Kevin Spratt, Ph.D., an eminent spine researcher at Dartmouth Medical Center in New Hampshire, wrote in 2003 about a medical research paradigm he called the “A-D-T-O” research model. A-D-T-O stands for Assessment – Diagnosis – Treatment – Outcome and the model reflects the 4 major factors involved in client care.
- ASSESSMENT – assessing the patients symptoms, general health, health history, goals and expectations to determine a diagnosis
- DIAGNOSIS – specifying their diagnoses based on their assessment findings
- TREATMENT – determining the “best”treatment based on the diagnosis and client
- OUTCOME – Evaluating the relevant outcomes associated with the treatment to assess efficacy and efficiency as well as costs
Spratt points out that these four A-D-T-O pillars are connected by three research links. Establishing the A-D link is where the effort must begin. Only after this A-D link is established can the D-T link.
Once the A-D and D-T links have been established, the third and final link seeks to determine the best treatment.
Although these 4 factors are well understood in healthcare we don’t seem to transfer the skills to our business.
In our businesses it follows that any business “medicine” delivered without first a through assessment and diagnosis can not be justified, equally substantially improved outcomes can be expected with any business “medicine” prescribed if A-D and D-T links have been established as it is no longer non-specific treatment for a non-specific diagnosis.
In addition to the 4 building blocks and three links of the model, client/owner “X” factors must be considered. X factors can include financial, emotional, and psychosocial factors or other that may mediate it moderate the nature of any link (A-D, D-T or T-O).
For example, in health an assessment could provide information that leads to a diagnosis of infection. The usual “best” treatment for that infection might be to prescribe penicillin. However a X factor indicating a client is allergic to penicillin would contraindicate that treatment and an alternative antibiotic that the patient is not allergic to would be linked to the diagnosis in this case.
When any of the links are poorly executed in health or in business the chosen “treatment” and relevant outcomes to assess the “treatment” efficacy are based on false assumptions and, therefore, “treatment” efficacy evaluations are likely to be biased – meaning at the most fundamental level the results will be biased. Which perhaps reflects the the grain of truth in the old joke.
A Good Samaritan comes upon a man on his hand and knees under a lamp post apparently searching for something. The Samaritan asks the man what he is doing, and the man indicates that he is looking for his car keys. The Samaritan gets down on his hands and knees and helps the man search for the keys. After some time, the Samaritan indicates that the keys just do not seem to be here and asks the man how he came to drop the keys. The man indicated that he had dropped them when he tripped down the street a ways in a dark alley. shocked by this information, the Samaritan asks why he is looking for his keys under the lamp post when he dropped them down the street in a dark alley. The man responded because the light is better here.
The joke is funny because of its absurdity of the reasoning the man used when deciding how he finds his keys. It is sad because this type of thinking seems to have generalised in to many businesses.
From an A-D-T-O perspective optimal analysis would be to match “best” treatment, which is dependent on the A-D and D-T links with the “best” outcomes, which is dependent on the T-O links and requires consideration of the client/owner “X” factors.
For example, if a quick “recovery” is the most important for Client A with Dx1, this might influence what is the “best” fit and what the most important factors are for evaluating “treatment” benefits and risks. On the the other hand for Client B with the same Dx1 pain relief might be the most important goal and again this might influence what “treatment” is best fit and what outcomes are “best” or most important for evaluating “treatment” benefits and risks. Thus with the A-D-T-O model a clients “X” factors may result in a common diagnosis Dx1 being linked to different “best” treatments that, in turn, link to different “best’ outcomes.
If the goal in healthcare and business-care is to determine the best “treatment” for a given diagnosis based on A-D link, the known information in the diagnosis should include client/owner specific factors including their goals, expectations, preferences and values.
The problem with failing to apply this objective process to our businesses and relying on “guru/expert” opinion is that experts “get into trouble because of… what they know for sure that just ain’t so” Mark Twain.
Applying the A-D-T-O model to business focuses on moving business “care” toward specific “treatments” and best “practice”.
If applied to the Anatomy and Physiology of a business the A-D-T-O model provides an excellent framework to analyse business issues”, not only is it a more reliable and valid process it enables you as the clinician to apply the skills you already have for to clients but for yourself, team and business…. that’s what I call a win:win:win 🙂
References: Use of the Assessment–Diagnosis–Treatment–Outcomes Model to Improve Patient Care Kevin F. Spratt, PhD MILITARY MEDICINE, 178, 10:121, 2013