Execution Is the Chariot of Genius

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By Brian McCardel, M.D.

In my earlier post on decision-making, I discussed the importance of discerning the consequential from the trivial, problems from dilemmas and prudential from absolute certitude. Once those steps are complete, it is time to take action. Oftentimes people treat the decision as the finale when in fact the decision just indicates which direction to take. It seems that decision-making and execution are interwoven and mutually dependent. This comes up a lot in the operating room, the place I spend most of my time as a surgeon, and I believe what happens in the OR provides invaluable insight and lessons into how to approach both.

It turns out there are things that take time because they are tediously methodical or incredibly delicate, and which simply can’t be done simultaneously well and fast. Certain medical procedures, absent a breakthrough in technology or surgical technique (think cataracts) will always require more time. However, some things just take a long time for some operators. This can be for a variety of reasons, but severe lack of dexterity is rarely one of them. It isn’t often that a surgeon is slow because he or she is clumsy. In my observations, being slow is more often the case of the tentative surgeon who takes many small steps forward and then nearly as many back in order to cover a very short net distance. Decision-making impacts execution, real-time.

I was having this discussion with a peer the other day, and he shared an analogy from his training: operating is like driving on a F1 race course. There are times to hit the accelerator and times to hit the brakes. The key is knowing the difference. You have to figure out what scenarios necessitate hitting the brakes, and what activities require hitting the accelerator. It is NOT about doing things as fast as you can! Rather, it is about doing things well as efficiently as you can. Lean methodology requires interrogation of each step in a process, such as:

Does this step need to be done at all?

If so, does it need to be done here?

Am I doing it to completion at this time?

If not, is it because I am doing it in the wrong order?

What steps could someone else do?

What steps could be done elsewhere?

Whether in business or in the OR, that discipline is crucial. Without it, bad decisions will continue to get made slowly, and execution will suffer. In fact, most decisions are about doing something. Should you or should you not do a particular thing. It is the lack of execution that is the graveyard of good decisions. Execution, not decision-making, is the chariot of genius.

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