Nicola Power

Coping with uncertainty: police strategies for resilient decision-making and action implementation

This study uses a hostage negotiation setting to demonstrate how a team of strategic police officers can utilize specific coping strategies to minimize uncertainty at different stages of their decision-making in order to foster resilient decision-making to effectively manage a high-risk critical incident. The presented model extends the existing research on coping with uncertainty by (1) applying the RAWFS heuristic (Lipshitz and Strauss in Organ Behav Human Decis Process 69:149–163, 1997) of individual decision-making under uncertainty to a team critical incident decision-making domain; (2) testing the use of various coping strategies during “in situ” team decision-making by using a live simulated hostage negotiation exercise; and (3) including an additional coping strategy (“reflection-in-action”; Schön in The reflective practitioner: how professionals think in action. Temple Smith, London, 1983) that aids naturalistic team decision-making. The data for this study were derived from a videoed strategic command meeting held within a simulated live hostage training event; these video data were coded along three themes: (1) decision phase; (2) uncertainty management strategy; and (3) decision implemented or omitted. Results illustrate that, when assessing dynamic and high-risk situations, teams of police officers cope with uncertainty by relying on “reduction” strategies to seek additional information and iteratively update these assessments using “reflection-in-action” (Schön 1983) based on previous experience. They subsequently progress to a plan formulation phase and use “assumption-based reasoning” techniques in order to mentally simulate their intended courses of action (Klein et al. 2007), and identify a preferred formulated strategy through “weighing the pros and cons” of each option. In the unlikely event that uncertainty persists to the plan execution phase, it is managed by “reduction” in the form of relying on plans and standard operating procedures or by “forestalling” and intentionally deferring the decision while contingency planning for worst-case scenarios.

A systematic review of the potential hurdles of interoperability to the emergency services in major incidents: recommendations for solutions and alternatives

This study presents a narrative synthesis of a systematic literature review relating to multi-agency interoperability and major incident decision-making in high risk, high stake environments. The review methodology includes the identification of relevant studies, a critical appraisal of the concepts inherent in the main review question and a narrative synthesis of the central themes that relate to the study as a whole. The review firstly outlines what, currently, appear to be the perceived defining features of successful interoperability by using the SAFE-T phase model of major incident decision-making. It then considers whether these defining features are realistically achievable in major incident practice. Findings suggest that the current definition of an interoperable network is too demanding for the inherent complexity and dynamic nature of the major incident task environment. Individual teams tend to focus on agency-specific behaviour, as opposed to coordinated multi-team functioning, and so collective interoperability is not achieved. Inevitably, this reduces the ability to perform collaborative behaviours, including decision-making and action implementation. The paper concludes that aiming for the current conceptualisation of interoperability along a hierarchical command structure may actually inhibit effective decision-making. Instead, multi-agency systems would do better to work towards an improved understanding of a non-hierarchical and decentralised yet interoperable major incident management network. Recommendations include the need to relate theory and practice in the development of multi-agency decision-making via simulation-based training and to deepen our understanding of interoperability to prevent inertia in high risk, high stake major incident environments.

A taxonomy of endogenous and exogenous uncertainty in high-risk, high-impact contexts.

By reference to a live hostage negotiation exercise, this study presents a taxonomy of uncertainty that can be usefully applied to assist in the categorization and application of findings from decision-making research conducted in naturalistic (specifically critical incident) settings. Uncertainty was measured via observational methods (during the exercise and by reference to video footage), decision logs, and postincident simulated recall interviews with trainee police officers. Transcripts were coded and analyzed thematically. Uncertainty was dichotomized as deriving from either endogenous sources (about the problem situation itself) or exogenous sources (about the operating system that is dealing with the incident). Overall, exogenous uncertainty (75%) was more prevalent than endogenous uncertainty (25%), specifically during discussions on plan formulation and execution. It was also qualitatively associated with poor role understanding and trust. Endogenous uncertainty was more prevalent during discussions on situation assessment and plan formulation. The taxonomy provides a useful way for organizational researchers to categorize uncertainty during the naturalistic observations of workplace interactions and decision making. It reduces the complexity associated with observational research to allow organizational psychologists to better tailor their recommendations for reducing uncertainty. Dealing with endogenous uncertainties would entail targeting decision making specific to the problem incident (e.g., introduce training or policy to reduce redundant fixation on rote-repetitive superordinate goals and focus on more short-term actionable goals during situation assessments). Dealing with exogenous uncertainties would entail improving decision making relating to management and team processes across critical incidents (e.g., training to clarify distributed roles in critical incident teams to aid plan formulation and execution). Organizational researchers interested in uncertainty management in the workplace should utilize this taxonomy as a guide to (a) categorize uncertainty and (b) generate applicable recommendations from their findings.

Offence or defence? : approach and avoid goals in the multi-agency emergency response to a simulated terrorism attack

When operating in multiteam settings, it is important that goals are cohesive between team members, especially in high-stakes, risky, and uncertain environments. This study explored goal consistency during a multiteam emergency response simulation. A total of n = 50 commanders from the UK Police Services, Fire and Rescue Services, and Ambulance Services took part in a simulated terrorism exercise, who were split into n = 13 teams. Each team responded to the same simulated terrorist event, which was based on a ‘Marauding Terrorist Firearms Attack’ (MTFA) at a city centre train station. Data were collected using electronically time-stamped ‘decision logs’ and post-incident questionnaires that measured team members’ self-reported goals. Goals that were ‘attack’ focussed (e.g., ‘treat patients’) were coded as ‘approach’ (i.e., focussed on achieving positive outcomes) and goals that were ‘defence’ focussed (e.g., protect emergency responders) were coded as ‘avoid’ (i.e., focussed on avoiding negative outcomes). It emerged that different agencies prioritized different goal types; Fire commanders initially prioritized avoid goals but then increased approach orientations, Ambulance commanders were consistently approach oriented, and Police commanders showed goal conflict (tensions between adopting approach and avoid goals). Despite goal differences, participants rated that their interagency goals were consistent in a post-scenario questionnaire, suggesting that commanders were unaware of the nuanced differences between their agency-specific objectives. At the multiteam level, teams who predominantly held attack/approach goals were significantly faster at decision logging early in the incident, yet defend/avoid teams were faster at decision logging later into the incident. Implications for multiteam coordination are discussed.

Redundant Deliberation About Negative Consequences: Decision Inertia in Emergency Responders.

Major emergencies are high-stakes, ambiguous, dynamic, and stressful events. Emergency response commanders rely on their expertise and training to mitigate these factors and implement action. The Critical Decision Method was used to interview 31 commanders from the police (n = 12), fire and rescue (n = 15), and ambulance services (n = 4) in the United Kingdom about challenges to decision making. Transcripts were analyzed in 2 ways: (a) using thematic analyses to categorize the challenges to incident command and (b) grounded theory to develop a theoretical understanding of how challenges influenced decision processing. There were 9 core challenges to incident command, themed into 2 categories: (a) those relating to the perceived characteristics of the incident itself; and (b) those relating to uncertainties about (inter)personal dynamics of the team(s) responding. Consideration of challenges featured prominently in decision makers’ prospective modeling, especially when thinking about goal accomplishment (i.e., What if I deploy now? What if I do not?). Commanders were motivated to save life (attack/approach goal), yet also sought to prevent harm (defend/avoid goal). Challenges led commanders to redundantly deliberate about what to do; their prospective modeling was related to the anticipation of potential negative consequences that might arise both for acting (attack) and not acting (defend). Commanders identified this difficult trade-off, yet described how experience and their responsibility as a commander gave them confidence to overcome decision inertia. Future research is needed to identify whether decision making training on how to anticipate and overcome difficult cognitive trade-offs would lead to more flexible and expedient commanding.

Extreme Teams : Towards a Greater Understanding of Multi-Agency Teamwork During Major Emergencies and Disasters

Major emergencies are extreme team decision making environments. They are complex, dynamic, high-stakes and fast paced events, wherein successful resolution is contingent upon effective teamwork. Not only do emergency teams coordinate at the intrateam level (e.g., police team), but they are increasingly required to operate at the interteam level (e.g., police, fire and ambulance teams). This is in response to the desire for networked and cost-effective practice and due to the evolving nature of modern threats, such as extreme weather events and terrorist attacks, which require a multi- rather than single-agency response. Yet the capacity for interoperability between emergency teams is under researched and poorly understood. Much of the teamwork research is based on student-samples or in artificial lab settings, reducing the salient contextual demands of emergencies (e.g., high-stakes, meaningful risk). Furthermore, the minimal research that has been conducted has tended to provide broad descriptive accounts of challenges faced during emergencies, but failed to develop and test solutions. This article identifies what is known about emergency teams and highlights why it is an important and timely area for research. It will focus on the challenges and solutions to three areas of team processing: cooperation, coordination, and communication. Future research must have a solutions-focused approach. This can be oriented around areas: training, sociotechnical networks, and policies/procedural guidelines. Greater collaboration between academics and practitioners can grow knowledge in this domain, ensuring that interventions to improve emergency teamwork are both contextually grounded and empirically validated.

Intensive care decision-making : Identifying the challenges and generating solutions to improve inter-specialty referrals to critical care

Introduction Decision-making regarding admission to UK intensive care units is challenging. Demand for beds exceeds capacity, yet the need to provide emergency cover creates pressure to build redundancy into the system. Guidelines to aid clinical decision-making are outdated, resulting in an over-reliance on professional judgement. Although clinicians are highly skilled, there is variability in intensive care unit decision-making, especially at the inter-specialty level wherein cognitive biases contribute to disagreement. Method This research is the first to explore intensive care unit referral and admission decision-making using the Critical Decision Method interviewing technique. We interviewed intensive care unit (n = 9) and non-intensive care unit (n = 6) consultants about a challenging referral they had dealt with in the past where there was disagreement about the patient’s suitability for intensive care unit. Results We present: (i) a description of the referral pathway; (ii) challenges that appear to derail referrals (i.e. process issues, decision biases, inherent stressors, post-decision consequences) and (iii) potential solutions to improve this process. Discussion This research provides a foundation upon which interventions to improve inter-specialty decision-making can be based.

Decision-making in intensive care medicine – A review:

Decision-making by intensivists around accepting patients to intensive care units is a complex area, with often high-stakes, difficult, emotive decisions being made with limited patient information, high uncertainty about outcomes and extreme pressure to make these decisions quickly. This is exacerbated by a lack of clear guidelines to help guide this difficult decision-making process, with the onus largely relying on clinical experience and judgement. In addition to uncertainty compounding decision-making at the individual clinical level, it is further complicated at the multi-speciality level for the senior doctors and surgeons referring to intensive care units. This is a systematic review of the existing literature about this decision-making process and the factors that help guide these decisions on both sides of the intensive care unit admission dilemma. We found many studies exist assessing the patient factors correlated with intensive care unit admission decisions. Analysing these together suggests that factors consistently found to be correlated with a decision to admit or refuse a patient from intensive care unit are bed availability, severity of illness, initial ward or team referred from, patient choice, do not resuscitate status, age and functional baseline. Less research has been done on the decision-making process itself and the factors that are important to the accepting intensivists; however, similar themes are seen. Even less research exists on referral decision and demonstrates that in addition to the factors correlated with intensive care unit admission decisions, other wider variables are considered by the referring non-intensivists. No studies are available that investigate the decision-making process in referring non-intensivists or the mismatch of processes and pressure between the two sides of the intensive care unit referral dilemma.