Aljoscha Nickel Health economist · Managing Director · Healthcare Advisory
Working method

Good decisions do not begin with a solution.

They begin with a precise question, an honest view of the evidence and an understanding of what must work in routine care. Only then do options, accountability and next steps become robust.

View the five working steps View potential work products
Starting pointDecision before format
Evidence logicFacts, assumptions, open points
Reality checkCare, operations, economics
ObjectiveAccountable next steps
Four working principles

Structure creates clarity when the situation is not clear-cut.

The method is designed for questions in which multiple interests, incomplete information and real implementation limits come together.

01Decision

The question comes before the format.

First clarify who needs to make which decision by when and what would make an answer sufficiently robust.

Which decision should become easier after the work?
02Transparency

Evidence and assumptions remain separate.

Documented information, modelling assumptions, stakeholder perspectives and open questions are visibly labelled rather than blended into an apparently certain statement.

What do we know, what do we assume and what is missing?
03Operating reality

Strategy needs to survive routine care.

Patient pathway, people, time, rooms, systems, financing and accountability are treated as parts of the same solution.

What changes concretely on Monday morning?
04Consequence

Analysis does not end with insight.

Options are connected with decision criteria, ownership, the next action and a realistic review point.

Who does what by when, and how will effect be recognized?
Five working steps

From the initial question to verifiable implementation.

The scope may range from a focused conversation to project support. The underlying logic remains the same.

  1. 01

    Frame the decision

    Clarify the starting point, objective, decision-maker, timeframe, exclusion criteria and intended outcome.

    Outcome: a clear decision mandate
  2. 02

    Organize the evidence

    Map available data, sources, assumptions, contradictions, perspectives and information gaps.

    Outcome: a transparent evidence and gap map
  3. 03

    Model operating reality

    Test the thesis against the care pathway, operations, stakeholders, incentives, resources, systems and accountability boundaries.

    Outcome: visible conditions and constraints
  4. 04

    Assess the options

    Compare alternatives, trade-offs, side effects, risks and implementation effort through transparent criteria.

    Outcome: decision-ready options
  5. 05

    Anchor implementation

    Define the decision, owners, milestones, measures, learning loops and the next review point.

    Outcome: realistic next steps
Evidence logic

Four kinds of statements deserve four labels.

Decisions become unnecessarily risky when knowledge, judgment and supposition sound equally certain.

01Verified

Fact or documented finding

The source, data date and scope are traceable. Even a documented value may have limits or become outdated.

02Assumption

Modelling or working hypothesis

A provisional input needed for analysis or planning whose influence on the result needs to remain visible.

03Perspective

Experience or stakeholder view

A relevant view from care delivery, management, market or use that does not automatically apply to every stakeholder.

04Open

Unresolved question or contradiction

An information gap that needs to be resolved, treated as a condition or consciously accepted as residual risk.

Potential work products

The work product follows the decision, not a standard template.

Depending on the question, the result may be one work product or a coherent combination. Scope and evidential strength are clarified upfront.

01Decision

Management brief or decision paper

Bring the initial question, evidence, options, trade-offs, risks, recommendation and open points into one concise view.

02Care and operations

Patient pathway or operating model

Make workflows, roles, handoffs, resources, exceptions and accountability boundaries visible as a functioning system.

03Actors

Stakeholder and decision map

Assign decision, use, budget, influence, effort and communication needs to the relevant roles.

04Economics

Criteria or scenario model

Translate assumptions, resources, benefit, cost, capacity and sensitivities into transparent, comparable scenarios.

05Implementation

Roadmap or pilot brief

Define work packages, owners, dependencies, milestones, measures and stopping criteria for implementation.

06Management

Management routine or review logic

Connect objective, measure, variance, action, accountability and learning loop in a repeatable management practice.

Engagement formats

As much structure as needed, as little project apparatus as possible.

The right format depends on decision readiness, stakeholders, evidence and implementation risk.

01

Focused expert session

Suitable for

A clearly bounded question with limited preparation time.

Potential outcome

A verbal assessment of assumptions, risks and next validation steps.

02

Management briefing

Suitable for

Preparation for an internal decision or management discussion.

Potential outcome

A concise written decision basis with unresolved points.

03

Working workshop

Suitable for

Several perspectives need to form one target state or approach.

Potential outcome

Documented decisions, accountability and next steps.

04

Project support

Suitable for

Analysis, decision and implementation depend closely on one another.

Potential outcome

Defined work products, a roadmap and agreed review points.

Clear roles

Accountability remains where the decision is made.

Good collaboration needs not only tasks but clear decision and professional boundaries.

01Client

Enable the decision and access

Clarify the objective, accountable people, relevant stakeholders, available information and real constraints; retain decisions and approvals.

02My role

Structure, test and translate

Sharpen the question, separate evidence from assumptions, connect perspectives, make implementation consequences visible and structure next steps.

03Qualified professionals

Make binding professional decisions

Clinical, legal, tax, regulatory, data-protection and financing approvals remain with the qualified and accountable professionals.

A good project start

Six details are enough for an initial assessment.

Confidential documents are not needed for first contact. A short, concrete description makes fit easier to assess.

Download the free decision check
  1. 01

    Which decision or change is pending?

  2. 02

    Who decides, and by when?

  3. 03

    Which people, organizations or sites are affected?

  4. 04

    Which data or sources are already available?

  5. 05

    Which practical constraint must not be overlooked?

  6. 06

    Which risk or outcome would be unacceptable?

The method in context

Four entry points for different decisions.

The method remains the same. The professional questions change with market, care delivery, organization or transaction.

01

Healthcare advisory

Test market, product, investment and care-delivery assumptions against evidence and real-world feasibility.

View advisory
Clear boundary

Decision support does not take over another person's decision.

The method structures questions, evidence, options and implementation. It does not replace individual clinical, legal, tax, regulatory, data-protection, financing or investment advice. Binding professional decisions and approvals remain with the accountable people. Patient data and confidential documents do not belong in an initial enquiry.

Start a question with structure

Briefly describe the decision, timeframe, stakeholders and largest open point. This helps identify the right format and next step.

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