The need for a thinking process

Mathematical genius Claude Shannon identified the need for thinking process. Shannon’s genius centred on the way he attacked problems. He didn’t just formulate a question and then look for answers, he was methodological in developing a process to help him see beyond what was in sight.

“It isn’t until you eliminate the inessential from the problem you are working on that you can see the core that will guide you to an answer. Details are important and useful. Many details are actually disproportionately important and useful relative to their representation. But there are equally as many details that are useless.” Claude Shannon

In business and in health you don’t find the core of a problem if you start off with an inadequate assessment process, an incomplete history, a poor examination, or an untested hypothesis all of which will result in a misdiagnosis and lead to either luck in the correct treatment being prescribed or malpractice.

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.

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.

For example: A patient walks in to A+E with chest pain, (to keep this simple) let’s assume there are only three possible causes of the pain, angina, chest infection or reflux. Each has a different treatment GTN, antibiotics or antacids.  If the assessment process doesn’t result in the right diagnosis the right treatment will not be prescribed and the outcome will not be successful for the patient.

Given the wrong treatment the patient may, by chance benefit from a placebo effect, receive no benefit at all, get sicker because he isn’t receiving the right treatment or worse still receive contraindicated treatment which causes further worsening of health.  Not only is the outcome for the patient critical but it should also be critical for the clinician, the hospital and pharmaceutical as their integrity and reputation will be affected by repeated misdiagnosis, and malpractice.

Increase the chance of success

With in the medical world there are processes used for the assessment, diagnosis and management of patients.   There are also known the “normal” parameters for the health of all our bodies systems and organs.  This enables a well trained medical team to perform thorough an assessment process, eliminate the information which is not relevant and identify what is relevant and where to focus a diagnosis.

The answers to most problems are within the patient” Robin McKenzie

And it is interesting to observe that since the 1980’s there is a growing incorporation and importance of patient self-reported data into research and clinical practice as we recognise the client holds their own answers…. It therefore consider that the answers to most of your business problems lie within your business.  Meaning that your clinical skills and training are directly applicable to how your run your business.

If amputating the wrong limb is a medical mistake, what is operating on a patient who doesn’t need surgery?” John Wennberg

Any business “medicine” that is therefore 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.

The ADTO model provides an excellent theoretical framework to analyse and conceptualise the interrelationships between businesses and their owners as they go through the process of growing a business and the associated pains.  Once you understand the anatomy and physiology of a business applying the A-D-T-O model is simple, straight-forward, and focuses on moving business “care” toward specific “treatments”.

Over time I felt the need to add the extra critical step of “I” for Implementation.  As a plan that is not implemented doesn’t delvier results so many people struggle with the taking the action required to acheive a result.  This now forms the A-D-T-I-O model, which I condsier the basis any clinician can use as basis improving for any business “disorder”.


A New Approach to the Low-Back Physical Examination. Behavioural Assessment of Mechanical Signs. Kevin F. Spratt, PhD. SPINE, 15(2), 96:102, 1990

Use of the Assessment–Diagnosis–Treatment–Outcomes Model to Improve Patient Care. Kevin F. Spratt, PhD. MILITARY MEDICINE, 178, 10:121, 2013