What a Root Canal Taught Me about Decision Making

X-ray of a person's mouth and teethA few weeks ago, on a cold Tuesday morning, I made my way reluctantly out of the office and towards my dentist’s surgery. I reluctantly walked up to the dentist’s door, subconsciously slowing down my steps as I approached – my fear was trying to force me to delay entering the building! I have a great dentist—she is patient and friendly—but nevertheless, I would be lying if I said I was looking forward to visiting. Particularly as this was the second of three planned appointments to have dreaded root canal therapy. It was my first ever root canal, and I had heard many horror stories from friends and family. As much as my dentist had told me it would be fine, the fear still set in.


Within 20 minutes I was settled in and lying in the dentist’s chair. She had put me at ease and was going about her work. As it turned out, my fear was unfounded, I felt no pain whatsoever.  Discomfort, yes—but nothing like I had feared. She was giving me regular updates about what she was doing, and how the procedure was going. I was actually feeling quite relaxed. At several points she took X-rays to see how the procedure was progressing.


As time progressed, it turned out that the procedure was more complex than she had expected, and she was struggling to fill to the very end of one of the affected roots. She had taken a couple of X-rays but was concerned that she couldn’t verify whether the filling reached the end. After looking quizzically at the X-ray on her screen, she turned to me and said:


“Adrian, I know I’ve taken a few X-rays already—I need to see from a different angle—is it OK if I take another X-ray? This will, of course, expose you to another small dose of radiation.”


I paused—I know nothing about the cumulative effect of X-ray radiation. I have no idea how many are safe—in fact I wasn’t even sure how many had been taken previously. I felt unsure how to respond—and a little confused. My gut feeling was that there was little risk, so I composed myself and replied (as best I could, given my mouth was full of wadding):


“I’m happy to go with whatever would be your professional recommendation.”


She nodded, took the X-ray. I am pleased to say that she completed the treatment successfully.


On the way back to the office, this situation was buzzing around my head. It struck me that the dentist had asked me to make a crucial decision, but hadn’t given me a specific recommendation or a context in which to make my decision. In a dentist’s chair this is completely understandable as ‘the heat was’ on and she needed an immediate decision in seconds—and in no way do I want to criticise my dentist. Yet, in business, we work with our stakeholders and clients to make high stakes decisions all the time. Are we giving our stakeholders all the information they need? Are we packaging the information up to a digestible format, and providing an actionable recommendation?


The importance of a decision package

Executive decision makers need to be able to make decisions quickly, decisively and confidently.  These could range from macro-level strategic decisions, through to product and process related decisions. It might involve decisions over what market to compete in, what software or hardware to buy, or what projects to run. There will even be micro decisions such as where to hold the Christmas party. Too little information and decisions can flounder; too much and we can drown in data.


I am certain that as well as making decisions, many readers support decisions in their professional lives. Whether you are an internal business analyst or a consultant working for a managed service provider (MSP), you will be helping your stakeholders to make informed decisions over the projects that they wish to run, and helping them to ensure that these initiatives are aligned with the organisations overriding strategy. With this in mind it is valuable for us to think about how we can effectively support decision making.


One useful artefact in our armoury is a decision package. This can be a brief document or a detailed document. It could be one page or one hundred pages—it could even be a presentation or a conversation. The nature of a decision package varies depending on the organisational culture (and its risk appetite) and the complexity and risk of the decision being made. If a decision was being made over a ten billion dollar IT investment, a lengthy business case document might be required. If a decision was being made over where to hold the Christmas party, a five minute discussion may suffice. The key objective is to provide just enough information, data and context for a confident decision to be made.


As a minimum a typical decision package needs to provide context and reasons that the decision needs to be taken, the options available, the costs, benefits & risks of each option and a recommendation. The table below builds on the dental example from earlier:


Factor Example
Context and reasons “I have conducted several X-rays and cannot be certain that the filling has been successful. Ideally I need to take a further X-ray from a different angle to be sure.”
Options “You of course have the option of refusing this—so your options are (a) to accept the X-ray or (b) to refuse it.”
Costs, Benefits & Risks of each option “The benefits of having the X-ray are greater certainty that the filling is successful. This reduces the risk of the treatment failing. There is no extra financial cost of the X-ray—it is covered by your treatment plan.


With every X-ray there is a small amount of radiation exposure, however you are well within limits that are considered safe. It is highly unlikely that you’ll experience any negative impact, I can provide the detailed statistics/government recommendations if you wish.


If you choose not to have the X-ray, then we will not be able to be certain that your treatment has been successful. This may lead to expensive re-work—ironically with more X-rays being required.”

Recommendation “My recommendation would be to take the X-ray, but I do need your consent to do this. I would be happy to answer any questions that you may have.”
Timescale for decision and impact of indecision “I do need a decision within a few minutes, or if you are unable to make a decision we’ll have to continue without an X-ray. But I am here to answer questions you may have.”


By providing these relevant pieces of information, succinctly, we help our stakeholders and executives to make informed decisions. We avoid analysis paralysis—underlying data is important, but it is useful to start with a high-level overview, and be prepared to drill down if required. We avoid analysis paralysis by providing just enough detail for the decision maker.


With better quality decisions, made with sufficient information, we get better business outcomes for us, our customers and other stakeholders—and a decision package can be an enabler towards these better quality decisions.



Do you have any suggestions or thoughts related to decision making or decision packages?  I’d love to hear from you – please add a comment below!


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This post was brought to you by IBM for MSPs and opinions are my own. To read more on this topic, visit IBM’s PivotPoint. Dedicated to providing valuable insight from industry thought leaders, PivotPoint offers expertise to help you develop, differentiate and scale your business

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Hi Adrian

I started reading your blog today, and I have already learned (actually re-learned) quite a few things :-).
Great stuff!


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