At the decision making workshop with @emergmedottawa, we discussed 8 specific ways to make better decisions.
Here’s a recap 🧵:
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Here’s a recap 🧵:
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1.Reduce decisions when possible:
Design your system so that decisions don’t need to be made in the moment.
Ever try to eat healthy? It’s far easier at the beginning of the day than the end. Rather than rely on will power, ensure your environment supports your goals…
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Design your system so that decisions don’t need to be made in the moment.
Ever try to eat healthy? It’s far easier at the beginning of the day than the end. Rather than rely on will power, ensure your environment supports your goals…
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i.e. remove the junk food from the house.
In medicine, use clinical decision rules, or decide a priori how you’re going to proceed before you’re faced with the situation. Create rules around frequent decisions.
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In medicine, use clinical decision rules, or decide a priori how you’re going to proceed before you’re faced with the situation. Create rules around frequent decisions.
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E.g. for blunt traumatic cardiac arrest I don’t routinely proceed with an thoracotomy…except under rare circumstances which I check for. Or for high velocity trauma, I always do a CT-A carotids...based on my lit review done before faced with the patient in front of me
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2.Sign post decision points:
Set explicit parameters or targets to trigger an action.
E.g. "at 80% we’ll halt attempts at intubation and re-oxygenate the patient."
This reduces emotion that can be tied to making decisions under stress. Plus promotes accountability
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Set explicit parameters or targets to trigger an action.
E.g. "at 80% we’ll halt attempts at intubation and re-oxygenate the patient."
This reduces emotion that can be tied to making decisions under stress. Plus promotes accountability
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3.Deliberately consider alternatives options:
This is one of the biggest decision making pitfalls. We often fail to consider alternatives. Using the heuristic “is there any other option” even after you’ve listed a few forces creativity and may illuminate viable alternatives
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This is one of the biggest decision making pitfalls. We often fail to consider alternatives. Using the heuristic “is there any other option” even after you’ve listed a few forces creativity and may illuminate viable alternatives
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After creating a differential diagnosis for chest pain, ask “is there anything else this could be”? Getting in this habit will result in new options come to light
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4.Assign probabilities to decisions: Virtually no outcome is certain. Its not enough to say “its likely” or “its unlikely” since we naturally assume this means it IS or it ISN’T. By assigning a numeric probability this conveys uncertainty & forces coming up with alternative
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consideration of alternatives. If there’s 80% chance the patient has appendicitis, by definition there’s 20% chance it’s something else
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5.Learn from decisions:
Use a decision making journal. This forces deliberate reflection on your state of mind and how your expectation/prediction matched the outcome. This promotes learning and hopefully improved decision making over time.
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Use a decision making journal. This forces deliberate reflection on your state of mind and how your expectation/prediction matched the outcome. This promotes learning and hopefully improved decision making over time.
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Review probabilities too...if you ALWAYS predict something to occur at 90% and it NEVER happens, its time to re-evaluate your predictions.
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6. Use one line summaries:
sometimes we get bogged down in the details. Simplifying a situation with only the most pertinent information can make a decision easier while eliminating extraneous information
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sometimes we get bogged down in the details. Simplifying a situation with only the most pertinent information can make a decision easier while eliminating extraneous information
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7.Use a pre-mortem:
Assume your decision or project has failed and come up with all the reasons why. Knowing these ahead of time can allow you to put into place mitigation strategies.
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Assume your decision or project has failed and come up with all the reasons why. Knowing these ahead of time can allow you to put into place mitigation strategies.
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E.g. my next intubation results in being unable to secure the airway…why? What led to this situation or a failed attempt? And what steps can I take to manage this.
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8.Debrief decisions:
Debrief either individually or as a team. Context should be focused on the decision making process not just the outcome. Both good outcomes & poor outcomes are worth reviewing b/c sometimes good outcomes still result from bad decisions (& vice versa)
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Debrief either individually or as a team. Context should be focused on the decision making process not just the outcome. Both good outcomes & poor outcomes are worth reviewing b/c sometimes good outcomes still result from bad decisions (& vice versa)
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