As you read this, people all over the world are making life-and-death decisions in the battle with the Covid-19 coronavirus. While patients flood into hospitals, doctors and nurses are deciding whom to treat and how; officials are deciding where to target resources as health systems scramble to cope with demand; scientists are deciding how to advise governments and which lines of research to pursue; and politicians are deciding which restrictions to impose on the public and how to cope with the economic fallout.
This virus is new, and it moves fast. The gravest of decisions are being made under conditions of high uncertainty and not enough time. There is no guidebook for dealing with Covid-19, no tried and tested rules for dealing with a pandemic on this scale. While no outsider should confidently advise on which decisions to make, there is an established body of evidence on how to make them.
While no outsider should confidently advise on which decisions to make, there is an established body of evidence on how to make them
To learn more about it, I spoke to psychologists who have studied and collaborated with decision-makers in unpredictable and often dangerous environments: police officers, military commanders, emergency responders, polar explorers and mountaineers.
Laurence Alison, professor of forensic psychology at the University of Liverpool, has worked closely with the police and other emergency services for three decades. What advice would he give those thrust into the decision-making frontline by this pandemic?
“The first thing I’d tell them is that they’re likely to experience a feeling of hopelessness – of being a bit lost and not knowing where to start,” he says. In new and extreme situations, decision-makers can get irritated and angry because it feels like they’re being asked to do the impossible. “It’s important to know those emotions are normal – just recognising that can make them less stressful.”
In an emergency, you often have more time than you might realise, experts say (Credit: Getty Images)
Pause, then think
Perhaps the biggest challenge faced by a decision-maker is when to make decisions. Make them too slowly and events overtake you; too quickly and you risk acting rashly.
“In stressful situations people often behave as if they’re under time pressure, even when they’re not,” says Professor Emma Barrett of The University of Manchester, who specialises in the psychology of extreme environments. Her collaborator Dr Nathan Smith agrees: “We’ve interviewed people who are experienced at coping in all sorts of extreme environments and asked them how they make decisions when a military operation goes wrong or there’s an avalanche at high altitude. Nearly all of them said that often you’ve got more time than you think – time to take a step back and just reflect for a few moments, so that your emotions aren’t driving the decision.”
Barrett recalls the Kegworth air disaster from 1989, when a passenger flight crashed on to a motorway embankment in Leicestershire in the UK. After it became clear that one of the two engines was malfunctioning, the pilot moved quickly to shut it down, but mistakenly switched off the only functioning engine. "He took a quick decision in response to danger cues when in fact he had a bit more time to establish which engine was faulty," says Barrett.
Related to this is the tendency for people in highly stressful situations to focus their attention so tightly on the decision in front of them that they miss vital new information, a phenomenon called ‘cognitive tunnelling’. The pilot of Air France 447, which crashed into the Atlantic Ocean in 2009, had become so fixated on levelling the wings of the aeroplane during turbulence that he failed to notice the aeroplane going into a dangerously steep ascent. This stalled the plane, sending it into a dive. Even as the alarm system blared ‘STALL’, the pilot did not comprehend what was happening.
In the rush to respond to an engine failure, the pilot of British Midland Flight 92 mistakenly shut off the remaining functioning engine, leading to the Kegworth air disaster
The ‘least worst decision’
There is also the opposite problem, when the decision-maker does too much ruminating and fails to act. Alison has coined the term ‘decision inertia’ to describe how people run into a psychological roadblock when all options look bad.
“The key issue when things go badly wrong usually isn’t that someone made the wrong decision, it’s that they did not take one,” he says. The police and military often find themselves faced with a set of options which all look terrible, and when that happens, “it’s normal not to want to pick one at all”.
Good decision-makers judge when further delay will end up costing more than any decision they take
Decision-makers can become paralysed, fixating on the regret they will feel should a decision have appalling consequences. A common reaction is to make repeated requests for more information, past the point at which more information can help them choose. Good decision-makers, says Alison, judge when further delay will end up costing more than any decision they take. They are skilled at taking the ‘least worst decision’ – at accepting, as he puts it, that “whatever you do is going to be wrong”.
Nathan Smith cites the excruciating decision taken by mountaineer Simon Yates, as recounted in the film Touching The Void, to cut the rope on his injured climbing partner Joe Simpson, even though he was aware that Simpson would probably die as a result. Yates had concluded that if he avoided the decision, both men would perish. (Simpson survived.)
Safeguard your team
Senior decision-makers have to set an example to their teams. Barrett notes that negative emotions, much like viruses, are contagious. “Even if you’re feeling anxious yourself, as a leader, you can role-model what a non-anxious person would do,” says Barrett.
Under pressure, leaders should pay special attention to the emotional state of team members. Smith recalls that the explorer Ernest Shackleton, during his escape from Antarctica, noticed that the evident despair felt by certain individuals among his crew was spreading to the others. He took the decision to have those individuals share his tent, effectively quarantining them from the rest of the crew in order to maintain morale.
To prevent despair from some team members affecting their colleagues, explorer Ernest Shackleton 'quarantined' them in his tent to uphold morale (Credit: Getty Images)
Pressure can put personal relationships under strain, and it can also lead people to avoid confrontation altogether. In crisis situations, the imperative to pull together sometimes leads the group to reach consensus on decisions before other options have been fully explored; leaders should encourage team members to tell them when they’re wrong and to deliver bad news when necessary.
Smith, who has been working with NHS decision-makers, notes that in high pressure situations, communication generally needs to be “short, sharp and clear”, sometimes to the point of abrasiveness. He told me that less experienced staff, like junior doctors, can find that quite hard, and senior staff should prepare them for it.
‘Focus on the goal’
Plans, drills and guidelines are essential, and so is a degree of adaptability. Alison advises decision-makers to “focus on the goal, not the decision”.
He cites the example set by the American police officer Stephen Redfearn, one of the first on the scene at a mass shooting in a cinema in Aurora, Colorado, in 2012. When Redfearn arrived he saw severely wounded movie-goers, some of them children. It was against policy to transport injured people in police cars, but the ambulances were having trouble getting to the cinema. Redfearn knew that unless he did something, some of the wounded would die. He took what he later described as a “crazy and unorthodox” decision, ferrying injured children in his car to local hospitals. What Redfearn did was “brave and creative and right”, says Alison; he kept his eye on the goal of saving lives. Alison notes that staff on the ground, who often have better information than superiors about unfolding events, should be empowered to improvise.
Redfearn, who now helps trains first responders in emergencies, has revealed that the Aurora incident extracted a steep emotional toll from him. The agony of the decisions he took that night – whom to save, whom to leave behind? – took years to recede. Once this crisis is over, let’s try and remember that those who have taken the most consequential decisions on our behalf will carry a heavy weight for a long time to come.