Insights into decision-maker's perceptions of good versus bad decisions in emergency services—A modified Delphi study

Abstract

Decision-making in emergency situations, such as those faced by fire, police, and health service personnel, presents unique challenges due to the high-stakes and time-pressured environment. Here we aim to better understand what emergency responders regard as constituting ‘good’ and ‘bad’ decisions in emergency situations. We administered a modified Delphi study, eliciting opinions from decision-makers across all these sectors towards consensus around the key elements of good and bad decision-making. Participants were first asked to define what makes a ‘good’ and a ‘bad’ decision, and subsequently to identify the top five most important elements of each. While consensus was not found, important insights were identified that can assist improve the standard of decision making at all levels of emergency response and management. We observed (i) a lack of a common understanding between participants of what a decision is, and how a decision differs from pre-decision and postdecision components; (ii) responses varied according to whether a free text description or the identification of separate elements was requested; (iii) respondents valued ‘goodness’ across different and at times unrelated components a scaled measure of decision quality as opposed to a binary evaluation of ‘rightness’; and (iv) pre- and postdecision elements are considered more important than the decision itself when determining the quality of a decision. To address the issues highlighted by the study we recommend improvements in training, and improvements to organization doctrine related to decision making, risk tolerance, assessment of decision quality and development of intent-based or principle-based operational guidance. Ultimately, incident controllers from all services must remain cognizant that they will face considerable scrutiny if they cannot explain how they arrived at the decision they made.