection of legendary leaders in radiology, including James Thrall, MD, Arl Van Moore, MD, and Richard Gunderson, MD (but more on them later). First up was Nabil Al-Najjar, PhD, a professor of managerial economics and decision science, who regaled the crowd with mental tricks, visual illusions, and a con that left no doubt about the role of bias in the decision-making process. “Judgment biases are built into our cognitive system a little like visual illusions,” he emphasizes. “The human brain evolved to deal with Stone Age problems: Should I hunt rabbit, collect some twigs? It was not designed to deal with risk, 20th century problems, modern medical diagnoses, etc.” Fortunately, research in decision sciences and psychology provide tools to help counter biases, one of which Al-Najjar shared: The pre-mortem, a technique that a leader can use to encourage and legitimize dissent so that multiple possible scenarios can be conceived, weighed, and considered. Leaders often choose people of different backgrounds, competencies and skill sets to participate. “It is hard for human brain to think of everything that could happen,” Al-Najjar says. Because most organizations do not prize dissent, a person coming in with negative scenario could be labeled as a troublemaker. He used an audience response-question about Facebook to set up the exercise: What is the likelihood that it will remain the dominant player in social networking in 2017. The pre-mortem on Facebook required that people imagine themselves in the following situation:
  • Five years have passed and the plan has failed.
  • You are in a meeting where you must explain the sequence of events: What lead to the bad outcome? What errors were made?
The exercise helps to correct human cognition failures and corporate-think, develop a prospective hindsight, and balance enthusiasm with delusion, Al-Najjar says. “What makes the most effective leaders are ones that can almost play it both ways,” he explains. “Pre-mortem allows you to explore the downside, but once you have made the decision, you need to explore it as enthusiastically as possible.” This idea generated a lot of concern among the radiologists, who perhaps envisioned this process as taking place in the partners meeting. “Every decision we make is a pre-mortem,” one radiologist groused later about the atmosphere in his practice when new ideas are raised. Perhaps this exercise is best conducted in committee after a decision is made? “You can’t hope for a perfect decision but you can hope for better decisions,” he suggests.

Read More About the first Radiology Leadership Institute Meeting on Stat Read

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