Pressure can put personal relationships under strain, and it can also lead people to avoid confrontation altogether. In crisis situations, the imperative to pull together sometimes leads the group to reach consensus on decisions before other options have been fully explored; leaders should encourage team members to tell them when they’re wrong and to deliver bad news when necessary.
Smith, who has been working with NHS decision-makers, notes that in high pressure situations, communication generally needs to be “short, sharp and clear”, sometimes to the point of abrasiveness. He told me that less experienced staff, like junior doctors, can find that quite hard, and senior staff should prepare them for it.
‘Focus on the goal’
Plans, drills and guidelines are essential, and so is a degree of adaptability. Alison advises decision-makers to “focus on the goal, not the decision”.
He cites the example set by the American police officer Stephen Redfearn, one of the first on the scene at a mass shooting in a cinema in Aurora, Colorado, in 2012. When Redfearn arrived he saw severely wounded movie-goers, some of them children. It was against policy to transport injured people in police cars, but the ambulances were having trouble getting to the cinema. Redfearn knew that unless he did something, some of the wounded would die. He took what he later described as a “crazy and unorthodox” decision, ferrying injured children in his car to local hospitals. What Redfearn did was “brave and creative and right”, says Alison; he kept his eye on the goal of saving lives. Alison notes that staff on the ground, who often have better information than superiors about unfolding events, should be empowered to improvise.
Redfearn, who now helps trains first responders in emergencies, has revealed that the Aurora incident extracted a steep emotional toll from him. The agony of the decisions he took that night – whom to save, whom to leave behind? – took years to recede. Once this crisis is over, let’s try and remember that those who have taken the most consequential decisions on our behalf will carry a heavy weight for a long time to come.
