THE QUALITY of medical care is determined by two main factors: the quality of the decisions that determine what actions are taken and the quality with which those actions are executed—what to do and how to do it. If the wrong actions are chosen, no matter how skillfully they are executed, the quality of care will suffer. Similarly, if the correct actions are chosen but the execution is flawed, the quality of care will suffer.
The importance of ensuring the quality of execution is well understood. In contrast, the medical profession has done much less to develop and evaluate its decision-making processes. If decisions are considered the command post and actions are considered the troops in the field, we have spent much more energy training and equipping the troops than providing intelligence and decision support systems to the commanders. The place to begin is with the ingredients of a decision.