Medical teams are constantly in high pressure, time sensitive situations. Decisions constantly need to be made that impact the health and wellbeing of other humans without delay. In order to make these decisions well, varied, complex and competing data points need to be assessed and brought together.

Teams are made of multiple disciplines but there is a well established and rigid hierarchy. Consultants ‘out rank’ nurses despite being further from much of the information needed to make good choices.

So how do they constantly make high quality decisions? Unlike in most professions, this activity is studied and has processes put around it to ensure positive outcomes. We spoke to some clinical professionals to find out their top tips:

Everyone in the team knows what area they have responsibility for. This is a discipline that they have studied for a number of years. This study, combined with practical application, allows people to have confidence in their area of expertise. They are deeply competent in the topic — and have proved it to themselves, and others, through a variety of testing and situations.

In addition to their own skill-set, people understand and respect the functions of others in the team. They see what value that role brings — and they know what they don’t know about that particular area.

Using Burch’s model of competence, they are described as ‘conciously incompetent’. Though the individual does not understand or know how to do something, they recognize the deficit, as well as the value of a new skill in addressing the deficit.

Clinical Reasoning is “The cognitive process whereby conclusions can be reached on the basis of information available” (Hagedorn 1995). As part of this process, medical practitioners must demonstrate the way they think and crucially, explain that to other individuals in ways they can understand.

As such, medical professionals of all types, develop and practice communication as part of their studies. From early on in their training, all the way through to their continued professional development there is a focus on this crucial skill.

Making good decisions is not the same as everyone agreeing on all aspects of the situation. More often than not, there will be competing viewpoints on the right way forward. At this point, it is important to remind everyone of the shared outcomes they are trying to achieve.

This is not a simple thing to make happen though. You need a skilled communicator that is comfortable exploring outcomes that differ in order to find those which are shared.

Even within the highly complex and personalised world of continuing healthcare, there are some steps which can be standardised. The first step is to never forget the decision you are making is about a person and not a line on a questionnaire.

That being said, you can categorise many situations with a tool that helps you weigh up priorities. This needs to take the areas you most regularly discuss and give a way of judging each.

In the context of ongoing healthcare, this means looking at a variety of needs and judging the nature, intensity, complexity and unpredictability of each. Critically, this framework still has a step that allows it to cater for particular needs which aren’t often seen. Without this ability to highlight aspects less regularly seen, you risk trying to fit everyone into a box.

Once you have completed this type of exercise, you can prioritise your discussion around the situations with the highest levels of disagreement.

Within most medical contexts, it is clear who the final decision maker is. Whilst all information needs to be heard and evaluated, in order to make decisions there needs to be a single point that makes the final call. Healthcare workers understand this and will actively bring up the topic to ensure everybody knows.

As an individual you need to be comfortable enough in the skill to flex whether you are making a decision or contributing to it. This might change from shift to shift due to the particular roles that people are playing that day. In one ward an individual may be a team leader and in another environment they are a practitioner.

By having the confidence in your own position you can avoid seeing every decision as a judgement on your own personal capability. Then you can contribute fully, even if you don’t have the final say.

Trust has been defined as the ability to put yourself in a situation where someone else can do you harm, but believing that they won’t. There are many descriptions of how to get to this point with a team or individual. Meyer et al focus on the professional aspect — citing Ability, Benevolence and Integrity as being key to generating trust:

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I believe in a more human version — where by understanding someone’s overall context, you can empathise with their perspective, come to respect it and eventually trust it — even if you don’t agree with it.

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Once you are at this stage, no matter how you define it, you can build a more constructive partnership. One of the healthcare professionals we spoke about being both a tightrope and a safety net for someone. This means that you push them to take risks but also are there for them to help deal with the difficult situations that inevitably arise.

This means that individuals need to evaluate which particular moments require them to play which role. When done correctly, this further builds trust between members of a team, whilst pushing decisions to be made effectively and efficiently.