The global pandemic taught numerous lessons-the most important one: When healthcare executives make good decisions, little else matters. When they refuse to make decisions or show a pattern of making bad ones, nothing else matters. Healthcare executives should hear this as a clarion call that awakened us all to the fact that we can no longer afford the short-sighted luxury of considering decision-making a passive, pristine process. It's not. It's messy. How did we fall into the trap of thinking of healthcare organizations in philosophical instead of pragmatic terms? Maybe when high-level executives started shying away from the difficult decisions, preferring to think of their organizations in abstract, ethereal terms that some like to call "culture." We fare better when executives realize they create the climate of a healthcare organization through a series of daunting decisions-decisions that sometimes force tradeoffs-sometimes untidy, but ultimately advantageous tradeoffs.

"Culture" offers a too-simple, too-subtle, too-convenient defense for just about everything, but "culture" clarifies almost nothing important. Executives must consider the beliefs that create culture, the decisions that drive it, and its ties to business results. Largely HR-driven, explaining the climate of a hospital started as a well-intended attempt to understand how humans work together, but it gradually morphed into a La Brea Tar Pit, where good intentions go to die amid all the dinosaurs and fossilized specimens of organizational decisions. Blaming failed mergers and acquisitions on "incompatible cultures" hastens the formation of the trap. Executives blame "culture," but, in truth, underdeveloped critical thinking skills-those abilities that allow us to discern-deserve more blame. Soon, patterns of bad judgment-those things that don't work but that people feel loathe to change because "we've always done it that way"-emerge. The trap takes the form of anti-learning, anti-change, and eventually, anti-success.

A paradox has emerged. On one hand, most agree that this trap compromises effective performance. On the other hand, healthcare executives devote too little attention to preventing, avoiding, or managing the trap. Healthcare executives need new ways of thinking about the environment of the hospital-new ways to describe and understand hospitals-ways that will help them design and implement interventions that reduce or eliminate problems, not perpetuate them.

This book presents an amalgamation of what the authors have observed-and in many cases, helped create-in their more than 80 cumulative years of consulting with large healthcare systems such as Mercy and Banner Health, small specialty hospitals such as Ranken Jordan Pediatric Bridge Hospital, and nonprofit elder care systems such asChristian Homes. Their in-the-trenches experience spurred them to arrive at this premise: To position healthcare organizations for more success, executives must make difficult decisions more consistently, more quickly, and more accurately-and they all depend on critical thinking skills.

The book specifically guides healthcare executives who want to sidestep the traps of indecision and move beyond mere good intentions. The stories and research will focus on real people who actively seek professional improvement or personal development. We will map the journey to making tough calls, identify the key roadblocks and typical wrong turns, and ultimately show readers not just how to unlock their decision-making potential while navigating an increasingly uncertain world but also how to improve the health of their hospitals.

Through compelling stories and surprising research findings, readers will discover that there's much more to decision-making than they ever imagined, and they will come away with tools to help them deepen their understanding of what it takes to make difficult decisions and to inspire others to do the same.