IntegrityWorks: Tools and Skills to Build Integrity

Q & A: Margaret Hambleton on Critical Thinking

Margaret Hambleton has over 20 years’ experience in healthcare compliance, including roles as chief compliance officer for large, integrated health systems providing services in multi-state regions. Through this experience she is recognized as an industry thought leader and highly sought after speaker and collaborator. She has a very well-rounded understanding of operations, having served in leadership roles in Risk Management, Human Resources, and Insurance Operations. Ms. Hambleton is currently President of Hambleton Compliance LLC, a consulting firm serving the healthcare and compliance community.

Margaret Hambleton and I have worked together for many years. We have disagreed on occasion. What I always enjoy is that Margaret never makes it personal. She makes it about the facts and information. She also is unafraid to speak her mind and disagree when she feels the need to. One of the most enjoyable aspects of working with Margaret is that when the decision-making process is over she supports what we have decided, even if it isn’t exactly what she had been advocating for. She moves on to the next challenge. She is the ideal person to help work through big issues because she uses an effective critical thinking process.

Roy (R): Do you think a critical thinking process can help people have more integrity?

Margaret (M): Absolutely. I have always said that if I had one superpower, it would be perfect perception. Think how wonderful it would be to know precisely why someone is doing or saying something; to understand the motivation, context, expertise, bias, etc. Unfortunately, none of us have perfect perception. Therefore, we have two things by which we can judge a situation; assumption or critical thinking. When we rely on assumptions, we ignore the impact of our own motivation, context, expertise, and bias. How can we claim to have integrity, even when we are attempting to do the right thing or take the right action, if we don’t put aside our assumptions and carefully, thoughtfully, and fully examine all the information available to us?

(R): Are experts helpful in the critical thinking process?

(M): Consulting with experts is certainly helpful in understanding the scope of the problem, evaluating gathered information, considering options, and understanding academic literature and best practices. One of the problems, however, is identifying the right experts. Many of us think of experts as those individuals with advanced degrees and special skills; the lawyers, auditors, executives, and other professionals. Sometimes we have to remember that the expert may be the clerk on the floor who is doing the work. The important thing here is that it actually takes some critical thinking to determine the right experts to provide useful insight into the question at hand.

(R): How do you make sure that you gather information from unbiased sources?

(M): You can’t—there is no such thing as an unbiased source. Whether we like it or not, we all have bias. Sometimes it is explicit and obvious, sometimes implicit, sometimes it is unintended, and sometimes it is the product of the system the problem is being evaluated in. The closest you could come to an unbiased source is probably double-blind peer-reviewed scientific research, but unless you are a physician or other scientist, this type of source is rarely helpful with the everyday problems most of us deal with. I think the question is: to what extent can we determine that the information being gathered is reliable? That is to say, to what extent can we trust and depend on the information we have gathered? To check to see if the information you have gathered is reliable, you should see if the information stays the same over time, if the information is internally consistent and consistent over multiple sources, and whether or not others looking at the same information draw the same conclusions. Even when you have clearly biased sources and you can confirm that the information provided is reliable, you may not want to discount it.

(R): Where else do people go wrong when gathering information to make a decision?

(M): Confirmation bias is always a problem when gathering information to make a decision. Humans love to be right. It is often easy to seek out information that confirms our assumptions and discard information that doesn’t confirm what we think is the right answer. To guard against confirmation bias, it is important to work just as hard to try and disprove your assumptions or what you think is the right answer as you do to confirm your assumptions.

Another thing that can go wrong is failing to modify the plan as you gather more information. Often, we start off with a robust plan about who we will talk to, how we gather and test information, and who we involve in making decisions. It can sometimes be really tough to modify the plan, even when we know that the plan is no longer effective. We just hate to change course.

Finally, I think that often we don’t do a very good job at defining the problem. Many times, we jump into fact-gathering without actually knowing, in very specific terms, what problem we are trying to solve. When we don’t define the problem well, we can’t determine what information is or isn’t important, or we end up addressing the symptoms rather than the cause of the problem.

(R): We don’t need the name of the person, but please describe someone you know who has remarkable critical thinking skills. What do they do differently than others?

(M): I worked for someone once who was infuriatingly good at asking questions. He could connect dots that to me just didn’t seem to be connected. Now, I hate feeling that I am not prepared. Before meetings with this individual, I would pore over the information I had gathered and think about what information I might still be missing, how the information is connected, what else might the information be connected to, and who else might have information that could contribute to decision-making. Without fail, during the meeting he would ask a question I had not considered. It was not just that he was one of the smartest people I ever met, but he could always see where the potential holes were. Even when there were not holes in the information, his questions always helped me be able to defend the decision with facts and data.

(R): Why do you think it is so hard for us to revisit a decision we have made, admit we were wrong, and make an adjustment?

(M): I think the problem is that we tend to frame the question as one of “right” and “wrong.” Just because a decision is made that doesn’t solve the problem or is not as effective as we would like, doesn’t mean the decision was wrong at the time it was made. No one likes to be wrong . . . and many will actively fight to prove they were not wrong. If we don’t think of a decision as wrong, but instead as an opportunity to learn more about the problem, it may not have the same judgmental connotations and make it more palatable to make adjustments and move forward.

(R): Do you think people in general have abandoned critical thinking skills?

(M): I don’t think that people have abandoned critical thinking skills, I think they just haven’t been taught these skills. When people think about the discipline it takes to critically think through a problem, they may think that it will take too much time, energy, and resources. While it might be counterintuitive, utilizing critical thinking skills and techniques generally gets you to a good decision much more quickly and efficiently.

(R): I believe that our collective integrity has hit an all-time low, people are fed up and the pendulum will swing back to a period of reason. Do you share this view?

(M): No, I don’t think our collective integrity has changed much over time. There are certainly people who will lie, cheat, and steal; there are people who refuse to listen to any argument that doesn’t support their position; and there are people who believe that anyone outside their “tribe” is somehow out to get them or less worthy of consideration. This has not changed, but what we have now is social media amplifying their troubling views. Our public discourse has certainly become more disturbing and, I hope, will swing back to more reasonable discourse. That said, I believe that the vast majority of people are people of integrity. They have good intentions and work hard to do the right thing. We see, time and time again, people willing to bring problems forward and working collaboratively to help solve those problems. What we need to do is figure out a way to amplify the good work of most people and the positive impact they have on our work and in our communities. By doing so, we will see our collective integrity continues to be strong and that doing the right thing is more rewarding than the alternative.

Now You Try: Try Thinking Critically

Practice thinking through a problem using the critical thinking process. Here are some problems you can try working out using critical thinking skills:

• Select something you have considered buying personally. The more complex a purchase or cost the better. Make a note of the best idea you have of what to purchase right now without further analysis. Save it for the end of the process. Now use the critical thinking process to determine what would be the best purchase decision. Several steps require the use of outside expertise. Feel free to use articles or other resources; however, for at least one of the “seek expert advice” steps . . . talk to a human directly. 

• Look at a big decision made at your workplace, like the purchase of some relatively expensive item, a major policy change, or a new product line. If you are not currently working, think of a past job or do this for a group you are currently involved with, such as a nonprofit, church, or any other group or organization.

Now follow these steps while working through your chosen problem:

• Identify the problem.

• Gather information.

• Understand and review the evidence with experts.

• Eliminate less valuable information with experts.

• Summarize the remaining evidence with experts.

• Select key point(s) with experts.

• Evaluate potential decisions with experts.

• Make a decision.

• Implement the decision.

• Test the effectiveness of the decision.

If you are working in a group, share your results with the group. Did someone take a different route to solve the same problem as you? Did someone have an innovative way they thought about the problem?

Here are some questions you can ask about your decisions for this exercise:

• If you made a decision before starting the process, compare it with your decision after going through the process. Did you come to the same conclusion after the critical thinking process? Even if you still came to the same conclusion, do you feel better about your decision after going through the critical thinking process?  And do you feel better prepared to sell others on your decision?

• Did you change your decision because of one step in the process? If so, why was that step important to you?

• Did you change your decision because of the whole process? If so, describe how the whole process helped you.