Decision-making under crisis: insights from the health service sector

PurposeThis study aims to assess National Health Service (NHS) decision-making protocols during the pandemic, with two primary objectives: (1) to establish whether decision-making protocols changed during the pandemic and (2) to evaluate if these changes could inform future decision-making strategies beyond the pandemic. By focusing on the shift from traditional to emergency decision-making processes, this research seeks to derive actionable insights for enhancing policy and practice in crisis conditions.Design/methodology/approachWe employ a mixed-methods approach, gathering data through an online survey targeted at senior NHS decision-makers involved in the pandemic response. Our survey collected quantitative and qualitative data to assess changes in decision-making protocols. The analysis included statistical techniques to quantify changes and thematic analysis to explore their implications, providing a detailed understanding of decision-making adaptations during the crisis and their potential future impact.FindingsOur findings clarify the role of the NHS values and constitution, which prioritize patient welfare, dignity and equitable access to healthcare, guiding all decision-making. During the pandemic, the urgency to respond swiftly necessitated modifications to these guiding principles. Traditional processes were adapted, allowing for more rapid decision-making while still aligning with the core values, effectively balancing immediate response needs with long-term healthcare commitments.Research limitations/implicationsOur research contributes to decision-making under crisis conditions within a healthcare context and brings together a theoretical background which has accommodated the development of models and approaches that can be utilized by both service and manufacturing organizations. In addition, we have sought to bring together the importance of decision-making protocols under crisis conditions using observations from respondents who experienced decision-making at a senior level prior, during and beyond the period of the COVID-19 pandemic, which has assisted in the models developed in this paper. In addition, our empirical research demonstrates the importance that the values of the organization have upon decision-making and how such values need to be adjusted in the light of crisis operations.Practical implicationsOur research provides insightful observations relating to the pressures upon decision-making protocols under crisis conditions and provides senior decision-makers with an approach to realigning values to cope with unusual and highly pressurized operating environments. Notably, there is a clear requirement for decision-makers to communicate clearly to staff the need to temporarily alter the modus operandi to reflect crisis operations.Originality/valueTo the best of the authors’ knowledge, this is the first study to explore decision-making in the NHS during a pandemic and to clearly demonstrate how such decision-making needs to be adapted to reflect the nature and scope of delivering a complex healthcare service under crisis conditions.