The DECIDE model is a six-step decision-making framework designed to help managers work through complex problems in a structured, repeatable way. Originally developed by Kristina Guo for healthcare management and published in The Health Care Manager, it breaks decision making into a clear sequence: Define the problem, Establish the criteria, Consider all the alternatives, Identify the best alternative, Develop and implement a plan of action, and Evaluate the solution. While it was built with healthcare leaders in mind, the framework applies to any setting where decisions carry real consequences.
The Six Steps of the DECIDE Model
Each letter in “DECIDE” maps to a specific phase. The idea is that by following these steps in order, you avoid the common traps of jumping to conclusions, overlooking options, or making a choice without ever defining what success looks like.
D: Define the Problem
The first step treats decision making as a problem-solving process. Before anything else, you need to identify what’s actually standing in the way of your goal. Guo’s framework suggests asking three questions: What is the problem? Why should anything be done about it? And what should or could be happening instead? That last question is important because it forces you to articulate the gap between where things are and where they need to be. A vague sense that “something is wrong” isn’t enough. You need a clearly stated barrier before moving forward.
E: Establish the Criteria
Criteria are the measuring sticks you’ll use to judge potential solutions. This step asks you to get specific about three things before you start brainstorming: What do you want to achieve with this decision? What do you want to preserve (things that are currently working)? And what do you want to avoid? Setting these criteria early prevents a common mistake, which is evaluating options based on gut feeling rather than consistent standards. If you skip this step, you’ll often end up circling back to it later when two alternatives look equally appealing and you have no clear way to choose between them.
C: Consider All the Alternatives
This is the brainstorming phase. The goal is to generate as many possible courses of action as you can, without judging them yet. Casting a wide net matters here because the most obvious solution isn’t always the best one, and premature narrowing can lock you into a mediocre choice. In a team setting, this means actively soliciting input from people with different perspectives and expertise rather than defaulting to whatever the most senior person suggests first.
I: Identify the Best Alternative
Now you take the criteria you established in step two and rank each alternative against them. The framework emphasizes two qualities a winning alternative needs: it should be high quality on its own merits, and it should have the support and acceptance of the people who will be affected by it. A technically perfect solution that your team won’t buy into is not actually the best alternative. This step is where structured comparison pays off. By scoring each option against the same criteria, you reduce the influence of bias and make your reasoning transparent to others.
D: Develop and Implement a Plan of Action
Making the decision is only half the work. The framework treats implementation as equally important, and it highlights two processes that determine whether a plan succeeds or fails: communication and coordination. The decision needs to be clearly explained to every person responsible for carrying it out, and it must be coordinated across departments or teams. A decision that isn’t communicated effectively to the people doing the work, or that isn’t aligned with what other parts of the organization are doing, is essentially worthless regardless of how well-reasoned it was.
E: Evaluate and Monitor the Solution
The final step closes the loop. After implementation, you assess whether the solution is actually working and gather feedback. This isn’t a one-time check. Ongoing monitoring lets you catch problems early and adjust course before a small issue becomes a large one. The evaluation phase also creates institutional knowledge: what worked, what didn’t, and what you’d do differently next time. Sharing those lessons in accessible formats (a brief summary, a team debrief, or a simple report) ensures the organization learns from the process, not just the individual who led it.
Why the Model Works in Practice
The DECIDE model’s main strength is that it forces you to slow down and separate tasks that people typically blur together. Most poor decisions don’t come from a lack of intelligence. They come from skipping steps: jumping to solutions before defining the real problem, evaluating options without establishing what “good” looks like, or choosing a path without planning how to actually execute it. The framework makes each of those phases explicit.
It’s also useful in group settings where decision making can become political or chaotic. When everyone agrees on criteria before brainstorming begins, the conversation stays focused on evidence rather than opinion. And because the steps are sequential and easy to reference, the model gives teams a shared vocabulary for where they are in the process and what comes next.
Where the Model Has Limitations
The DECIDE model assumes you have the time and information to work through each step deliberately. In fast-moving situations that demand an immediate response, a six-step framework can feel too slow. It’s best suited for decisions where you have days or weeks to deliberate, not minutes.
The framework also relies heavily on the quality of the people using it. Establishing criteria, for instance, only works if the criteria are genuinely relevant and not shaped by blind spots. In healthcare settings where the model has been studied, researchers found that clinician bias, lack of perspective-taking, and low receptivity to collaboration could all undermine the process. A structured framework doesn’t automatically override the human tendencies that lead to bad decisions; it just makes them easier to spot.
There’s also a practical tension around time. Thoroughly brainstorming alternatives, ranking them against multiple criteria, coordinating implementation across teams, and building in evaluation loops all take effort. In organizations where leaders are already stretched thin, participation in each step can fall short. Research on structured decision-making interventions in healthcare found that time constraints were a consistent barrier to full engagement, with clinicians averaging fewer coaching sessions than recommended.
Applying the Model Beyond Healthcare
Although Guo developed the DECIDE model specifically for healthcare managers, nothing about the six steps is unique to medicine. The framework works for any decision with meaningful stakes and multiple stakeholders: choosing between vendors, restructuring a team, selecting a new software platform, or deciding how to respond to a competitive threat. The core logic (define what’s wrong, decide what matters, explore your options, pick the best one, execute it clearly, and check whether it worked) is universal.
If you’re using the model for a personal decision rather than an organizational one, the steps still apply but some compress naturally. You won’t need a formal communication plan when the only person implementing the decision is you. But the discipline of defining the real problem, setting criteria before exploring options, and circling back to evaluate results can improve the quality of choices at any scale.