Understanding How Organisations Ensure Fair Decision Making

Doctors meet with hospital administrators at board meeting

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The General Medical Council (GMC) asked RAND Europe to identify relevant lessons from multiple sectors in the UK where professionals make complex, high-impact decisions in a regulatory context. Researchers investigated the tools, practices and processes used by organisations in the healthcare regulation, legal regulation and defence and security sectors.

The study identified more than 30 decision making tools, practices and processes available to regulatory professionals. A key finding was that the GMC is already using most of these tools and techniques, including guidance, audit, consistency checks, calibration meetings, mentoring, use of decision making templates and training.

Background

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. To address these challenges, regulators can draw on a range of tools and techniques to strengthen their organisational decision making processes, including decision making advisory panels, quality assurance, audits, mentoring and training.

Regulators use a range of tools and methods to ensure that decisions are made in a fair and unbiased way. Approaches to decision making may affect an organisation’s reputation, influencing perceptions of the fairness of organisational procedures. As well as promoting fair outcomes for individuals, robust regulatory decision making is important for protecting public safety.

Goals

In this context, RAND Europe was commissioned by the General Medical Council (GMC) to undertake a study examining the tools, practices and processes used by different organisations to support fair decision making. The overall purpose of the study was to help the GMC learn from methods used elsewhere, and to draw lessons for its own internal decision making activities.

The study drew upon academic insights into decision making and an exploration of the decision making practices of three comparator sectors in the UK — healthcare regulation, legal regulation, and defence and security. Specifically, the researchers examined the decision making tools used by the Nursing and Midwifery Council (healthcare), the Solicitors Regulation Authority (legal) and different organisations within the defence & security sector.

Methodology

Two main methods were used to deliver this work:

  • A Rapid Evidence Review, in order to provide an overview of existing decision making tools, practices and processes, identify barriers to fair decision making, and assess how organisations ensure that decision making standards are high in quality and consistency; and
  • Key informant interviews with policymakers, practitioners and academic experts, to develop a better understanding of the decision making tools and approaches used across a range of professional domains.

Findings

  • There is a large body of academic work on decision making theory, but little agreement on what constitutes ‘fair decision making’.
  • Organisations use different language to describe the concept of fair decision making, including objectivity, consistency, transparency, reliability, accountability and evidence-based decision-making.
  • The literature highlighted several factors that support robust organisational decision making: strong leadership and demonstration of emotional intelligence; an open and transparent organisational culture; and a clearly defined organisational structure. Another finding from the literature was that engaging in critical thinking and inviting constructive challenges from colleagues can lead to fairer decision making.
  • Decision makers in health, legal, and defence and security organisations face a range of challenges regarding fair decision making. These include:
    • Ensuring consistency across an organisation. This is more problematic for larger organisations due to the wide range of decisions that are made, and for organisations with a higher staff turnover. Internal consistency checks, which can involve calibration meetings within and across departments, can ensure that decision making processes are consistent.
    • Finding the time to reflect on decisions, consider what worked well and what could be improved, and ensure that lessons learned are recorded more systematically. Decision making document templates can be used to help ensure that decision making processes and outcomes are recorded routinely.
    • Keeping pace with legislative changes, which are often complex and directly affect the professional activities of decision makers. Horizon scanning can help decision makers keep track of wider changes in the legal and regulatory environment.
    • Avoiding bias and ensuring that any decisions made are based on a proper and objective consideration of all relevant facts. Unconscious bias training can be delivered to help staff weigh up information, provide clear reasons for decisions, and know when to seek advice or guidance from a colleague in order to manage their cognitive biases.

Conclusions

The study found that the GMC are already employing a number of decision making tools and techniques, including guidance, audit, consistency checks, calibration meetings, mentoring, decision making templates and training.

The research highlighted a number of good decision making practices. These include the following:

  • Clearly attributing specific roles and responsibilities for decision makers (e.g. through a Scheduled Delegation of Decisions).
  • Clearly communicating information to employees concerning the resources at their disposal to help decision making (e.g. through access to legal advisors, and guidance documents).
  • Fostering transparency, a learning environment, and open communication about decisions and their outcomes.
  • Promoting good knowledge management practices, so that the decisions and reasoning behind them are documented and accessible to others in the organisation (e.g. through decision document templates or justification of decisions).
  • Ensuring that there are discussions regarding how to sustain and improve decision making processes and outcomes on a regular basis.

RAND Europe and the GMC will be running a seminar on 22 November 2017 to launch the findings of the research to stakeholders with an interest in this area. The seminar will enable organisations to learn from others about the challenges they face and what they are doing to improve the fairness of their decisions. The GMC will use the findings of the research and the outputs of the seminar to identify how it might further strengthen decision making practices.