The key skills of effective decision-making

One of the primary roles of a good leader is to make good decisions. The consequences of a leader’s decisions include whether or not they stay in the position in the long‑term. Making decisions is not a simple, isolated process, but depends on the information and time available, as well as the amount of stress placed on the leader.

The book Crisis Management in Acute Care Settings (Springer 2011) outlines five steps of good decision-making, which we will consider in turn.
 
The first step is to be prepared. Preparedness includes being alert to the need to make a decision, as well as understanding what information you are receiving. A good decision-maker knows when he is stressed, tired or otherwise distracted and takes this into account when forced to make decisions.

Assess the situation
By defining the problem you can be selective about the information you are going to use to make your decision. The amount and reliability of the information available will depend on a number of factors including time, complexity of the situation, number and sources of information. It is useful to build a mental model which can be shared with others in order to check your reasoning for errors and to identify gaps in information. A good decision-maker appreciates that there is a balance between having as much information as possible and the time available to make a decision; as one becomes more expert at decision-making one’s estimate of the time available becomes more accurate.

Make a decision
In his book Thinking Fast & Slow (Penguin 2012) Daniel Kahneman argues that we all have two methods for arriving at a decision. The ‘fast’ method is a gut feeling, unconscious and automatic. The ‘slow’ method is rational, conscious and requires mental effort. These two processes can be used by a leader to make any number of decisions, whether long-term strategy or short-term purchases. However, a leader who is aware of these two approaches can ask themselves which method they are using, because they have benefits and risks; they should be used at the right time by the right person.
    
You should use the fast method when you are an expert in the given field, as experts have the knowledge and experience required to be able to make decisions based on the ‘big picture’. For example chess grandmasters can get a ‘feel’ for the board and the next good move by glancing at the positions of the pieces when time is limited but a decision is still required (the decision not to make a decision because time is limited is still a decision).
    
You should use the slow method when you are a novice – novices need to make logical, reasoned step-wise decisions. Novices do not have the experience required to make a decision based on a rough overview. You should also use this method if you are an expert confronted with a new situation to act as an overseer of fast decisions, i.e. when you want to keep an eye on a fast decision and be able to change it if necessary.
    
So next time you have a gut-instinct about a decision, ask yourself if you are an expert in this field. If not, your gut-instinct is likely to be wrong.
    
Your decision-making will also be influenced by your leadership style. If it is democratic then your decisions will have to reflect the opinions of others. If it is autocratic this will be less of an issue.
    
Decisions should have maximum efficiency divergence. This means that the decisions must have a likely good outcome (efficient) and allow the maximum possible additional decisions to be made (divergence).

Once you have reached a decision, the next step is to act on your decision. Little is gained from delaying its implementation. It is useful to ensure that the decision is carried out as you intended it to be by having a method of checking on its execution. In addition, be explicit in communicating your goals, providing sufficient direction without stifling individual innovation.

Review your decision
This may be the most important step in decision-making. It is inevitable that we will make poor decisions. Reviewing our decisions allows us to mitigate the effects of the poor decision as quickly as possible, and to reduce the number of future poor decisions by learning from our mistakes. Reviewing your decisions needs to be an active process and can be greatly improved by requesting feedback from others including coaches and experts. In the Scottish Clinical Simulation Centre we use video-assisted debriefing to allow the participants to review their own actions and decisions in a crisis scenario. This review is facilitated by a trained member of staff and uses input from other team members.

An ongoing process
As mentioned in the introduction, a good leader makes good decisions. However, this is an acquired skill, and as with all skills it requires deliberate practice with coached feedback to ensure that your expertise develops.

Using decisional aids and being open to feedback on your performance may help you make the transition from good to great leadership.

Further information
www.scsc.scot.nhs.uk