PICO: 4 Steps to Asking Better Questions

Many of my current friends and colleagues are not aware of it, but I actually spent the first half of my professional life working as a medical professional.  There are, of course, many differences between working in a medical setting and working in a traditional business environment.  But one of the biggest – in  my view – is in the use of critical thinking processes and evidence-based practices.

Without a doubt, there are many reasons why true scientific methods – actual randomized, double-blinded, rigorous research methodologies – are rarely applied to the world of business:

  • “There isn’t time.  We have to work to do, we can’t be wasting resources on some ‘placebo’ process.”
  • “If the research is inconclusive we’ve wasted our investors money.”
  • “We operate in the ‘real world’.  There are too many variables to account for.”

Be more “critical”

However, there is one place where we can all do a much better job of applying critical thinking processes to our daily grind – it’s the way that we ask questions.

Posing questions is critical to improving any activity or process.  We should be constantly asking questions about our performance, our methods, our strategies, our processes.

Root Cause Analysis – one of the fundamental building blocks of the Continuous Improvement movement that has spawned Kaizen, LEAN, and Six Sigma – uses the 5 Why’s approach to uncovering the true underlying reason for problems.  The philosophy is that you must repeatedly ask questions to get to the root of the problem.

This isn’t Cosmo

So, why do I favour the questions that medical professionals ask? Well, modern medicine is, at its core, based in the concept of evidence-based practice, and this requires that disciplined critical thinking skills be applied.  They don’t “follow their gut”, they don’t take their health care instruction from Cosmo or Men’s Health, and they are trained to ask good questions.

The kind of question that you and I typically hear:

“Why do our operating margins continue to shrink no matter what we do?”

The kind of question that a medical professional will typically ask:

“In adults who sustain a grade three anterior cruciate ligament injury, does immediate surgical reconstruction using autograft techniques result in better five year outcomes than waiting six to eight weeks to perform the same intervention?”

PICO

Structuring good questions really isn’t difficult.  It just requires a small amount of effort and a 4-step process that is well known in medical circles: PICO

  • P: Problem
  • I:  Intervention
  • C: Comparison or Contrast
  • O: Outcome

“In adults who sustain a grade three anterior cruciate ligament injury (P), does immediate surgical reconstruction using autograft techniques (I) result in better five year outcomes (O) than waiting six to eight weeks to perform the same intervention (C)?”

The order doesn’t matter, just be sure to include all four components to pose a “good” question.

Consider our previous question, “Why do our operating margins continue to shrink no matter what we do?”.  Now, let’s rephrase:

“Our operating margin declined by 2% per quarter for the past six quarters (P), if we move to an on-line bidding platform for our commodity inputs (I) rather than continuing with the negotiated contracts that are in place (C), can we achieve 15% improvement in operating margin from current levels (O)?”

By using these principles, you can better clarify your situation and create an improved understanding of the issue.

So, what do you think? Is there a place for these tools in the “real world” workplace?


note: this post originally appeared on the Delta Blog, 14 January 2011

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