1. Bolwell, Brian J. MD, FACP

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I recently read a Harvard Business Review article entitled, "The Elements of Good Judgment" by Sir Andrew Likierman. The graphics accompanying the article are pictures of an owl from various angles, presumably because owls are believed to be wise. I can't validate the wisdom of owls, but the tenants outlined on decision-making and how to exercise good judgment are exemplary qualities for aspiring or seasoned leaders alike.

Owl. Owl... - Click to enlarge in new windowOwl. Owl

The author defines judgment as "the ability to combine personal qualities with relevant knowledge and experience to form opinions and make decisions." He describes various components of good judgment beginning with learning which includes filtering out your own biases-conscious and unconscious. Second, is the skill of listening, emphasizing the importance of being skeptical when presented information in order to identify gaps in data. He further suggests that one should try to discern any biases from the source of information that is the basis for a decision. Finally, he highly recommends getting input from people on more than one side of an argument-especially from people with whom you disagree or can offer a dissenting opinion to the topic at hand.


His breakdown of good judgment has a direct correlation to leadership. I especially like the advice that one should be skeptical of information that does not make sense. I frequently encounter information that seems dubious. For instance, I'm given a data set, and the presenter wants me to agree with the conclusion of the presentation straight away. But as I look at the data, the desired comment does not make sense, or flow from the provided information. While it may be tempting or easier to just "go with it," a prudent leader should pause and ask pointed questions. Obviously, one would need to do so with tact and respect.


Another component of good judgment, as described in the article, is to seek diversity, not validation. The author says that "unfortunately, many CEOs and entrepreneurs bring people on board who simply echo and validate them." The manner in which Abraham Lincoln composed his cabinet is frequently cited as a best practice. Lincoln purposely formed a cabinet largely composed of individuals who disagreed with him. Seeking diverse opinions is always useful, whether in a formal way (assembly of a cabinet), or more informally (asking someone outside of your inner circle). Studies have shown that optimally performing groups have an environment that encourages diversity of thought. Obtaining different perspectives is a key part of good judgment. As you progress up the career ladder, you will already have the people who tell you yes, but it's up to you to seek and appoint those that will offer a different point of view.


Likierman emphasizes the importance of detachment when making decisions. Key is the ability to understand one's own biases, intellectually and emotionally. Biases can cloud judgment and take a decision-making process off track. Likierman suggests having processes in place that keep people aware of biases. I think this is a very important point. It is only achievable if you have insight into your own biases. One way to do so is to go through formal training on unconscious bias. I have done so, and it is a worthwhile experience.


The final point in Likierman's essay is that one should evaluate the feasibility of execution. "When reviewing projects, smart leaders think carefully about the risks of implementation. A leader with good judgment anticipates risks after a course has been determined and knows by whom those risks are best managed."


This is a critical point as change is constant. All organizations try to anticipate the future and set goals to serve them well moving forward. Often, several new goals are launched simultaneously. There is extreme focus on the "what." What we need to improve. What we need to change. What we need to prioritize.


A focus on the what is extremely important, it is the core of strategic development. But equally important is the "how." How are we going to execute these new goals? How do we designate who owns what parts of the new project? How do we determine if we have the resources in place to be able to execute?


Knowing how to execute is central to good leadership. This is especially true when leading physicians. Physicians require data to make decisions. So, a big part of how to execute is having reliable and transparent data. Execution also generally requires teamwork. Therefore, part of operationalizing new goals is forming highly functional teams. In addition, not all people have equal skills. Therefore, seek out those who excel at operations and who also get things done. With an assembled team, ask them about the feasibility of implementing a new decision. If challenges exist, have an honest conversation and, if necessary, modify the new goal.


Good judgment is a lot like good leadership. Listen to many stakeholders. Encourage diversity of thought. Keep learning. Never believe that you have all the answers. Talk to the front line about how to implement a new goal. Stay humble.


As far as owls go, I googled the question, "Are owls wise?" It turns out that, although they are great hunters, they do not seem to be wiser than other birds. They certainly look wise in pictures. As for me, I do not believe that I appear particularly wise in my pictures. Therefore, utilizing good judgment, I asked Oncology Times to post a picture of an owl to accompany this essay.


BRIAN J. BOLWELL, MD, FACP, is Chairman of the Taussig Cancer Institute and Professor of Medicine at the Cleveland Clinic Lerner School of Medicine. Cleveland Clinic is a top 10 cancer hospital according to U.S. News & World Report.


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Brian J. Bolwell, MD... - Click to enlarge in new windowBrian J. Bolwell, MD, FACP. Brian J. Bolwell, MD, FACP