The evidence arrived after the vote
A hospital network had to commit to imaging equipment months before the clinical evaluation of one system reported.
Engagement
Decision framing, 2 weeks, then evidence review, 4 to 8 weeks, then board handover, 2 weeks.
The decision in front of the board
The network was replacing imaging equipment across its sites. A clinical evaluation of one system was underway and would report after the board had to commit. The procurement window closed first. Nobody disputed the sequence. The board could not have both the evidence and the price.
Two ways of failing were open. The board could vote and then treat the later findings as a footnote, because reopening would be awkward. Or it could delay, call the delay caution, and keep equipment running past its service life. Both read well in the minute at the time. Neither survives a reader who already knows how the evaluation turned out.
What Plenary did
Framing took two weeks and produced one change. We stopped asking which system to choose. We asked whether the case for the chosen system held if the evaluation reported at the worse end of its range. A board can answer that before the evidence lands. It cannot answer the first question at all.
Then we wrote down, before the vote, the findings that would change the answer. Each one was specific enough to check against a published result rather than argue about later. The evidence review covered what could be checked at the time. That meant the vendor’s own data, the service record of the installed base, and the assumptions in the business case. Where confidence was thin, we said so next to the number it applied to. The board session ran forty minutes.
What happened next
File status
Closed, then checked against the evaluation.
When the evaluation reported
The board did not reopen the argument. It read the findings against the triggers it had agreed in advance. One trigger had been written for that finding, and the board acted on it for the sites still to be fitted. The sites already fitted kept the equipment. We had written that risk down before the vote, and it fell the wrong way. No new paper was needed, because the minute from the original vote already explained why.
“We wrote down what would change our minds, then we checked. It took one meeting instead of a season.”
Ask which of these is closest to your file.
The gap is in what we can say, not in what we have done.