Right now, NHS leaders are being asked to make long-term decisions when even the immediate working landscape is uncertain. To make informed choices and defensible decisions in this situation, leaders need to capture all the available data, identify gaps and work through the possible scenarios.

Stay aligned with your core principles and those of your organisation. Your values should be at the heart of your decision making; using them as guiding beliefs will help you make better choices. When you get it wrong—as we all do sometimes—if your rationale shows that you were acting with honesty (no hidden agenda), integrity (no personal gain) and transparency (clear documented reasoning), it will be easier to defend your decision under scrutiny.

What’s the objective? What’s your end game? Keep your focus on what you want to achieve. There will always be compromises and changes to your plans, but these should not be to the detriment of the required outcome. Defining what success looks like will help you to filter out any distractions.

How reliable is the information you’re working with? Is it from a trustworthy source? If it’s anonymous or untested, be clear about that and give it less weight than something that you know is true without reservation. Document what is fact, any constraints and your working assumptions.

Using hypotheses allows you to make educated guesses to guide your decision-making. They serve as initial explanations based on your existing knowledge, helping you to predict outcomes and test assumptions. By narrowing possibilities and focusing your attention, hypotheses can reduce uncertainty, enabling quicker, more strategic choices. Well-formed hypotheses provide direction and can be refined or discarded as new data becomes available.

If you’re unfamiliar with the area, which experts can help? They can’t and won’t make decisions for you, but they’ll give you a strong foundation to work from, providing new possibilities or ruling out some of your initial hypotheses. Seeking a range of views and opinions will help you to see things from different perspectives.

Is the risk and threat posed by the problem so great that you need to make a decision now? If not, when do you need to make it? How much time have you got to think it through and gather more information? Some of my best decisions were made the following day; it’s amazing how your mind works, even when sleeping, so that something that seemed complex can suddenly seem straightforward 24 hours later. But equally, a timely decision can be better than a seemingly perfect one taken too late.

With challenging decisions, it can be tempting look for a different approach to your normal one. This may be necessary sometimes, but sticking to your tried and tested methods can help bring clarity and confidence to your decisions.

A wrong decision can be justified based on the information known at the time and the reasonableness of your decision. Own it, don’t try to pass the blame or make excuses. When you become aware of new information, review your original decision and don’t be afraid to change it if necessary. Learn from results and adapt.

Consider worst-case and best-case scenarios. Ask yourself: “what’s the cost of being wrong?” If the consequences are serious, test small and use the results to verify your choice or amend where appropriate. Is not responding a worse outcome than taking action?

The more limited the information, the more challenging the decision, particularly when the outcome is important. There is always a risk of procrastination and imposter syndrome creeping in. Remember you’re in the job on merit and because of your past successes—be confident in your ability. If it’s ‘gut instinct’, write down what’s forming your view; this will help you to rationalise your thought process and support your choices. //