Produced by Dr Nathan Smith, University of Manchester
Expert reviewed by Professor Laurence Alison, University of Liverpool
Download the printable 1-page PDF version of this brief here.
Why is decision making relevant?
Workers will regularly need to make important decisions whilst tackling the covid-19 outbreak. Some decisions will be made under conditions of extreme stress. Thus, understanding factors that influence and impact upon decision making is important.
Decision-making is defined as a commitment to a course of action that is intended to serve the interests and values of particular people. During a crisis, decision making is affected by several sources of information and prior knowledge, such as factual (or possibly statistical) information, what we hear from others, and the messages provided by organisations.
It is also impacted by the physical and psychological state of the person making the decision. Under conditions of extreme stress and uncertainty, a person’s capacity to evaluate and critique the different options available can be impaired.
This is relevant in the context of covid-19 because of the novelty of the situation, the likely high tempo of work, and the fact that resources might be stretched and access to people and equipment needed to do the job may be limited. These factors can ultimately contribute to people struggling to make decisions and failing to act in time (or at all). The process of failing to act is referred to as decision inertia.
Decision inertia is something that has often been observed in high pressure extreme situations, exemplified by people finding it hard to make choices and pick the best course of action. Sometimes this means having to pick between 2 bad options, known as ‘least-worst’ decision making.
This process of repeatedly cycling through potential options in order to figure of what to do is termed ‘redundant deliberation’. Indecision stemming from redundant deliberation is problematic in high pressure situations and can, in the worst cases, lead to loss of life.
Redundant deliberation is more likely to occur when there is no standard policy to guide decision-makers, or, as might be the case with covid-19, when normal practices and policies might not fit the actual circumstances faced. Difficulty making decisions has also been linked to individuals having to sacrifice or violate values that are really important to them.
Factors that can reduce the likelihood of redundant deliberation and decision inertia include:
Encouraging quick-thinking and creative, adaptive and imaginative approaches to problem-solving that may not rely on policies and procedures not tailored to the unique situation.
Using scenario-centred discussions involving entire teams to run through what-if situations enabling solutions to be identified ahead of time. This reduces the need to think about the choice once the situation occurs.
Making sure individuals understand how their values might impact upon their decision making so that this can be addressed before getting into high pressure situations.
Focusing on the goal, rather than the decision. This requires commitment from team members to work towards the same goal.
Determining the immediacy of decisions and prioritising the ones that are most important ‘now’.
Using rapid debriefs to capture errors and near misses and have a way of logging those lessons.
The rapid formation of teams of individuals who might not be used to working together can also lead to confusion over who is responsible for what and might slow down decision making processes.
Leaders should take some time to define (or redefine) clinical and operational roles (including the role of psychologists) in responding to the outbreak. Roles may be defined based on clinical experience and inpatient service knowledge, for example.
New policies and standard procedures that are specific to the situations that are already or are anticipated to be encountered may need to be developed.
Encouraging quick-thinking and creative approaches to problem solving is important for people to take swift action in uncertain and dynamic situations. To support this and minimise concerns over making mistakes, a psychologically safe environment backed by appropriate policies is needed.
Having clear guidelines to support the steps of decision making and when decisions might need to be escalated to someone higher up will help those with less experience make the right calls.
Spending time identifying ‘what if’ scenarios can help generate solutions ahead of time. If well learnt, these solutions can guide individuals’ and teams’ action when having to make decisions under pressure.
Being well rested, fed and hydrated is important for being able to respond quickly and effectively and make decisions.
Clear communication, especially during handovers, is needed to ensure that everyone knows who is in charge and responsible for making decisions.
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