Prescription without Diagnosis is Malpractice
A Common Dilemma
Consultants are periodically faced with the decision of whether to agree to do exactly what a client wants vs. proposing what a client truly needs.
The dilemma is clear. If a consultant pushes back on the client’s request or suggests something different, the engagement opportunity might be lost. On the other hand, if the consultant believes what is being requested by the client is unwise, unsafe, risky, illegal or unethical, and agrees anyway, the consultant will be complicit to a bad decision, an unsuccessful outcome and its consequences.
Most situations that reflect this dilemma don’t reach the unsafe, unethical or illegal range, but they often present pitting a client’s request, which may not be in their own best interest due to ignorance and lack of expertise, against the expert consultant’s recommendation.
While there is a chance that executing to the client’s wishes will ultimately achieve a good outcome, more likely, it won’t.
As far as assessing and accepting blame, the consultant can always hide behind, “Well, I just did what you asked.” While this logic might appear to be a safe position, if a failure results, no one wins. Both the client’s business and the consultant’s reputation are damaged.
Thus, the dilemma:
Does the consultant sublimate their own expert judgment and execute to the client’s wishes if they are unsound, insist on a different course of action or simply walk away?
A Medical Example
Imagine a patient who visits a doctor with a complaint of burning pain in the lower right abdomen. What if, without an examination, the patient immediately requests removal of their appendix – and asks for a proposal?
Perhaps, hoping to reduce costs, the patient may have even thumbed through Gray’s Anatomy and, using a mirror and a Sharpie, placed an “x” precisely where they believe the incision should be made.
Would a qualified, board-certified physician comply with that request?
Not likely.
Rather, the physician would politely advise the patient that it was essential to conduct a basic exam, run some tests, conclude on a diagnosis and, only then, prescribe a plan for treatment.
The same rigor should be followed by any consultant you engage. Thus, the key that unravels this consultant’s dilemma is an objective assessment.
The Best Approach (even in an emergency)
Experienced, expert business consultants should suggest an assessment before recommending a course of action and accepting an assignment. That’s what the word consultant means – an adviser. Laborers for hire, on the other hand, typically are expected just do what they are told. On the other hand, a client hires a consultant, in large part, for their advisory expertise.
General consultants will have general assessments. Specialty consultants should have specialty assessments – and perhaps several from which to choose depending on the preliminary discovery, (the equivalent of the doctor’s office visit). And, while an assessment combined with the consultant’s expertise, will produce a recommended course of action, it is essential that the consultant and the client achieve a conceptual agreement before proceeding.
An effective assessment process
Step 1: Pre-Screening Diagnostic
The first step is a phone screening. In the medical example, a patient sees a rash, feels a pain or has a fever. Something is wrong. They call the advice nurse expressing the symptoms and, based on the minimal diagnosis, a visit is scheduled.
It should be the same in consulting. The honest consultant will accept a house call, if a preliminary telephone call indicates it is within their specialty and the problem warrants intervention. If not, they will refer someone that has the appropriate expertise – or suggest two aspirin.
Step 2: Assessment and Expert Confirmation
In the next step of a business diagnosis, a tailored self-assessment, provided by the consultant, is performed by key employees associated with the area of concern. This creates a 360 degree, first-hand perspective of the symptoms. The consultant then validates those areas of concern with face-to-face, on-site, personal interviews.
Step 3: Diagnosis and Treatment Plan
In the medical case, the doctor reads the test results, combines them with the patient’s expressed symptoms, concludes a diagnosis and suggests a treatment plan based on the current state of medical science and his own experience.
The same process is sound in business consulting.
Step 4: Proposal and Execution
The patient (or client) concurs with the treatment (or improvement) plan, and it is launched.
A note of caution: Consultants can only make recommendations based on the assumption that they have all the available information. A client’s (or patient’s) willingness to communicate honestly is essential to the successful process.
How to Know if a Recommended Assessment Process is Valid?
Once you have decided that an assessment is essential, here are some questions that should help determine its quality.
Is the assessment designed for this specific situation?
If it is not, you may have the wrong specialist in your office.
Is it multidimensional?
A doctor never diagnoses based on a single parameter. An accurate diagnosis needs to include multiple parameters to narrow down diagnosis and root cause. The figure below shows an 8-dimension assessment for Operations and Infrastructure. Note that shortcomings are clear and remediation plans are more readily designed and executed.
Has it been shown in the past to be accurate in suggesting an effective course of action?
Your consultant should have case studies which reveal the direct positive outcomes of programs suggested by the assessment.
Does the self-assessment elicit comments and observations of employees up and down in the organization – not just the executives?
Is your consultant listening carefully and asking insightful, penetrating questions about the results?
Does the consultant document the discussions and send you what they heard for your confirmation?
Have we shared all relevant information to assure the consultant is aware of any extenuating circumstances?
Are the recommendations aligned with the validated assessment results?
A Final Word
Assessments increase success and…
- reduce fear, giving employees an integral role in the diagnosis and improvement road map
- align the consultant’s and client’s thinking and objectives
- organize and prioritize investment
- focus the organization, and
- encourage collaboration
Peter Adams founded Lighthouse Information Systems 35 years ago while working as a deployment specialist in the health care information systems arena. In a moment of epiphany, he realized that the primary goals of his complex projects were not to make some new IT technology work, but rather to make the client’s business wildly successful.…
Peter's EXPERTISE
- ERP selection and implementation
- Operations and process analysis
- Technology as a strategic asset
- Business assessments
