Satisficing and the Damascene moment

7 05 2009

Last week I was away visiting a colleague and rather like Saul of Tarsus I had a moment of clarity and understanding as I travelled. Somewhere in the air over the Adriatic as I read, “The Exceptional Manager: Making the Difference” (Delbridge, Gratton and Johnson 2006)  I read a paragraph containing the word satisficing. With an explanation of that word came my own, personal, Damascene moment.

The concept of bounded reality in philosophy was described by Herbert Simon (1956) to encapsulate the decision making process of an individual faced with a finite amount of time and the limitations of their own knowledge and experience. The decision that is arrived at amounts to necessary simplification of the situation and subsequent interpretation and decision making on the basis of previous experience. The result is seldom optimal but hopefully acceptable. Thus it is held to be a satisfactory, sufficing decision; satisficing.

This behaviour is exemplified by the consensus approach of group decision making and also the short-term view of resource management. It is commended by many as an optimal strategy in management.

As a surgeon this sort of decision making and behaviour is anathema. What is required in surgical practice is not a “best guess in the time available” approach. Study of all available knowledge of a problem, utilising the combined and continually advancing wisdom of a group on a subject and a set of limited, predictable outcomes allows optimal decision making within a finite amount of time and (hopefully) the best answer.

My mistake, changed in a moment of clarity and understanding, is that management practice is not the same as surgical practice; decision making and behaviour in management is necessarily satisficing.

Perhaps this exposes my naivety but this after all is a learning journey.




9 responses

7 05 2009
Anne Marie Cunningham

I’m a bit confused (not for the first time!). You agree that in both scenarios there is a finite amount of time. How in practice is the decision making different? Can you give some examples?

7 05 2009

The difference between a satisfactory and the optimal decision

7 05 2009
Anne Marie Cunningham

I guess I am not believing that decisions in medicine (including surgery) are usually optimal. I was hoping you would give some examples so that I can understand how you understand management/surgery as having different proceses. Medical decision making is a form of management after all. There are often many more stakeholders than just the patient.

8 05 2009

I cannot speak for my colleagues in Medicine and try, as best as I can, to speak only of my own experience and understanding.

I think fundamentally what I am suggesting is that the “knowledge” of a surgeon is not their own but the distillation of the years of experience and knowledge of others to the point at which there are a finite ways of deciding and the information to make that decision is not limited by our experience. This is not true of decisions made in management. The knowledge is usually personal and experiential and often significantly affected by external factors, some of which may be unknown even to the practitioner.

Thus it is to be expected that, within a given range, a child with significant abdominal pain will be treated (note i didn’t use the word managed) in roughly the same way wherever and whoever they are treated by if the practitioner is of a similar knowledge and experience. The same would not be the case for a group of managers in different settings faced with say a requirement to make 5% efficiency savings.

Once again it is important to stress that my comment is not intended to be critical merely highlighting differences in process and outcome.

I do accept that sometimes decisions in Medicine are made in a satisficing manner but the basis of knowledge is not a bounded reality due to the nature of Medical understanding spanning more than simply the experience of the practitioner. Ars longa, vita brevis

8 05 2009
Anne Marie Cunningham

Thank you for explaining further. I have a much better sense of what you mean now. I will think it over as you make a very intriguing point.

Anne Marie

11 05 2009

I agree with Anne Marie, it is intriguing, especially if you unpack all the points that jump out from your responses to both of us.

Love to get my teeth into all of them but the washing up awaits…

If you place management into the experiential camp then by the force of your argument surgery (and medicine in general?) should be labeled didactic….

If surgical decisions are arrived at optimally from a basis of definitive, recorded knowledge then necessarily they will be predictable and may be planned for….

So where do these ‘multitude of factors, that are constantly changing and totally variable’ come from? They are there I agree, but if not from the clinical element then where… and why?

(The cheek was regarding content rather than actuality.)

utor iter itineris

the point i am trying to make is that management decisions are variable and complex and made for and despite a the same is not true of medicine (or particularly surgery). the knowledge of medicine is built on many many… Read more years of the same repeated situations, thus knowledge grows. management knowledge cannot be shared or learnt as it is so complex and variable. thus satisficing.

15 05 2009


I think we are agreed that surgery has a limited number of options, the knowledge is held by the community and therefore not “bounded” and this is an essential difference from management.

not sure where your phrase “‘multitude of factors, that are constantly changing and totally variable’ comes from. can’t find it in my posts anywhere.

am not sure about your Latin. ?start the journey? my quote is from the Hypocratic Oath- the art of medicine is longer than life itself ie the knowledge of medicine spans more than one life; it is accumulated knowledge.

15 05 2009

‘enjoy the journey’
but my latin is almost as old as the language

quote from one of your wall replies

25 05 2009

Неоднократно доводилось читать подобные посты на англоязычных блогах, но это не значит что ваш пост мне не понравился

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