WRAP decision making approach

OVERVIEW

The WRAP approach is a decision making process advocated by Chip and Dan Heath in their book, Decisive

WRAP is a mnemonic/ acronym for:

  • Widen frames
  • Reality test assumptions
  • Attain detachment
  • Prepare for failure

This page summarises the approach described in the book.

WHY HAVE A PROCESS FOR DECISION MAKING

For consequential decisions, the Heath brothers argue that ‘process trumps analysis’.

  • In other words, having an effective decision making process is more likely to lead to good decisions than extensive analysis of the factors at play in the absence of any specific process.

WIDEN FRAMES

‘Narrow framing’ must be avoided when making a decision

  • Narrow framing is the tendency to consider a decision out of context.
  • The Health brothers refer to this as ‘spotlight thinking’, a tendency to focus on the obvious and the visible rather than what is outside the immediate view.

Narrow framing can be avoided by:

  • being suspicious of ‘whether or not’ questions
    • These typically reflect a false dichotomy and neglect the big picture
    • For instance, ‘should I marry Jim or not’ is a ‘whether or not’ question, perhaps the better question to ask is ‘how can I make my life happier and more meaningful?’
    • Instead of asking “Should I buy a new car or not?”, ask “What is the best way I could spend some money to make my family better off?”
  • Instead of asking ‘Should I do this OR that?’, ask yourself, ‘Is there a way I can do this AND that?
  • Always consider the opportunity cost of any decision, e.g. when making a purchase, what else could the money be spent on?
  • Use a ‘multi-tracking’ approach to answering the question posed
    • Instead of building a case for two options, start developing 3-6 alternatives
    • Subject the alternatives to multiple iterations of feedback, cull 1-2 alternatives with each cycle until one remains
    • This has the advantage of the proponents of the alternatives not having their ego bound to any particular option and they are more likely to take feedback as constructive rather than personal criticism
  • Ask yourself, what would I do if neither of the ‘whether or not’ options were possible?
  • Look for solutions elsewhere
    • e.g. ‘bright spots’ within an organisation, see what effective people within an organsiation are already doing
    • e.g. see what competitors and related industries are doing
    • e.g. use analogies; the closer the related field the safer, but less novel the solutions are likely to be; the more distant the field from which an analogy derives the higher the risk, but the greater the novelty
  • Beware of false options that appear to widen the frame but actually force an option
    • e.g “Mr President, would you like to surrender, continue our current policy, or start a nuclear war?” (only one option is really being presented, the middle one!)

REALITY TEST ASSUMPTIONS

Many decisions are made based on information that is confined to the inside of someone’s head

  • As a result they subject to cognitive biases and inevitable flaws in the decision maker’s mental model of the world
  • One of our most important biases is confirmation bias, our natural tendency to seek out information that supports our intial judgement, rather than that which dissuades us from it
  • In general, the ‘outside view’ (how things generally unfold in situations like the one we are facing)) is more likely to be accurate than the ‘inside view’ (our evaluation of our specific situation)

Assumptions can be ‘reality tested’ by:

  • seeking additional data
    • e.g. talk to others, especially those with prior experience and those with opposing views
    • ask hard specific questions, e.g. “what are the problems with this?” rather than “what can you tell me about this?”
    • research the topic for objective data
  • force oneself to consider information other than that which confirms our biases
    • ask “what information would I need to change my mind?”
  • run ‘experiments’
    • e.g. conduct a pilot, shadow someone, perform ‘as if’ the decision had already been made, build a prototype
  • play the devil’s advocate and encourage others to do the same
    • if everyone agrees tell them ‘the decision will be deferred until a further meeting to provide time for the team to develop disagreement’
  • reflect on your values and priorities before making a decision

ATTAIN DETACHMENT

Detachment is required to separate emotional involvement from the decision making process

  • For instance, we may naturally want to hire someone we like, but are they really the best person for the job?
  • Some decisions may be unpalatable, lead to loss of face (e.g. ‘sunk cost’ bias) or cause harm, but may still be necessary

Useful strategies include:

  • delay the final decision from the heat of the moment
  • ask ‘what would my successor do if I wasn’t here?’
  • ask ‘what advice would I give a friend if they were faced with this decision?’

PREPARE FOR FAILURE

A correct decision can never be guaranteed in an information limited, time limited world where the future is inherently unpredictable

  • we have a native tendency to overestimate our ability to predict the future
  • Anticipate that the decision may be incorrect, and plan to ameliorate this

Useful strategies include:

  • Conduct a ‘premortem’
    • “let’s say that in 2 years time this decision turned out to be a disaster… what went wrong?”
    • similarly can ask ‘ things went great… what went well?’
  • Guard against hubris
    • we are more likely to over-estimate our ability to predict the future if we have recently be lauded for our expertise and achievements or have a high degree of self-importance

COMPARISON TO THE ‘BENJAMIN FRANKLIN’ PROS AND CONS APPROACH

A useful contrast to the WRAP approach is the ‘weigh up pros and cons’ approach originally attributed to Benjamin Franklin.

  • Most people use variant of this method when they take the time to think through a decision
  • although many decisions involve even less process and analysis, and are made simply based on intuition or ‘gut reaction’

Benjamin Franklin’s method:

  • When making a decision one should make 2 columns, one each for pros and cons
  • All the pros you can think of are listed in one column, all the cons in the other
  • Each pro/ con is then assigned a weighting according to its importance
  • The totals are added, and the column with the highest combined value determines whether pros outweigh cons, or vice versa, thus allowing a decision to be made based on ‘the winner’

However, this ‘Benjamin Franklin’ approach is inherently flawed:

  • it is subject to narrow framing
  • Typically the decision is framed as a ‘single option’ or ‘whether or not’ question (see above)
  • It is limited to what you can think of; a better approach is to seek more data, e.g. talk to other people, research the question
  • it is not necessarily reality tested, we tend to seek out information that supports our biases and the information used may be entirely derived from the ‘internal view’
  • it is subject to emotion and confirmation bias
    • the weighting of pros and cons is skewed by emotional reactions. We are more likely to assign values to individual pros and cons according to our ‘gut reactions’. Values are at risk of being revised to confirm an initial judgement
    • Benjamin Franklin’s partial solution to this was delay tallying the values of pros and cons for a few days, so that the weightings could be reassessed and additional pros/ cons thought of
  • the process typically leads to an ‘all or none’ answer and does not mandate back up plans in the event of the wrong decision being made

References and links

Books

MIME 700 2

SMILE

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

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