Improving Professional Decision Making in Situations of Risk and Uncertainty: A Pilot Intervention

Social workers and other professionals providing mental health services are regularly required to make high-stakes decisions in situations characterised by conflicting demands. To better understand the factors that drive clinical decision making in situations of risk and uncertainty, we used a design-based research framework to pilot a new approach for improving professional decision making. The programme, which combined simulated interviews, a master class series and personal monitoring of real-time decisions, was designed to focus explicit attention on biological, emotional, cognitive and contextual influences on decision making. Preliminary results from a pilot study suggest that during and immediately following the intervention, clinicians demonstrated new insights into their decision making processes. In addition, they reported benefitting both from the opportunity to reflect individually and share reflections with others. Physiological data demonstrated an association between stressful decisions in real-world clinical practice, elevated heart rate and emotional responses. Qualitative data suggested that client risk represented only one aspect of decision making that resulted in emotional and physical responses, and others included team dynamics, socio-evaluative stressors and organisational and societal factors. This innovative decision making programme creates new opportunities for integrating research, practice and education and shows promise of improving social work practice.