Decision-making in groups under uncertainty

Abstract

The authors have studied daily decision-making processes in groups under uncertainty, with an exploratory field study in the medical domain. The work follows the tradition of naturalistic decision-making (NDM) research. It aims to understand how groups in this high reliability context conceptualize and internalize uncertainties, and how they handle them in order to achieve effective decision-making in their everyday activities. Analysis of the survey data shows that uncertainty is thought of in terms of issues and sources (as identified by previous research), but also (possibly a domain-specific observation) as a lack of personal knowledge or skill. Uncertainty is accompanied by emotions of fear and shame. It arises during the diagnostic process, the treatment process and the outcome of medical decision making.

The most frequently cited sources of uncertainty are partly lacking information and inadequate understanding owing to instability of information. Descriptions of typical group decisions reveal that the individual himself is a source of uncertainty when a lack of knowledge, skills and expertise is perceived. The group can serve as a source of uncertainty if divergent opinions in the decision making group exist. Three different situations of group decisions are identified: Interdisciplinary regular meetings (e.g. tumor conferences), formal ward meetings and ad hoc consultations. In all healthcare units concerned by the study, only little use of structured decision making procedures and processes is reported. Strategies used to handle uncertainty include attempts to reduce uncertainty by collecting additional information, delaying action until more information is available or by soliciting advice from other physicians. The factors which ultimately determine group decisions are hierarchy (the opinion of more senior medical staff carries more weight than that of junior staff), patients’ interest and professional competence. Important attributes of poor group decisions are the absence of consensus and the use of hierarchy as the predominant decision criterion. On the other hand, decisions judged to be effective are marked by a sufficient information base, a positive discussion culture and consensus.

The authors identify four possible obstacles to effective decision making: a steep hierarchy gradient, a poor discussion culture, a strong need for consensus, and insufficient structure and guidance of group decision making processes. A number of intervention techniques which have been shown in other industries to be effective in improving some of these obstacles are presented.