Triage: How to Better Prioritize Your Opportunities & Problems

In the story of the doctor who attended police SWAT school, one of the skills that I identify in adaptive people is the ability to triage.  

In emergency medicine, triage is the process of a hasty evaluation:

• to determine the threats to life of an injury or illness, 
• as compared to another patient, 
• balancing the potential for reward or success,
• due to an increased demand on limited resources.

Imagine a fully staffed, but empty hospital emergency department. No patients. Doctors and nurses sitting around...waiting. In walks an injured person. There is no triaging going on here. It's purely an evaluation and investigation - followed up by all-hands-on-deck response. On its face, the process might look the same as triage...but it's not. There is no second or third patient splitting the attention and resources of the medical staff.

Triage is a comparative process. It plots two or more things against each other. It ranks problems and opportunities according to a set of criteria or principles. (Now if you're arguing that the comparison above with the solo patient is actually against the unknown future patient who might be rolled into the ER at any given moment...then you're ahead of the game here! /wink)

This ranking or prioritization method demands a technical knowledge base and understanding. It also requires a special mindset. How can we describe that mindset? Do we have the "adaptive literacy" in our society to articulate what makes a good prioritizer? 

People good at triage are non-linear thinkers. They understand that many aspects in life do not roll out in a step-by-step fashion. They embrace the unknown and various levels of predictability of the future. They consider the options of not only what might be occurring right this moment, but also what future options exist.

This brings me to a related skill: forecasting.

I'm absolutely convinced that the sun will rise tomorrow morning, in the East. I'm less certain of tomorrow's weather. I'm even less confident in the morning rush hour traffic on my way to work. Each of those things has varying levels of predictability. But based on what?

Forecasting and prediction is developing or using existing mental models. It's about applying what we've previously learned or experienced to help build out the future. Some refer to this as running If-Then scenarios through their heads, examining possibilities or probabilities. It's also more than that.

Forecasting is more than just the next phase of what might happen. Higher order thinkers push those non-linear models out several decisions or changes in the future. They consider the options of the options of the options. They branch out the possibilities like tree roots seeking ground water.

Higher order thinkers push those non-linear models out several decisions or changes in the future. They consider the options of the options of the options.

Not every branch on the mental model, flowchart, or decision-tree is assumed to have equal potential. (Unless we are talking about absolutely closed systems with completely randomized chances, like a deck of shuffled playing cards.)

Risk (and reward) management is about putting the appropriate or reasonable weight onto different possibilities. How do I define or describe risk and reward? I use the same model to weigh good things as I do bad things. But for the sake of terminology, I generally refer to this in terms of risk, danger, or threat.

Risk and reward have three components:

• Urgency is a factor of time, as in how much time do I have to figure "the thing" out before it occurs?
• Frequency or probability is the likelihood of "the thing" occurring.
• Consequences relates to the penalties or benefits from "the thing" occurring. 

These three aspects combine to form an overall assessment of risk or reward.

We take this loose/subjective method of measuring risk or reward and apply it at every branch or juncture in the model, flowchart, or decision-tree. This sounds like an unreasonable endeavor, especially if time is of the essence. That might be true! This is why discretionary time is such a valuable resource in decision-making. Time equals information gathering and processing. 

Luckily, many of our industries have repeated or predictable problems and opportunities that can reuse mental models based on experiences - of not only the individual decision-maker, but of the organization as a whole. For example, hospital emergency rooms have the same injuries and illnesses over and over again. As such, they have expectations, systems and responses set up in advance. A triage nurse does not have to consciously go through this risk management process to determine whether the boy with a broken wrist or the man with chest pains should be attended to first. The nurse relies on training, education, and experience to subconsciously rank those two patients in the triage process. The nurse is on auto-pilot. 

Triage comes down to a mindset that includes:

• Non-linear thinking and modeling 
• Forecasting and prediction
• Risk and reward analysis

It's certainly not an objective science, relying on rigid data or evidence. It's just as much an organic art, that accounts for subjectivity, values, personal biases, and preferences. Regardless, the adaptive process of triage reduces stress and maximizes output in complex situations.

Whether you're relying on existing mental models or synthesizing them on-the-fly, s/he who makes the most accurate mental models, most quickly....wins.

How do you triage?

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Lou Hayes, Jr. is a police training unit supervisor in suburban Chicago. He studies human performance & decision-making, creativity, emotional intelligence, and adaptability. Follow Lou on Twitter at @LouHayesJr or on LinkedIn.