The Premortem: How to Facilitate

This is an excerpt of an article written in July 2026 by our partners at Consulting for Human Services.

How to Run a Premortem With Your Leadership Team

A facilitation guide you can use in a single meeting. Roughly 60 to 75 minutes. No special tools required.

Before You Start

Pick one real decision or plan to test. A premortem works best on something specific rather than the whole organization at once. Good candidates right now include your fiscal year budget assumptions, a planned program expansion, an affiliation or acquisition under consideration, or your current Medicaid contingency posture.

Decide who is in the room. Aim for the people who would actually own the consequences: executive leadership, finance, program and clinical heads, HR or workforce, and quality. A board member or two can add value, though keep the group small enough that everyone speaks.

Name a facilitator and a scribe. The chief executive should participate but should not lead the exercise, and should speak last in the sharing round so the team does not anchor on the boss’s view.

The Steps

1. Set the scene (3 minutes). The facilitator restates the plan or decision in plain terms and fixes a future date, usually twelve to eighteen months out. Then delivers the prompt: “It is [date]. This plan has failed completely. The failure is now a fact, not a possibility. Your job is to explain why it happened.”
2. Generate silently and independently (8 to 10 minutes). Everyone writes their own reasons for the failure, alone, with no discussion. Silence is the point. Independent writing prevents the loudest or most senior voice from shaping what others are willing to say. Encourage specifics over generalities.
3. Share round-robin (15 to 20 minutes). Going person by person, each names one reason at a time while the scribe captures it on a shared surface. No debating and no defending the plan yet. Keep circling the table until the reasons are exhausted.
4. Cluster and prioritize (15 minutes). Group the reasons into themes. Then rate each cluster on two axes: how likely it is, and how badly it would hurt. The handful that score high on both are your focus.
5. Assign owners and first moves (12 to 15 minutes). For each priority risk, name one person accountable and agree on one of two things: a concrete mitigation to begin now, or a specific early warning signal that, if it trips, triggers a predetermined response.

I/DD-Specific Seed Prompts

If the room is slow to start, offer these as failure scenarios to react to:

• The state cut or froze a rate we depend on, and we had not modeled a version that severe.
• DSP vacancies crossed a threshold that forced us to reduce census or hand back a contract.
• Cash ran short faster than our reserves projection suggested, and a line of credit was not in place.
• A serious incident or a settings-rule finding damaged our standing with families and the state at the same time.
• An acquisition or affiliation we pursued drained management attention and capital instead of strengthening us.
• A federal eligibility or paperwork change quietly shrank the number of people we were authorized and funded to serve.

A Few Facilitation Guidelines

Independent writing comes before any talking. This is the single most important rule, and it is the one teams are most tempted to skip.

No one is allowed to defend the plan during generation and sharing. The point is to find reasons it fails, not to relitigate whether it is a good plan.

Capture everything, including the reasons that feel unlikely. The value often hides in the risk someone almost did not mention.

End with assignments, not just a list. A premortem that does not leave the room with owners and first moves was a venting session, not a planning tool.