DECISION — MAKING: The benchmark of an excellent CEO

Oct. 1, 2003
"Look it up, size it up, but don't postpone your life just because you can't make up your mind." � Author unknown

by Cathy Jameson, PhD

Decision-making may be one of the most difficult responsibilities of a CEO — and you, doctor, are the CEO of your practice. In both your professional and personal life, decisions need to be made on a regular basis.

In a June 21, 1999, article in Fortune magazine titled "Why CEOs Fail," authors Ram Charan and Geoffrey Colvin listed the main reasons as:

1) Poor execution
2) Not getting things done
3) Being indecisive
4) Not delivering on commitments
Challenging "side effects" of not making decisions are:
• Lost time
• Increased stress
• Loss of productivity

Why do people avoid making decisions? The reasons are many and we'll list a few here. See if you recognize yourself in some of these.

Fear of failure

Fear of failure can be either a conscious or a subconscious filter that hampers your own personal progress. Fear of failure is the main reason people do not write goals. This strong inhibitor also ranks as a major barrier to decision-making.

Many people take so long to make decisions that the moment of magic in which a decision could have made a constructive difference is lost. Zig Ziglar says that many people have "paralysis by analysis." The fear of failure is so dominant that not taking that step out into the unknown is easier, seems to make more sense, and is less risky. It may be easier to avoid a decision than to make one. Then, if things don't work out the way you think they should, you won't have to say to yourself — or hear anyone else say — "I told you so!"

No matter how much analysis goes into a decision, sitting back and not making the decision is usually worse than doing nothing. Oftentimes, the results you get may be different than what you expected, but they also might be better than you expected! That can't be all bad!


Attitude plays a major part in how you approach decision-making. If you make a decision and you do not get the results you had hoped for, then step back and evaluate what has happened. Has your goal changed? Did the plan of action have some weaknesses that need to be strengthened? Did you need some resources, mentors, coaches, etc., to help you along the path? Or did you think that you had to "go it alone?"

Stop thinking that you have to know everything and that you have to be a master of all things. In this complicated and sophisticated world in which we live and work, no one can know everything.

I have a corporate consultant who works with us here at Jameson Management, Inc. There is no way that I can know everything or that I can see everything clearly all the time. Sometimes, I am too close to a situation to analyze it quickly enough and without too much "baggage." In addition, there is always someone who has more experience and knows more than I do. So, I turn to these experts to "coach" our team to be better and better. I honestly believe that the day we think we know it all or the day that we think we cannot become any better is the day we need to close our doors. We must be on a continuous path of improvement.

As dentists, you have the same commission — to constantly improve! The only way to continually improve is to step out of your comfort zone and stretch toward new horizons. That means that you must risk. No one has ever achieved ultimate success without taking some risk.

When you take a risk, you might not get things right the first time ... you may make some mistakes. However, instead of viewing a mistake as a failure, step back and look at your progress. What did you do well? Then, do more of that. What didn't go so well? Change it! Don't let yourself wallow in a state of self -defamation, self-defeat, or loss of impetus. Alter what needs to be altered and take another shot at the project. Learn from your mistakes. You will be better and stronger on the other side!

I am sure there have been times in both your professional and personal life that you have taken a long time to make a difficult decision. However, once you made the decision, you probably then took the steps necessary to move that decision into action, and afterwards, you felt a sense of relief or accomplishment. Carrying around a mire of thoughts in your head, knowing that a decision needs to be made and the sooner the better, can be stressful.

Write out your thoughts. Get your thoughts organized. Do the classic "Ben Franklin" approach. Write the words "Pros" and "Cons" across the top of a page. Then write out a statement about the decision you need to make.

Next, write out the negative and the positive possibilities. What could go wrong? And, on the other side, what could go right? Then study your lists. If the pros outweigh the cons, go for it! At that point, you should feel an immediate relief from stress. That's because you are now on a path of action. You may make mistakes, but you will learn from them ... and you will be wiser and better for those mistakes unless you let yourself wallow in self-pity. You must refuse to let yourself say things like, "See, I knew I shouldn't have done that. I just should have continued doing things exactly the way I was doing them before." Another word for that kind of reaction is stifled ... or dead!

Do not let fear of failure stifle your life. Don't develop "paralysis by analysis." Be a leader — a leader who does a careful evaluation, then makes a decision. Studies have shown that one of the major factors that leads to the demise of a CEO is the inability to make a decision ... and to make that decision quickly!


Another major barrier to decision-making is "perfectionism." Some people are incapable of making decisions because they want or expect things to be perfect. Of course, there is no such thing as perfection, so these people go through life "on hold," waiting for everything to be "just right." This also goes back to the fear of failure issue. The fear that going ahead with a decision will provide anything less than perfection deters many people from moving out of their comfort zones and going ahead with anything.

In reality, many people who profess "perfectionism" are lacking in self-confidence. It takes confidence to make a decision. It takes even more confidence to step up to the plate to correct a mistake if things don't go as planned or if the desired results are not achieved.

Perfectionism is not a foreign characteristic in the dental profession. Many dental professionals think that they have no margin for error in their clinical dentistry or in their management skills. L.D. Pankey professed striving for excellence in everything that you do, because he knew there was no such thing as perfection. He was making an effort to relieve some of the self-induced stress that so many professionals develop.

Begin your journey to become a better leader by being a better decision-maker. Start with a small decision. Work toward getting a constructive result. If things don't go well, figure out why they didn't and view what you are trying to accomplish from a different direction. Then, go on to the next decision. As you are progressing, make an internal note of how things are going. Don't forget to pat yourself on the back (with your internal self-talk!), so that as you work toward becoming a better decision-maker, you constantly gain strength and confidence.

Fear of hurting someone

The heart of a dentist is so big that it won't fit into your body — and that's just the way we want you to stay! You have a level of compassion and caring that is rare among human-kind. You know that many people perceive you as someone who "hurts them" ... someone who "gives shots," "cuts up their gums," and "drills holes in their teeth." We have all heard that many times. In reality, you don't want to hurt anyone, and you go out of your way to make sure that you don't. All members of the team are the same way — i.e., the clinical assistant, the hygienist, and the business staff.

No dentist wants to hurt patients, physically or emotionally. You may hesitate to tell patients what they need to know out of fear that you will hurt their feelings. In addition, you may do the same thing with team members. You sometimes don't tell each other things that may be bothering you because you don't want to hurt another team member's feelings.

In fact, taken to an extreme, many doctors hesitate to release a team member who may not be working out very well or who may be causing problems in the practice. They don't discharge the employee because they don't want to hurt that person's feelings.

Lack of confidence

Lack of confidence can relate to several different issues in connection with decision-making. This lack of confidence may be due to:

1) Inadequate skill level
2) Inadequate skills of a colleague or team member
3) Insufficient preparation or training
4) Timid or nonassertive personality
5) Being "stuck" in the status quo
6) Poor leadership abilities

What to do about these barriers

• Be a risk-taker — understand the value of a mistake! Rarely does a quality team member make a mistake on purpose. If a staff member is truly trying to perform a job well and with good intention, a mistake can occur, but it occurs honestly.

Mistakes can happen when a person steps out of the norm, walks the extra mile, or tries something extraordinary. The people throughout history who have made the greatest contributions are those who have been willing to risk.

Think of risk as a two-sided coin. On one side of this coin called "risk" is the chance that you will make a mistake. But if you look at each mistake as an opportunity to grow, to learn, to get better, and to become wiser, then a mistake can become an asset. The other side of that coin called "risk" is the greatest of all success. Success is elusive if you are unwilling to take risks. Be a risk-taker. Learn from each and every mistake. Wisdom, growth, and ultimate success are the partners of mistakes.

• Know when to stop and move into action. Enough already! Remember the "paralysis by analysis." There does come a time when it's simply time to move on — and there's usually no better time than the present. Who knows what tomorrow will bring? Do you want to look back on your life and your career with regret that you never did the things you really wanted to do? Do you want to retire one day knowing that you never accomplished the practice of your dreams ... that you never reached the goals that were sleeping in your heart and mind?

I hope not! I hope you will be able to look back on your life and your career and say, "I'm so glad that I achieved my goals!" Know when to stop thinking about something, to stop doing "research," to stop procrastinating. Nothing will be better due to procrastination!

As Denis Waitley said, "Nothing in life will ever be accomplished if all obstacles must be overcome first."

• Clarify expectations. If making a decision is so complex or so difficult, take it one bite at a time. Think through the situation. Determine what you want. Be specific. Then, ask yourself, "How am I going to accomplish this?"

Clarify your expectations and the expectations of anyone with whom you may be interacting. In many situations, it's best to start with the end in mind.

Let me repeat these two valuable questions:
"What is it you want?"
"How are you going to get it?"


• Be strong! Don't waiver when you are sure of your decision. As a leader, you will continually be called upon to make decisions. You are not in a popularity contest, although being liked and respected by your employees and colleagues are desirable qualities. In all cases, you must make decisions that are good for the organization! Sometimes, a staff member may not like or agree with your decisions. However, if you have studied a situation and you feel you have made the decision that is in the best interests of your organization as a whole, then stick to your guns. It's also important to give your decision enough time to be tested. See if the decision accomplishes the desired results.

If, upon evaluation, you find that the decision did not accomplish the results you wanted, then step back, re-evaluate, reorganize, and look at what you want to accomplish in another light. Don't be so egotistical that you keep on doing the same thing in the same wrong way just because that's how you made the original decision. One of the strongest, most courageous things you can do when things don't work out as planned is to step up to the plate and admit being wrong. Being able to say you made a wrong decision, that you are sorry, and that you are willing to learn and go on are all signs of a great leader. However, don't waiver and/or falter at the first sign of difficulty or challenge.

Dan Millman asks this question: "Which is harder, riding a bicycle up a hill or down? Which makes you stronger? Going up the hill or coasting down?"

Strength is developed by peddling uphill!

Specific guidelines for effective decision-making

1) Set deadlines.

2) Decide quickly on small issues and go on to the next one. Make the call.

3) With larger decisions, make a series of small decisions that will keep you moving forward.

4) Once you've come to a conclusion, have confidence in yourself and in your decision.

5) You may not "get it right" the first time. Acknowledge that when appropriate ... but don't back away from your responsibility to "decide."

Decision-making worksheet

1) Why is this decision necessary?
2) If I make this decision, what will be the benefits — the positive end result?
3) If I make this decision, what could be the down-side effect — the negative end result?
4) What are the decisions that can be made? What are the alternatives?
5) What are the pros and cons of each alternative?
6) What effect would each of these alternatives have on the practice?

"An effective executive does not make a great many decisions. He/she concentrates on the important ones. They try to think through what is strategic and generic, rather than 'solve problems.' They try to make the few important decisions on the highest level of conceptual understanding."
Peter Drucker
The Effective Executive

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