Top five tips for defensible decision making in the healthcare sector

4 minute read 20.07.2020 Shane Evans, Rebecca Bedford, Kate Plowman

Leaders of healthcare organisations are making tough and rapid decisions about critical responses to the unfolding COVID-19 pandemic. What can you do now to safeguard your organisation against potential hindsight scrutiny?

Here, we share our top five tips from our recent webinar on defensible decision making.

1. Plan and prepare

Don't wait for an emergency to arise. Plan for the likely outcomes and the remote but potentially devastating outcomes in your Pandemic or COVID-19 Plan. Prepare by taking steps to mitigate against these risks. Even if unsuccessful, this will assist to demonstrate that reasonable steps were taken. Establish your framework for decision-making, by reference to your organisation's purpose and values, prioritising safety above all else. Communicate this framework well to assist staff, patients/residents/participants and those attending onsite to understand the plan and notification channels. Ensure you have 24/7 ability to call upon expertise, infection control measures, PPE, additional workforce and a broader network of health care providers.

2. Don't delay, or be rushed

While you may not have all the facts when you need to make a decision, where health is at risk, it may be worse if you wait. Do the best that you can with the available information. But don't be forced to rush a decision that is less urgent. If a key decision such as closure is under consideration, put interim protective measures in place. Be flexible and continually re-assess your decisions as new information comes to hand. In an emergency, protecting staff, patients, residents and participants is the priority, as well as reducing the prospect of community transmission.

3. Documentation is key

The decision making process is as important as the every decision made – a good decision making process, and committing your decisions to writing – will improve your decisions. Document the key facts relied upon, considerations you weighed, competing issues you balanced, the options, the evidence in support and be clear why the ultimate decision was made. Let the documents speak for themselves, evidencing that staff, patient, resident or participant safety was paramount. If at a meeting and a verbal decision was made, create a contemporaneous record as soon as possible.

4. Assume external scrutiny

Prepare for contentious decisions or matters to be the subject of an inquiry, complaint or claim. Build a file of documentation sooner rather than later and keep all relevant documentation in a single secure location. Engage proactively with your regulators in order to provide reassurance that you are managing risk appropriately.

5. Avoid the common traps

Ask probing questions and maintain a rigorous level of inquiry before embarking on decisions - don't assume that everything you are told is right. Do not rigidly stick to a decision even though circumstances are changing. Check that draft documents, such as minutes of meetings, are accurate. Consider the best mode of communication, as oftentimes phone calls or meetings are better than email chains. Don't forget to record the positive steps that you have taken such as updating policies, training of staff and communications about internal and external COVID-19 planning. Ensure that you communicate well with internal and external stakeholders, in a timely and transparent manner on an ongoing basis, about your preparations and in the event one of the identified risks arise.

In applying these considerations to the clinical scenarios, we heard that with restrictions easing and ongoing community transmission, it is reasonably foreseeable that a second surge could stretch your organisations' resources. The critical step you should take now is to properly plan and prepare, evidencing that the risks were assessed and reasonable steps were taken in response, so that you are able to demonstrate that you took appropriate action to minimise the risk of this occurring and were able to manage if the risk arose.

In applying these considerations to the workforce scenarios, during the pandemic there are many decisions that your organisation will take in relation to staff. Be mindful of your WHS obligations, ensure all directions issued to staff are lawful and reasonable, and be careful not to unlawfully discriminate. You need a COVID-19 response plan, and it should contemplate all the significant risks and decisions you might need to take, and closely follow the advice and guidance of health authorities.

If you get these basics right, while there will be still hard decisions to make, the rigour of your decision making will lead to better decisions and put you in the best position possible to respond to the risks identified. It will also be your best defence when your response to the pandemic is scrutinised in the future.