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Research Questions

  1. What academic definitions and frameworks exist around 'fair decision making'?
  2. Which tools, practices and processes can be used to ensure high quality and fairness in decision making?
  3. What lessons can be drawn from this study for the GMC's decision making practice?

Decision making is a core activity for professional regulators. However, high-impact regulatory decisions are often made in an uncertain environment affected by resource constraints, individual biases and time pressures. Regulators can draw on a range of tools and techniques to strengthen organisational decision making processes to address these challenges.

RAND Europe was commissioned by the General Medical Council (GMC) to conduct a study examining the tools, practices and processes used by organisations to support fair decision making. Based on a literature review and research interviews, this study aimed to help the GMC draw lessons for its decision making activities from methods used elsewhere.

This study draws on research insights and an exploration of the decision making practices of three comparator sectors in the United Kingdom (UK): healthcare regulation, legal regulation, and defence and security. Specifically, the report examines the decision making tools used by the Nursing and Midwifery Council (NMC) (healthcare), the Solicitors Regulation Authority (SRA) (legal), and various organisations within the defence and security sector.

The study provides an analysis of challenges facing decision makers and highlights a number of tools, processes and methods available to address these issues. A core finding is that the GMC is already employing most of the tools and techniques identified in the analysis, but that additional methods can further strengthen its decision making practices. This study will have relevance for GMC directors, policy staff and operations staff, as well as for researchers and practitioners working within the field of organisational decision making.

Key Findings

There is a large body of decision making theory but little agreement on what constitutes a 'fair decision'.

  • While the research brief outlined by the GMC concerned 'fair' decision making, this term was found to be absent or inconsistently applied in the literature and by interviewees.
  • In consultation with the GMC, the analysis instead focused on indicators of 'fair decision making': objectivity, consistency, reliability, transparency, accountability and evidence-based decision making.

Decision makers across sectors appear to face a range of challenges, including:

  • Ensuring consistency across an organisation;
  • Recording decisions and capturing lessons learned;
  • Keeping pace with legislative changes;
  • Avoiding bias in decision making;
  • Managing available information effectively; and
  • Ensuring that staff use the tools available.

The study identified more than 30 decision making tools, practices and processes available to regulatory professionals.

  • The GMC is already using most of the identified tools, processes and practices.
  • Additional methods including automated decision making and improved assessment of competences can further strengthen GMC decision making practices.
  • The effectiveness of these methods is linked to organisational culture, structure and leadership.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Research Insights on Fair Decision Making

  • Chapter Three

    Findings from Comparator Sectors

  • Chapter Four

    Conclusion

  • Appendix A

    Literature Review Methods and Approach

  • Appendix B

    Literature Cited in the Review

  • Appendix C

    List of Interviewees

  • Appendix D

    List of Interview Questions

Research conducted by

The research described in this report was commissioned by the General Medical Council (GMC) and conducted by RAND Europe.

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