Decision-making by influence

As HCPs we manage multiple co-morbidities, meds, consults, & more for our patients. What happens when we have to manage multiple life-impacting considerations? Here's a framework to help.

Step 1: itemizing all the considerations you need to contemplate

Let’s itemize all the considerations that this healthcare provider has to make:

• Child - current education

• Life partner

• Home purchase

• Cohabitation

• Relocation

• New venture

• Advanced study

• Coparenting

Normally, one would suggest prioritizing each of these items - I won’t. In the right context, each of these can occupy the #1 spot for your attention. And since you have so many items to consider, there’s a good chance that things in your world will fluctuate, moving items up and down your priority list.

So, rather than create a priority list, let’s create an influence map.

Notice that none of the items to consider geographically occupies the center. Moreover, every item worth considering is influenced by and influences every other item. This fact is our starting point, from which you will begin to gauge how influence can travel.

Step 3: assigning value, influence, and directionality

This part of the process begins the iterations that you will undertake as your decision horizon approaches. To do this, you’ll need the following:

• paper, in which your starting influence map (t = 0) begins on the last page

• colored pencils/markers/highlighters

You will use the following markers to denote things on your map:

1. arrowheads: these indicate the direction of influence. For example, if your *child’s current educational status* is going to influence your *relocation*, trace the line from the former to the latter and place the arrowhead on *relocation*.

   1. If the influence is bidirectional, place arrowheads on either side of the line connecting the two items.

2. line thickness: the thicker the line, the more influence one item has on another. As you move forward in your decision horizon timeline, you’ll create new influence maps where lines become thicker, thinner, or remain the same, based on how you feel, new information you receive, and so on.

3. node size: the size of each item (node) represents your current value for it. Larger circles indicate that you have greater value for it compared to some other item. How is this different than a priority list?

   1. In a priority list, there is no indication of whether one item influences another, and what the magnitude of that influence is.

Step 4: iterate

Iterations can be event- or time-driven, or both. Update the map (in reverse chronological order) as you obtain new information, allow for a specified period of time to elapse, or external events occur that are material to your decision-making.

Step 5: final output

The final output will give you

1. directionality,

2. relative value, and

3. influence.

You can use any or a combination or all pieces of information to guide your decision-making.

Good luck.