The decision journal: writing the reason before the result

A decision journal for managers is a short written record of each important decision, made before anyone knows how it will turn out. It holds the choice, the reason, the options you turned down and what you expect to happen. Later, you compare the result with the reason. I would ask every manager on an international patient desk to keep one, because it is a cheap way to learn from decisions rather than from luck.

What a decision journal records

Farnam Street, in its guide to the decision journal, lists eight things to write down. They include the situation, the problem as you frame it, the options you seriously considered and why you rejected them, and the range of outcomes you think could follow. The Farnam Street template also asks you to state what you expect to happen, with the reasoning and the odds you give each outcome. Its last entry is unusual: the time of day, and how you feel in body and mind.

For a manager, I would cut that to one page with six lines. The decision, in one sentence. The owner. The options set aside, and why. What I expect to happen, and by when. The sign that would tell me I was wrong. The date I will look again. The mood line stays, as a tick box: tired, rushed or calm. It costs a second and it explains a lot at review.

An entry is not the minutes of a meeting. It is not an approval form either. It records a bet, in plain words, while the reason is still fresh.

Why the reason has to come before the result

Memory is a poor witness to our own thinking. Farnam Street puts it bluntly: our brains edit the past to make us look better and smarter. Once the result is known, the story we tell about the decision shifts to fit it. That is hindsight. A written entry stops the edit, because the reason is on paper before the result arrives.

The second problem is outcome bias, which means judging a decision by how it turned out rather than by how it was made. A 2023 paper in the International Review of Social Psychology describes it as decisions with good outcomes being rated more favourably than the same decisions with bad ones. That paper repeated an older experiment with 692 online participants, and the International Review of Social Psychology reports that the effect held, with larger effects than the original. The first study, the paper notes, asked people to rate medical decision cases.

For a manager this matters in a practical way. If results alone decide who gets praise, people learn to take safe, small bets and to hide sound ones that went wrong. Good reasoning that met bad luck gets punished. Careless choices that met good luck get copied. A journal gives the review something else to look at: what was known, what was expected and why.

A result tells you what happened, but only the reason written beforehand tells you what you knew.

How I would run it for the first 30 days

Week one is about the threshold. Not every choice needs an entry. I would require one for any decision that commits money above an agreed sum, changes what a patient is promised, moves a person's role or cannot be undone within a week. Everything else stays out, or the journal becomes a chore nobody reads.

Week two adds the premortem. Harvard Business Review describes a premortem as a session where team members assume the project they are planning has just failed, and then look for the reasons. I would fold a short version into each entry: one line on the most likely reason this choice fails. It takes a minute. It also gives quieter people a safe place to write down a doubt they may not say aloud.

Week three sets up the review. Each entry already carries a date. I would hold a monthly session where each manager reads out two entries whose dates have passed, one that went well and one that did not. The only question is which part of the reasoning held and which did not. The result is noted but not scored.

Week four audits the journal itself. Were entries written before the decision or after it? Were the expectations specific enough to check? Did anyone write "we will see" as a forecast? A vague entry is marked vague and rewritten next time. After 30 days, the team decides whether the threshold is right.

There is a real trade-off here. Writing slows decisions, and some cannot wait. A coordinator handling a late flight at midnight must act first. For those, I would accept an entry within 24 hours, clearly marked as written after the event, so nobody mistakes it for a forecast. The other risk is that a journal turns into a defensive file, kept to protect the writer. The monthly review guards against that only if a well-reasoned loss is treated with respect in the room.

Where this meets the patient who crosses a border

An international patient desk makes many non-clinical decisions each week. Which languages get an interpreter on call. Whether to open a new source market. Which transfer firm meets arrivals at the airport. How late the helpline stays staffed. Whether to accept a booking date that leaves the coordinator stretched. Clinical choices belong to qualified clinicians and sit in the clinical record, not in a manager's journal. The journal holds the operating bets around that care.

Those bets shape what a patient from abroad meets on arrival. A patient comparing India with other destinations cannot read the minds of the people planning their trip. They can, though, meet a service whose choices were made on stated reasons and checked against what happened. When a helpline change goes wrong, the journal shows whether the reason was weak or the luck was bad, and the fix differs in each case.

This is part of how I think India earns first choice for medical travel and aesthetic care. Fair prices and skilled clinicians get a patient to look. Operations that can explain their own choices, and correct them in the open, give that patient a reason to trust the plan. A journal is a small tool for that. It turns "we think this works" into a record someone can test.

Opening the first entry

I would start with the next decision that meets the threshold, not with a template project. Write the choice, the reason, the rejected options, the expected result and the date to look again. Share it with one peer before acting, so the entry cannot quietly change later. Then wait. When the review date comes, read the reason before you read the result, and ask the peer to do the same. If next quarter's choice to add a language desk for a new market goes into the journal first, the team will know a year later whether it chose well or simply got lucky.

Sources

Questions people ask

What should a manager write in a decision journal?

Keep each entry to one page. Write the decision in one sentence, who owns it, the options you set aside and why, what you expect to happen and by when, the sign that would show you were wrong, and a date to review it. Farnam Street also suggests noting the time of day and how you feel, which helps explain rushed choices later.

How is a decision journal different from meeting minutes?

Minutes record what a group agreed. A decision journal records a bet: the reason, the expected result and the odds, written before anyone knows the outcome. That timing is the point. It lets a later review separate sound reasoning that met bad luck from careless reasoning that met good luck, instead of judging every choice by its result alone.

Should clinical decisions go into an operations decision journal?

No. Clinical decisions belong to qualified clinicians and are recorded in the clinical record under their own rules. An operations journal holds the non-clinical choices around care, such as interpreter cover, helpline hours, transfer firms and which markets to serve. Keeping the two apart protects clinical judgement and keeps the journal about what the manager actually decides.