In the medical billing world, we have gone way past the days of the clerk sitting in the doctors office punching out her bills by hand and popping them in envelops. Today, things are a lot more sophisticated. Bills are generated via computer and in some cases, the biller never even sees a piece of paper or a form. Yes, we've come a long way. Unfortunately, with this sophistication also comes a lot of headaches. Why? When you're dealing with machines, especially computers, they have a tendency not to work right on occasion. This is especially true on the retail sales end of medical billing, the problems common to which we will be covering in this installment.

You would think that with many supermarkets now having automated checkouts that scan your item and register the price for you without the cashier having to punch in numbers manually, that this process would be just as simple for the billing agency who also runs a retail operation. Well, for the most part it is. However, there are things inherent to medical billing and retail sales that you don't have when going to a supermarket.

One of the biggest problems and the most annoying to the patient, is when they're getting a prescription filled and the biller has to run it through to see if the insurance covers it and the computer is down. The question should be, is it down? In many cases what the problem is, is that the server on the other end is down and there is nothing wrong with the computer on the end of the cashier. In this case there is nothing you can do but wait until the server comes back up. Many times a patient is asked to come back another time. This is the annoying part.

But what if the server isn't down? This is easy enough to check out by simply putting in a call to the main location. In this case, the problem is most likely in the wiring to the server. In this case, a technician is going to have to be called in to find out where the break in the cable is. Of course, it can always be a bad network card.

What if the connection is good though and when trying to scan in the item, it doesn't show up in inventory and no price can be gotten? In this case, it can be one of two things. Either it is a new item and the item hasn't been entered yet into the database, or the label on the item itself is wrong. This actually goes back to the barcoding issue of printing out bad data. In either case, the item will need to be looked up manually. Make sure you have manual price sheets.

Other times, you can't find the patient to see if they're covered for the item. In this case it is either that the patient was never entered into the system or the patient gave you the wrong information at the counter. Either have the data center put in the patient info, or double check that they gave the insured name and not the patient name, if they are different.

Yes, retail sales in the medical billing world, with all our technology, can be a royal pain. Hopefully, these few tips will get you through most problems.

If you think the following scenario is uncommon, then you haven't been in the medical billing industry long enough. What follows is a sample of what can go very wrong when billing Medicare for somebody's, well, whatever it was supposed to be.

You've just got your DME software all setup. The patients are in, the inventory is in, the doctors and facilities are in, the insurance carriers are in and you're ready to start billing.

And this is what happens.

John Doe pops up on your computer. He's a recent patient at Doctor Jones. It appears that he has been treated for some disease of the lungs and he has prescribed an oxygen concentrator for the patient and several months of oxygen to be given to the patient. The medical billing person goes through the procedure and bills Medicare for the oxygen concentrator and oxygen for the first month. This goes on for about 11 months.

On the twelfth month, the patient dies and the equipment needs to be picked up. Mind you, Medicare has been paying for this item for almost a year now. The maintenance men go to the patient's home to pick up the concentrator and find, not a concentrator, but a wheelchair. You can imagine their confusion. Well, they call up the DME company and tell them what they found. The DME company says, "Well of course there is a wheelchair at the home. John Doe had his legs amputated".

Oops. To say the least anyway. Now, we've got a real problem. For starters, we've been collecting money for an item that is a heck of a lot more money than what the patient actually got. That's fraud and a serious crime. Second, Medicare obviously doesn't know about this or they wouldn't have paid on the item. So what do you do? Do you tell them?

Here is where it gets sticky. Medicare IS going to find out, first of all, that the patient is dead and then they're going to find out how the patient died. And then they're going to put two and two together and realize that this patient never had an oxygen concentrator. That's when the investigation begins.

Can you see where this is going? At best, the company is going to get charged back for the misbilling. At worst, they're going to get charged with fraud. Somewhere in between there are other things that can happen but we won't get into them. None of them are pleasant.

Where this is all going is simply, as soon as you find out about the error, report it to Medicare immediately. If you report the problem, the chances are that you will simply be charged back for the error and paid for the wheelchair instead.

The truth is, this happens more often than you realize. Computers make mistakes. People make mistakes. So if you should find out that you have billed an insurance carrier for the wrong item, report it right away. The alternative is a lot of trouble that you don't want.

In the world of medical billing, there is a lot of red tape. The government itself has so many regulations that they're enough to strangle a billing company to the point where they can just about do business. And just when you thought that this problem would at least end with the software that you buy to do your billing with, you get hit with more red tape and regulations. In this installment, we're going to discuss the issue of software registration, both on the end of the manufacturer and the biller.

A company can't just decide it wants to make a piece of medical billing software. Well, it can, but selling it is going to be another issue altogether, at least in the United States. See, the good old USA has very strict guidelines that have to be followed when doing your medical billing. That's why, if you're sending claims electronically, there are a zillion record specifications that need to be transmitted. Forget to dot one "I" or cross one "T" and you're looking for trouble. Because of this, insurance carriers, especially the government-controlled ones, require that software be registered. If you look at your records' specifications you will find that one of the records requires the biller to send over the software version that they are using. If this version isn't on the carrier's list of approved vendors, your claim will not be processed. So, how does a software vendor get their software approved?

Well, it's one heck of a tedious process. After the software is made, they have to send a copy of it to every insurance carrier that they want to bill. This usually includes every Medicare and Medicaid agency in all the 50 states. So we're talking about at least 100 carriers. The good news is that if you send to just one to start and you're rejected for whatever reason, you probably won't be accepted by any of the others and therefore can save yourself the trouble of sending your software out to those other carriers. Once you're approved by one, most likely you'll be approved by them all.

To get your software registered is actually simple. You make a sample claim file of fictitious names and transmit the claim file to the agency. If the file passes, you're registered with that carrier. If it doesn't, you're not. It's pretty much the same thing with the medical billing company as well. They also have to send a test claim in order to get approved to submit claims to that particular carrier, even if the software itself was already approved. I told you there was tons of red tape.

Ultimately, it is rare that a piece of software doesn't get approved, unless of course it is a total piece of junk, in which case nobody is going to buy it anyway. Still, this process must be followed to the letter. Once your software is approved by the carrier, you get a certificate of some sort. It makes nice wallpaper.

The things that medical billing people take for granted. Open up your software, push a button, login. Push another button, get a patient menu. Push another button, pull up a patient. Click, click, click and the process goes on and on. Medical billers have no clue what is actually going on behind the scenes of their software. In the following installments and this is mainly for you tech heads, we're going to show you exactly what goes on behind the scenes with your medical billing software with the main parts of the system. To cover everything would take a lifetime.

We'll be covering how patient files get put into the system and how they are ultimately access by a biller and placed into a work order to be billed. While this seems like a very simple process, it is actually quite complex and requires a lot of indexing and cross-referencing.

Another thing we're going to cover is how a claim gets sent electronically. This is one of the mysteries of medical billing as this whole process is actually invisible. While you can see a patient being pulled to a page, you can't see a claim file being transmitted. How does it go? Where does all that data come from when you have so many record specifications? How does the software know to interact with your transmitting device, which is usually your modem? These and other questions will all be answered.

We will also discuss how forms are printed. How does the software know exactly where to place that patient name and address? How do you choose a form, as there are so many of them? Where does the data get pulled from when all you see in front of you is a patient name?

If you're curious as to how security is set and how the software knows to lock somebody out of a certain part of the system, we're going to cover that too. The many options that you have to security systems make this part of the system mind boggling to say the least. We'll do a detailed walk through of a DME security system and show how it works.

Wonder how your software knows how to read those automated posting files that come from Medicare with all your money tied up in them? No problem. We'll dig deep into the auto posting system so you can see exactly what is going on behind the scenes there.

What about those add-ons? How does the system know that you even have them or not? Remember, they are not part of the standard package and have to be added later. So what is actually done by the software maker to let your system know that an add-on is there?

Finally, we'll show you how the software manufacturer can tell if you have a valid copy of the software and when it's time to pay your maintenance fee on it. This gets into some really low level programming.

The above topics will all be covered in future installments. So get a box of lightly salted popcorn and enjoy the show.

In a previous installment of medical billing goofs, we discussed what happens when you bill the wrong item to a carrier and how you can be charged with fraud, but what happens when you send a bill to the wrong carrier. What follows is a genuine story. It's kind of funny when you read it, but the truth is, it's far from funny. This is some serious stuff.

A medical billing company, we'll call them XYZ company, was sending out a claim for a patient, we'll call him John Smith, to Medicare Region A, which is in the New York area of the United States. Now in actuality, the name of the patient was a common name so there could have very well been many people with that name.

Anyway, the bill makes its way to Medicare Region A and the response from Region A is that they are not going to pay the claim because the patient that the company was billing was dead. Well, to make a long story short, the medical billing company gets on a conference call with Medicare Region A and the patient. On the one end, the patient is screaming at the carrier, "How can I be dead? I'm right here". The carrier simply responds that according to their records, the patient is dead.

Well, this back and forth goes on for quite a while with quite a few phone calls. Finally, Medicare Region A decides that they're going to go over the patient's records with the patient and the medical billing agency. So they begin the questions starting with name, address, etc. Well, when the patient gives the carrier his street address and state, the carrier responds with the following. "Sir, Texas is not in our region". Well, it turns out that the patient had the same street address as another patient in New York. Everything was exactly the same except for the state, which nobody bothered to check. So what happened was that the patient had his claim sent to Medicare Region A when it should have gone to Medicare Region C.

Everybody had a real good laugh about this, but the problem still wasn't solved. Now the claim had to be forwarded to Medicare Region C. The problem was that the medical billing agency was not licensed to bill Medicare Region C. They only had a package to bill Medicare Region A. So now they had to see if they could get Medicare Region A to forward the claim to Medicare Region C. Well, they could, but there was a charge for this. Well, the medical billing agency said no way. So what did they do?

They got a hold of another medical billing agency that did bill Medicare Region C and arranged to do a swap. They'd bill one of their patients for them, thus incurring the cost, if they'd bill Medicare Region C for them. The company agreed and sent the claim. The problem was finally solved.

I live in a neighborhood that is 35 years old and have lived here for 12 years. A lot of transient families move in where the breadwinner who works for a major corporation gets transferred to Pittsburgh for a new position with a company and then they buy a house in our neighborhood. They choose this neighborhood, I'm sure, partly because of the nice wooded lots and the established landscaping that takes years to cultivate.

So they move in and immediately call the local tree removal company and within a month their yard is leveled and I mean, leveled. Then they call a landscaper and turn over all the grass and plant sod or, more amusing, pay tons of money for tons of top soil and spray their yard with a combination of seed and fertilizer which looks like spray paint to plant a new lawn. Then they remove original stone walls and replace them with treated landscape timber or formed concrete block and rip out the established vegetation and plant seedlings. After about six months, they replace the siding and the shutters. Window replacement to a newer style usually follows, where the windows might be five or six years old when they moved in since the last person moved.

By the time these folks are finished, they end up with an entirely new house and new yard that does not seem remotely connected to why they would buy the house in the first place. And then their company moves them out and the process starts all over again with the power saws and the trucks and the contractors as my husband and I watch bemused.

This is an example of the public we are dealing with: new, improved, better, different, throw it away.

As restaurateurs in the last part of the 20th century, where the public has been flooded with choices, we, too, have gotten caught up in the hysteria: new, improved, better, different, throw it away.

Dining in the 20th Century took us through a whirlwind tour from Europe to the Americas, bringing cultural influences to a land of agricultural-plenty morphed with home-cooking methods down on the farm influencing the rural, family owned roadside diningrooms of the 20s to the emergence of the elegant fine dining restaurants from New York to Hollywood from the 30s to the 50s. With the automobile no longer a luxury, came the drive-in restaurants which postwar were replaced with the coffee shops and vendomats of the 60s. Then the beginnings of real franchising and the development of the bolder theme-style concept restaurants of the 70s emerged. In the early 80s, we had the chain restaurant explosion with restaurants in every concept and style from quickservice to upscale available. In the 90s, most grocery chains joined the take-out segment of foodservice operations. In the last two decades, a lot of operations scrambled to survive. Some did and many didn't.

The last decade or so of uncertainty for a lot of us wasn't projected in the actuarial tables when Mom and Pop built the family's restaurant. We expected that our hard labor and family treating staff like members of our own would be enough to keep them and, at the same time, keep our customers coming back. We were so busy in the revolution of our industry, that we didn't discover until it was too late what was upon us. We took comfort in the historical circumstance of how it was just the locomotion of change "out of our control" and a sense of delight in the fact that we lasted longer than most deciding that, "Today's public is fickle anyway."

As the chain sector expanded into new markets, planning was handled by some of the world's most sophisticated marketing strategists. But moving too fast or too slow in the precarious process nearly toppled some well-established enterprises. That same damned unpredictable public was at it again.

In this Millennium, we have new decisions to make and an opportunity to step out of our shadows past. But before we dash forward to the next new concept of Gothic Inns or Clockwork Orange Juice Bars we may want be more circumspect and seek a new restaurant reality where dining and hospitality is as it should be. As we want it to be. Not dining pitting operation against operation. Not bankrupting ourselves emotionally with worries and fears about who's going to "steal" our next customer. Not putting pride above common sense and reducing our prices to fill our tables when our costs exceed delivering.

We can choose to review rather than revolve, focus on ourselves rather than predicating our decisions based upon what everyone else is doing and perhaps, in the process, get back to the basics of providing good food and professional service which is what this industry is supposed to be all about.

Operations need a sense of renewed possibility, of determined viability, of a sincere purpose. We have a thriving economy and more people dining out more than ever, but we cannot find enough qualified staff to serve them -- partly because we do not take the time to train them. We have ever-changing demands for products and services, but we are either stuck and afraid to change our menu and try something new or we just toss our menu up in the air and decide it's all no good. We know what we can buy and, if we don't know, we have vendors clamoring at our doors. But we don´t know what our customers will want because we are moving too fast to even think about it.

The strength in the rigidity of our past is what has made some of us last, but that very rigidity is what has kept some of us on this merry-go-round unable to break free. The future requires taking bolder, creative steps and thinking about new possibilities. The future is about thinking about what our customers want before they think of it themselves within the spectrum of what we can truly provide.

Our past has been littered with disposables which hopefully are biodegradable:
"Not producing? Close the doors."
"Ineffective? Fire him/her."
"Save that venue here? Nah, too much work."

We need improvisation -- not obliteration. We need to be reasonably concerned about aesthetics, but more concerned about what and how we deliver. We must seek new ways to reach out to our customers and connect with them. I have seen the grandest of restaurants sit idly as an icon of "what was". The people are all gone. The brick and mortar now only a monument.

We need to care for and cultivate our staff for the brazen world of customers who are out there. We must embrace them with not only respectable salaries and benefits, but also with our heart so that they feel valued. Most of all, we must rid ourselves of the foolish notion that they are lucky to be working for us when we know better. If we are fortunate enough to participate in these actions, maybe then we will not have to fight the public decry of overall poor service and the associated lack of professionalism tagged to our industry.

This time calls for revised hospitality operations intelligence. We must be aware of the broad impact of social and economic implications that have affected our industry. We must make the time to study our market and feel its pulse. We must adjust and shift our position attentively with enough industry prowess so that we call attention to ourselves to capture the right kind of customers lost within the media blast inside an industry attempting to outdo itself. If we are lucky, some may take notice. And those who do will be our best voices.

In the final analysis, is the human element that will outlast all the concepts and structures. The rural diningroom. The upscale restaurants. The drive-in restaurant and coffee shops. The vendomat and theme restaurants and chains. It is the human element that offers hospitality. Those customers who meet dining professionals who are pleasing will embrace them. And those guests who meet dining professionals who are inattentive will jilt them.

We must recognize that restaurant success is always a deliberate act of will. It's really not that complicated. You must always watch your food and labor costs, but you can always afford to be generous with your consideration and creativity. It'll be worth it. Your new customers will be taking advantage of you in no time.

We take so much for granted in this world. We expect everything we buy to work perfectly and when it doesn't, we throw a tantrum. Well, can you imagine what the programmer who creates your medical billing software feels like when he fixes one bug and then another one pops up? What follows is a true story, which just goes to prove that the truth can sometimes be stranger than fiction.

A medical billing software company was creating a new software package to bill UB-92 claims. Up until this point in time, they had only done NSF 3.01 specifications. So the first thing they had to do was get the specifications from the carrier and send them off to programming so that the programmer could begin work on them.

A few weeks passed and the programmer had the specifications completed and was ready to test the module. So they set up some test claims and transmitted them to the carrier. When the test results came back, they showed that there were several fields that were transmitted in error. No problem. The programmer made note of the fields and made the changes. He then transmitted the claims again and waited for the results to come back.

This is what happened.

In fixing the fields that were wrong, he inadvertently broke some other fields. Okay, no problem. He would simply fix the fields that he had broken. He proceeded to do this and retransmitted the claims back to the carrier. Much to his puzzlement, the original fields that were broken were broken again. Now he was really scratching his head. He knew he had these fields fixed. He even went over the source code to make sure that the fix was still in. It was. So what was wrong? None of this made any sense.

Well, he called together the programming team and they all looked at the original code and the fixed code. They all agreed that the fix that the programmer put in to fix the original problem was still there and thus should still work. And yet, it didn't. So what they did was put a trace in the code to see exactly what was going on.

When the trace got to the part of the source code that was fixed, it didn't do what it was supposed to do. It was following the path of the original code. This made no sense. Well, after much investigation they finally found, by accident, that the programmer was using the wrong library routine. Even though the source code was fixed, the object code for it was not placed in the library so it wasn't being processed.

These are the kind of nightmare's that programmers go through all the time. So the next time you open up your medical billing software and it doesn't quite work the way you expected it to, please remember that there is a human being on the other end who's as frustrated as you are by the whole thing.

Planning a restaurant depends on your target market, the type of food you are serving and customer turnover.

Reception

The best place for the reception, where you would take bookings, greet customers and process bills is at the front of the restaurant, near the door.

Bar

It is advisable to have a separate bar near the entrance for diners to wait for companions or for a table to become available.

Circulation

Think about how you want customers to get to their table and how you want meals to be served. This can be forced by the use of furnishings to block throughways etc.

Space

The amount of space you should allow per customer will depend on the type of standard expected by the restaurant. The more upmarket and expensive the restaurant the greater amount of space you should allow. A seated diner will take up to 2ft (61cm) of floor space from the table therefore 6 sq ft should be allows per table for four.

To create a busy, buzzy atmosphere you may want to put the tables closer together, however this must be thought through as it may discomfort the diner. This might work in your favour by encouraging faster turnaround times.

Kitchen

A kitchen can either be hidden away or made the focal point of the restaurant (Fifteen, 140 Park Lane). In this case be aware that cooking smells and noise will be present in the restaurant which might upset a few people.

Internal fittings

The selection of internal fittings (chairs, tables etc) will depend on the style of restaurant you are planning. Make sure it is pleasing to the eye and a specialist restaurant designer may be the best choice to aid you. Also the lighting of the restaurant is exceptionally important, it can help enhance the overall mood of the restaurant and the appearance of the food being served.

The subconscious mind is a very powerful thing. If you have a negative or lazy attitude about you, then you will have no choice but to be negative or lazy. If you mope around and complain then you will achieve nothing. If, on the other hand, you are upbeat and cheerful, then you will generally have a good day and achieve quite a lot. If you dress successfully, people will treat you better than if you dress like a bum. Sad fact I know, but it’s the truth in today’s society.

I found years ago that in a home business you need to put just as much effort into your appearance and your attitude, if not more, as you did when working in secular employment. I’ve had to learn to improve my telephone manner, my enthusiasm on the phone and, by looking at myself in a mirror while speaking, I realized why I couldn't sell anything. I needed a check up from the head up!

With a home based business, if you dress business casual, comb your hair, brush your teeth and smile you will then start to feel like a professional. It’s this feeling that will come across on the phone and the more confidence you have the faster your business will grow.

Working from home should be exciting, after all how many people can say that their daily commute consists of going from their bedroom to across the hall to their home office? Working from home on the Internet should be something you do with pride. I have always been consistent in my actions and conscientiously believe and expect the rewards for my efforts to be granted to me.

You should try and answer emails within 24 hours, minimum. The maximum time frame you would want to wait to respond is 48 hours. To accomplish this you will want to set aside time each day just to respond to emails. Some say three times a day, morning, mid afternoon, and evening is best as it ensures everyone gets a timely response.

There is immense satisfaction in seeing people answer your ads, having people respond to your flyers, having prospects ask about your products & opportunity and respond in a positive way. Having people buy your products and assisting them in starting a home business should give you a great sense that you are helping someone improve their lot in life.

Make sure you are courteous and professional. There are some times you just don’t feel like answering a question that has the answer plainly on your website or in a sales letter, or some question you feel is irrelevant or foolish. The urge to send a fiery response may be there. If you do not feel you can politely and professionally answer, take a break. Come back after you took some time to cool down. Remember, the customer who asked the question may be basing their decision to get involved with you on your answer, so you want to be as thorough and polite as possible when answering. Do not push away a customer or potential customer with a hasty emotional response.

In a home based business your chief aims are to sell your products and teach others to duplicate your success. Out of this can come strong bonds of friendship, as your team develops and your network grows. There is immense satisfaction in running a successful Home Based Business.

All in all, our decision-making equipment is pretty sound. We don’t follow the lead lemming over a cliff. We can’t be fooled into thinking that a 99-cent lure is a meal. We don’t try to catch car fenders with our teeth. Then again, it wasn’t a dog who launched New Coke. So there are a few bugs – little design flaws of the mind – that can have big consequences.

People are clinically overoptimistic, for instance, assigning zero probability to events that are merely unlikely (such as a massive iceberg in the path of a really big ship). We see “patterns” in the random movements of stocks the way our ancestors saw bears and hunters in the scatterplot of the night sky. We make choices that justify our past choices and then look for data to support them. Not only do we make these errors; we make them reliably.

That’s the good news. Predictable errors are preventable errors. And a few simple techniques, like those below, can help you steer clear of the most common wrong turns. They can get you to your go point, that decisive moment when the essential information has been gathered, the pros and cons weighed, and the time has come to get off the fence.

Problem: Authority Is Not Bestowed Tool: Pursue Responsibility

For some, responsibility is simply bestowed: a princess is handed the kingdom upon the passing of the monarch; a favorite son inherits the family business. For most, however, the authority to make decisions must be actively sought.

Born in the Bronx of an interracial marriage, Jaime Irick thrived from his earliest days by tackling new challenges. In high school, he jumped into sports; at college, he took on social service projects. After graduation, Irick joined the military, qualified as an airborne Ranger, and found himself promoted up the officer ranks. Back in civilian life, he repeatedly asked for larger and stretch assignments. “I’ve never been fully qualified on paper for a job that I’ve had,” he told me, yet he so readily embraced his duties that ever more responsibility came naturally his way. With a new MBA degree in hand, Irick brashly contacted GE’s chief executive, Jeffrey R. Immelt, with a simple message: “I always wanted to run something.” The personal appeal to the CEO worked. Today, as director of sales in General Electric’s Homeland Protection division, Jaime Irick plays a significant role in one of Immelt’s growth businesses.

Madhabi Puri Buch did much the same at ICICI, one of India’s premier banks, which she joined in 1997. With little experience in fairly specialized fields, she tackled a succession of responsibilities, ranging from Internet trading to mortgage financing. Finally, she asked chief executive K. V. Kamath to give her a crack at running the “boiler room” of the bank, the back office that handles the enormous volume of paper, telephone, and electronic data that surges through the bank every day. “In the past,” she explained, “I had been given assignments where I had no experience. Yet they worked well!” Now she upped the stakes by taking on one of the bank’s least glamorous but most critical operations. Her friends thought she had been “sidelined.” Instead, Buch mastered the essence of still another banking function by taking responsibility for deciding how to remake it.

Problem: Unfamiliar Responsibilities

Tool: Appraise the Past

In embracing new responsibilities, past decisions can serve as a natural curriculum for avoiding future mistakes.

Liu Chuanzhi was working at the Chinese Academy of Sciences in 1984 when his country commenced its momentous liberalization. Inspired, Liu formed what would become Legend Group, at first distributing a few foreign personal computers and eventually morphing into China’s largest PC producer. In 2005, rechristened as Lenovo, the company acquired IBM’s personal computer line, making it the number three PC producer globally. As a young man, Liu had wanted to become a fighter pilot with the People’s Lib­eration Army. Instead, he became one of the world’s most successful entrepreneurs.

When Liu left the state-­sponsored research laboratory in 1984, he knew nothing about how to build an enterprise, so he set about learning to do so by studying his own go points in minute detail. At the end of every week, Liu and his top aides met to review major decisions of the past five days. Many errors were committed, he told me, but the weekly debrief helped “to ensure that we don’t make [the same] mistakes in the future.” Thanks to the reviews and lessons drawn from them, Lenovo was able to weather China’s economic gyrations while others faltered. By routinely looking back on his decision processes, Liu Chuanzhi constructed his own decision template for going forward.

The after-action review can be monthly, quarterly, yearly, or even daily, depending on the decision-making tempo. In July 2004, I watched a wildland fire crew in action against a raging blaze in Yosemite National Park. Every afternoon without fail, the incident commander, operations director, planning chief, and a dozen responsible firefighters gathered to review the present day’s decisions and decide on the next day’s actions. At the end of each of the fact-drenched, disciplined reviews, one of the participants would pose four questions: What had been planned for the day? What actually happened during the day? Why did that happen? And what should be done next time? Round­robin style, each crew member addressed each of the topics. Only in that way could firefighters stay on top of a situation that changed constantly with the fire’s ever­changing momentum. The principle: study the past, even if it is only yesterday, and heed its continuing lessons.

Problem: Inexperienced Gut

Tool: Educate Your Instincts

“Go with your gut.” “Follow your intuition.” “Trust your feelings.” The sayings are commonplace, but do our instincts make good decisions? In fact, blind instinct cannot be trusted, but it can be educated. The main purpose of flight simulators, for example, is to allow pilots to experience unlikely surprises so many times that, should one actually occur, their response will be reflexive. “Train like you fly and fly like you train” is how they put it at NASA’s astronaut training program at the Johnson Space Center in Houston. Consistent with that dictum, astronauts undergo an exhaustive curriculum that includes some five hundred simulated landings of the shuttle before flying it. No wonder so many of the space travelers are apt to say upon returning to Earth, “When something went wrong, I went into my training mode.”

Practice does not always make perfect, but it certainly helps. When he was named Episcopal bishop for the diocese of Pennsylvania in 1998, Charles E. Bennison drew on the three decades of experience since his ordination to tackle a succession of touchy issues. Despite widespread opposition from priests and laity, he pushed through plans to hire a full­time fund­raiser to shore up finances for the 162­parish diocese. Later, again knowing he would encounter protests, he suspended a church rector who opposed the ordination of women and gays. “Day by day I don’t have too much doubt because I trust my intuitions,” he said. “I may be making big mistakes, but I feel fairly confident on an incremental daily basis that I am in touch and that I am making the right decisions.” That doesn’t mean Bennison jumps to the go point. Far from it. “I’ll stew and waver and listen and take in data and talk to all kinds of people before I feel comfortable with something,” he said. But it does mean, that in getting to go, he consults a well­educated gut.

“If you get educated about something and then you live that, the line blurs between what your instincts used to be and what they are now,” General Peter Pace explains. “Your mind touches on resources it’s not even conscious of touching on.” In the words of Blink author Malcolm Gladwell, that is the “power of thinking without thinking.”

Problem: Analysis Paralysis Tool: The 70 Percent Solution

Only professors and journalists get paid to say, “On the one hand….” When the rest of us continue to mine and massage the data in pursuit of perfect knowledge – and thus perfect certainty – we are edging toward that clinical condition of decidophobia, fear of facing a go point.

The Marine Corps battles this syndrome with the “70 percent solution.” If you have 70 percent of the information, have done 70 percent of the analysis, and feel 70 percent confident, then move. The logic is simple: a less than ideal action, swiftly executed, stands a chance of success, whereas no action stands no chance. The worst decision is no decision at all.

Analyze, but not overanalyze: that is the message Hewlett-Packard executive vice president Ann Livermore sends to HP’s Technology Solutions Group, a $30-billion-plus business that en-compasses enterprise storage and systems, software and services, and employs 95,000 IT professionals. She places a primacy on “fast enough” – decision making based on sufficient information, not perfect data. GE teaches the same at its retreats. By requiring ranking managers to vote up or down, individually and publicly, on a variety of proposed changes, GE avoids the endless analysis that compromises decision tempo.

Drawing upon his own tumultuous experience as president of Pakistan since 1999, Pervez Musharraf says that while a leader must hear opposing views and engage people in the deliberations, he or she “must never suffer from paralysis.” Moreover, in reaching a decision, rarely are all the data available to be sure of its outcome. “Decisions are two­thirds facts and figures,” Musharraf contends, and “one-third a leap in the dark where you don’t have all the facts.” If you increase the short side of the equation, you’re too impulsive, but if you increase the other side, you’re not a leader.

Problem: Mistakes Happen

Tool: Tolerate Them – Once

Short of perfect information and analysis, mistakes are sure to happen. The secret, says Peter Pace, is: “Don’t beat yourself up. If you’re not making mistakes, I don’t need you in my organization,” which in his case includes some 2.4 million uniformed troops. “I want you doing 90 percent right in a big universe rather than 100 percent right in a small universe.”

Charles Elachi directs the Jet Propulsion Laboratory, NASA’s contract agency for unmanned space missions, including the 2004 Spirit and Opportunity Mars landings that found evidence of water between layers of volcanic rock. Given the technical complexity of space flight, Elachi insists that every significant pre-mission decision at JPL receive intense peer appraisal and even outsider review. To ensure disciplined decision making during a mission, he also insists on resilience. “We operate under very heavy pressure,” he says. “Many critical things are riding on our decisions. You have to have nerves of steel. Everyone involved in the project has to keep calm and composed so that we can think clearly about what is happening. Anyone who panics under pressure is just in the wrong business.” To instill those steel-like nerves among his 5,500 employees, Elachi requires less experienced workers to witness JPL veterans making decisions.

Predictably, though, some of JPL’s decisions do go wrong. A mission to Mars in 1998 ended in such a high-­profile, costly failure that the mission’s top two managers were ready to resign. Elachi would not let them. “Normally, when a project fails, people look around for someone to blame,” he says, “but if you hang the person who made the mistake, you’ve also lost a lot of experience.” Instead, Elachi told the two managers, “We have spent $400 million training you. You have to learn from those mistakes, and I’m sure you will not repeat them.” Six years later one of the managers was serving as a mission director and the other as a deputy manager for the highly successful Spirit and Opportunity trips to Mars.

Problem: Rush to Judgment

Tool: Preserve Optionality

Many decisions come with looming deadlines: the battle is lost, the market opportunity gone if you do not act in timely fashion. Even without a deadline it can still be tempting to get the hard business of choice making over with. The more one can tamp down the uncertainties and let the pieces fall in place before deciding, however, the more likely one will reach the right go point.

As U.S. treasury secretary from 1995 to 1999, Robert Rubin faced a string of momentous decisions ranging from the bailout of the Mexican peso to China’s application to join the World Trade Organization. Time and again, Rubin elected to keep his “choices open for as long as possible,” a proclivity that his then­deputy Lawrence Summers calls “preserving optionality.”

As CEO of Scottish Power, an energy producer with major operations in the United States and United Kingdom including extensive wind farms, Ian Russell makes investment decisions entailing hundreds of millions of dollars at a shot. One of his new power plants alone can guzzle $350 million; wind farms have consumed $3 billion. With so much riding on each go point, a rush to judgment on any one decision could result in a strategic error from which recovery would be extremely costly.

Not surprisingly, Russell takes his time in making such choices. “Let’s be careful,” he warns, and to that end he works to ensure that his team understands the decision options, appreciates their upsides and downsides, and knows what might go wrong with each so that the company does not look “foolish in a year’s time.” For decisions of such scope, Russell counsels waiting three, six, or even twelve months to diminish complexity and reduce uncertainty as much as possible before pulling the trigger.

Reprinted from THE GO POINT: When It’s Time to Decide. Copyright © 2006 by Michael Useem. Published by Crown Business, a division of Random House, Inc.