A Publication of WTVP

The cure hinges on three simple, yet powerful questions.

When it comes to employee healthcare coverage, “not deciding” is not an option. But what can you do when the rules keep changing, a thousand heated opinions vie for precedence in your brain, and the future is as murky as mud? You employ a decision-making model that will get you unstuck.

Whether your politics are deep-red, deep-blue or somewhere in between, the Affordable Care Act is making your life more difficult—or at least more confusing. There’s no end to the speculation on what Obamacare may cost companies. You’ve heard reports and rumors of owners dropping coverage, cutting full-time jobs to part-time, and passing costs along to employees. And if yours is a smaller company, the possibility of receiving the new Small Business Health Care Tax Credits—which require switching to plans purchased through a government exchange—adds an extra layer of complication. Frankly, all the handwringing and second-guessing has you paralyzed. You just don’t know what to do.

Actually, the answer is fairly simple: make some decisions, and get back to work. In short, break your Obamacare paralysis.

At some point, you have to stop worrying and take action, even if you cannot predict the future or control what happens next. It’s true that this is not the best of all possible decision-making situations. It combines the risks of uncertainty and high stakes. Still, you have to decide. And you can—once you get unstuck.

Why are so many business owners feeling stuck? Quite simply, it’s because they have to make their healthcare decisions in a complex, shifting and uncertain landscape of regulations and options. No matter how much research you do, no matter how many experts you consult, the future of healthcare in the U.S. is as unknowable as the future health of your employees. Your insurance decision space is wide open, dependent on many variables, and tied up with complex interdependencies.

And here’s the thing: These kinds of decisions aren’t just about the raw numbers. One must factor in “intangibles” like employee engagement and goodwill and the long-term benefits of high productivity and low turnover. In the end, decisions based solely on saving dollars can come back to bite you. Bright, young prospective employees may find better offers elsewhere. And you will surely pay a very high price for healthcare decisions that create or perpetuate a culture of fear and resentment.

So… confusion, uncertainty and high-stakes outcomes. Sounds relaxing, right? Not really, but it is doable. And only one decision-making method can serve in such a complex landscape. We call it Adaptive Action.

Adaptive Action consists of three simple questions that help you deal with any complex problem: What? So what? and Now what? No matter how messy your challenge, these questions are certain to get you—and keep you—unstuck. When you consider these questions, you build your capacity to see, understand and influence patterns, even in the most chaotic environments. The discipline of Adaptive Action can help you get the greatest opportunity out of your current healthcare-related challenges. So take out your word processor, legal pad or video camera, and record your most honest answers to these questions.

WHAT? Questions
1. What do I know for sure about health insurance options for my organization and employees? What can I find out? What is totally unknowable until the future reveals it? Uncertainty is the greatest challenge to good decision-making in complex situations. Some things you don’t know, but you can find them out. Other things you cannot know, no matter how hard you try. These unknowables depend on many variables and complex interdependencies, so only time will tell how and when they will become knowable. If you want to use what is knowable to your best advantage, be really clear about what you do not or cannot know.

Consult experts or do your own research to fill in the blanks, but don’t waste time on the unknowables. Name them, write them on a piece of paper, and put that paper into your bottom drawer. Take it out once in a while and ask yourself if any item has moved into the realm of the knowable or known. Until then, don’t waste any more time speculating.

2. What has worked well in the past for my triple bottom line of profit, employee engagement and sustainability? In these complex times, you do not have the luxury of thinking of only one thing at a time. Not only are your major measures and concerns massively interrelated, they are also related in unpredictable ways. A small change in profitability, employee engagement or sustainability may have tremendous and long-lasting effects on any one of the other factors. Or not.

In chaos theory, this is recognized as the butterfly effect, because a sensitive system might respond in unpredictable and exaggerated ways to a small disturbance like the flap of a butterfly wing. On the other hand, a potential tsunami may show up as a ripple. You may never know the answer, but you can increase your adaptive capacity when you ask the right questions. Focus your questions on patterns that are significant to your success and how those patterns are related to each other.

3. What opportunities for growth do I see for my business in the next five years, and how will they affect our triple bottom line? It’s always tempting to focus on the immediate needs and concerns, especially the ones you can control. For that reason, you may be thinking about your healthcare decision only in terms of your current employees and next quarter’s income statement. That would be a mistake. The success of your business over the long term depends on what is outside just as much as what is inside your sphere of control. Take some time. Look around. Consider the future and its potential as you make this important decision for today.

4. What am I willing and able to invest in a healthy and satisfied workforce? It may be harder than you think to engage seriously with this question, but it is more important than you imagine. You may be tempted to answer based on your fading memory of your MBA or the flowery language of your corporate vision or the stories you tell yourself about your values and ethics. None of those will serve you well. Pause and take stock of what really matters to you, your board, stockholders and other stakeholders. Where does the welfare of workers fall in your hierarchy of values? What are you willing to risk and what do you expect as a reward?

SO WHAT? Questions
1. So what are the best and worst scenarios for our balance sheet? For my employees? For the future of my business? Your decision is sure to have many consequences, but you can predict only some of them. Whatever you decide, there are likely to be unintended consequences—there always are in chaotic situations. You cannot squeeze all of the surprise out of the environment, but you can spend some of your intellectual capital imagining both the likely and the unlikely consequences of your possible paths. Don’t get stuck in analysis paralysis, but do look at multiple possibilities from multiple perspectives to keep surprises to a minimum.

2. So what are the expectations of my employees? Their hopes? Their fears? You may not be in the habit of consulting your employees on issues of policy, procedure and practice, but on this issue, it is critical you consider their perspectives. Why? Not just because healthcare is literally a matter of life and death, but because it is the most tangible evidence they have of your investment in them as workers and human beings. This is something your employees will notice, and they’ll remember it every time they show their insurance card, write a check for a co-pay, or choose not to take a sick child to the doctor. It matters to them, so if you want them to support you, it has to matter to you.

3. So what is the health profile of my community, and how likely is it to support healthy behaviors for my employees and their families? No man is an island, and the same is true of your company and your employees. Health is a systemic pattern that emerges from myriad factors from available bike paths, to local grocers, to accessibility of drugs and alcohol, to firearms restrictions, to school lunches and community clinics. The health profile of your community will influence the healthcare needs of your employees and their families, so it should be one of the factors you consider as you make this critical decision.

Your investment in healthcare depends on the health of your employees. If they’re healthy, there’s less risk, and you can afford to invest less. And that depends on the support of the community. The more supportive the community, the healthier the employee, the less the risk and the lower the investment. This leads, ultimately, to the question about what you can do to influence the health profile of the communities in which your employees live and work.

4. So what are my real options for action, and what are the risks and benefits of each? Depending on how you answer the other questions, you will have identified a range of opportunities and constraints. As you bring them together, you will recognize a short list of reasonable options from which you can choose. Make those options explicit and be creative as you identify the risks and benefits of each to you, your company, your employees and their families.

NOW WHAT? Questions
1. Now what will you do in this decision-making cycle, realizing that you will have other chances to make different decisions as more evidence accumulates? When you’ve identified your options, all you have to do is choose one. This is almost as easy as it sounds. You may want to include other people in your decision-making process as you consider your Adaptive Action questions above. You may want to wait awhile to see if some of the unknowables become knowable. But ultimately, you will make a choice from a finite list of well-considered alternatives that emerged from your So what? questions. Every Now what? is followed by the next What?, so, depending on what happens next, you will have more information and be more ready to answer the questions in your next Adaptive Action cycle.

2. Now what indicators will I use to evaluate consequences of the current decision and prepare for decisions in the future? This question constitutes risk mitigation in complex systems because it leads you into iterative Adaptive Action cycles. Because the environment is changing, your assumptions will change, the answers you’ll give to these questions will change, and your choices should change along with them. When you are forced to make a decision in an uncertain environment, your best and safest option is to prepare right away for the next decision. What? So what? Now what? Next what?

3. Now what should I communicate, to whom, and how? What should I say about my choices and the reasons behind them? You do not have the option to keep this decision to yourself. This is a topic that is out in the open, and it is loaded with fear for every one of your employees. Even if you have to limit their involvement in the decision or their options for healthcare, you must share what you can with them.

You can tell them what you decided, why you decided it and how you plan to revisit that decision, if and when the situation changes. If you absolutely could not absorb the added healthcare costs and stay in business, let your employees know. Of course, in such a situation, you should also engage them in brainstorming ways to make your business more profitable so that, hopefully, the situation will be remedied in the future.

4. Now what have I learned, what do I need to learn, and how will I learn it to be better prepared the next time such a challenge/opportunity arises? Learning is the most important leadership competency in times of complex change. You have to stay awake, keep your options open, and focus on adaptive action. Ask What?, So what? and Now what? in iterative cycles about all your important decisions in all places and times.

Yes, there will be a next time. That is the central, and oddly reassuring, truth at the heart of Adaptive Action. Things will surely change, and you’ll get… if not a do-over, at least a do-next.

The simple questions of Adaptive Action will not give you answers, but they will help you make the most of the information and options you have. Then, they will help you do it again. And again. And again. Repeating that cycle is all you will need to do as this complex environment of health and healthcare continues to evolve toward an unknowable future. iBi

Dr. Glenda Eoyang and Royce Holladay are co-authors of Adaptive Action: Leveraging Uncertainty in Your Organization (Stanford University Press, 2013). A pioneer in the field of human systems dynamics (HSD), Dr. Eoyang helps organizations thrive in the face of overwhelming complexity and uncertainty. Holladay is a leader among HSD associates around the world. Adaptive Action is available at bookstores nationwide and from major online booksellers. For more information, visit