A better path often starts by seeing what the apparent choice leaves out.
Science and patient sit at the two ends of the arc: what the therapy is, and who actually receives it. Capital, regulatory strategy and leadership are how a program travels from one to the other. Programs move with the most confidence when a decision is settled across all five domains together.
Start with the impact that matters. Surface what must be true, then identify which assumptions carry the most downstream weight.
Connect the system around the question. Test the evidence, alternatives and dependencies before committing to a path.
Converge when the evidence is sufficient. Record why, be clear about what would justify reopening it, and carry the learning forward.
What impact do you want to have? What would have to be true for it to work? Asked in each domain, those two questions surface the assumptions a plan is quietly standing on.
Every assumption has a basis, the evidence that supports it, and a load, what else fails if it turns out to be wrong. Most plans record the first and never measure the second. Work the plan without the assumption and see what falls.
Progress compounds when a decision, once made, holds. When a new stakeholder arrives or the reasoning behind a choice is lost, the question can quietly open again.
TMDG treats convergence as part of the work. A decision is reached deliberately, recorded with its reasoning, and reopened only when new evidence gives a reason to.
A finished brief is not needed. I read every message myself and reply with the two questions I would ask first. If I am not the right person, I will tell you who is.
Roberta Duncan, Founder and Principal