Medical Affairs leaders often sense when their input is not landing the way it should. The analysis is rigorous. The recommendations are grounded. But the weight those recommendations carry in the room does not reflect what is behind them.
The Decision Weight Diagnostic exists to determine whether that gap is structural, i.e. built into the way the executive system processes Medical Affairs input, and if so, where it is occurring and why.
It is not a personality assessment. It is not a communication audit. It is a structured diagnostic that examines the specific points at which a Medical Affairs function's contribution gets limited in executive settings: in how it is framed before it is heard, how it is processed when it is heard, and how much it actually shapes what gets decided.
The Diagnostic is a complete engagement in its own right. It produces a formal written report with a clear determination. Whether any further work is warranted depends entirely on what the Diagnostic finds.
What the Diagnostic Examines
The Diagnostic is organised around three domains which represent the three points at which a Medical Affairs contribution can be limited in executive settings.
Judgment Formation
Before anyone evaluates what you are recommending, they have already formed a view about how to receive it. Formation examines that framing — the interpretive template through which your contribution will be received, established before a word of content is processed. When that framing works against you, the strength of the recommendation becomes largely irrelevant.
Judgment Evaluation
This is where the recommendation meets the room. Evaluation examines how your contribution is processed in real time. Whether challenge is engaged with as a substantive exchange or treated as a test of credibility, whether nuance is being read as rigour or hesitation, and whether the reasoning behind a recommendation is visible enough to be weighted.
Judgment Reliance
Reliance is the downstream question: does your input actually shape what gets decided? This domain examines whether Medical Affairs input is anchoring decisions, influencing them, or being acknowledged and set aside, and whether that pattern holds across different executive contexts or shifts depending on which executives are present.
How the Diagnostic Works
The Diagnostic works from real interactions, not hypotheticals. It has three components.
Structured self-reflection
Before we meet, you complete a structured instrument that surfaces how you experience decision weight across the three domains; where authority feels assumed, where it feels negotiated, where your input lands and where it doesn't. This is not a scored assessment. It generates the hypotheses we test in the interview.
Diagnostic interview
A 60–90 minute structured conversation, domain by domain. Not a coaching session but a disciplined evidence-gathering process. We work through specific recent examples: how recommendations were framed, how challenge was received, what happened after the meeting. The goal is to distinguish patterns that are structural from those that are situational or developmental.
Communications review
Where available, I review materials the function has used in executive settings, e.g. presentations, recommendations, briefing documents, relevant email communications. These give an independent read on how Medical Affairs is positioning itself and how its reasoning is likely to be received by the executive system, separate from how it feels from the inside. Where patterns remain unclear after the interview and materials review, structured input from relevant stakeholders may be incorporated.
Evidence from all three components is assessed across the three domains. The Diagnostic does not produce a score. It produces a determination.
What the diagnostic produces
The output is a formal written Diagnostic Report — a structured analysis of what is happening across each domain, concluding with a determination in one of four categories:
Structural Constraint The limitation is in the system, not the individual. Individual effort will not correct it. The Decision Weight Recalibration programme is warranted.
Capability Constraint The pattern reflects genuine gaps in capability that are consistent across contexts. Structural recalibration is not the right intervention.
Mixed Constraint Both structural and capability factors are present. The report specifies which is which and what follows from each.
No Material Constraint No systematic underweighting identified. The report explains what is driving the presenting concern.
Each determination is stated with equal confidence. The Diagnostic is as useful when it finds no structural constraint as when it does.
Next step
Every engagement begins with a complimentary 45-minute Discovery Conversation. It is a structured conversation, not a sales call, in which we establish whether the presenting pattern points to a systemic limitation, and whether the conditions are right for the work to be done properly. Not every situation is a fit, and that assessment runs in both directions. Engagements are undertaken selectively.
If the Diagnostic is not the right next step, you will be told so directly.