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Lessons for the NHS from high-stakes decision making

What can be learned from situations where high-stakes decisions have to be made?

“The route to making safe high-pressure decisions is high quality leadership and team work, moulding a just and safe culture. Mission rehearsal is key to getting it right when it counts; however, time needs to be made available to achieve this - can the NHS acknowledge that this time needs to be ring-fenced? Massive thanks to the panel, I learnt lots and will take ‘pragmatic pessimism’ away as my golden nugget of the day.” – Dr Jonny Hynes

“Healthcare requires clear decision making in pressurised and stretched circumstances, where the stakes can be life or death. I believe that better decision making can be developed, and I was delighted to join such an impressive panel to share ideas and find common ground. Recognising risk, navigating uncertainty, the appreciation of windows of opportunity, and pragmatic pessimism form the basis of the approach I have formed and taught across different acute settings. Stretching the conversation to leadership, culture, and risk holding was inspiring and thought provoking from an organisational standpoint.” – Dr Christopher Adcock

“High-stakes decision making in healthcare is all about managing uncertainty, complexity and competing priorities. This panel was full of the wide breadth of expertise needed to equip NHS leaders to make the very best decisions both day-to-day and during crises. I was delighted to participate and I hope these essential discussions continue to strengthen healthcare leadership in the NHS and beyond.” – Dr Gemma Bowsher

On 22 November the Intellectual Forum brought together speakers from the police, the military, and conflict zones to talk about high stakes decision making for the Midlands Decision Support Network INSIGHT22 Festival.

The NHS has developed its own culture around decision making. In this panel, curated by the Intellectual Forum, we heard from four speakers with experience of working in both healthcare and other pressured areas - the police, military, and conflict zones - to share the lessons learned from combining the two careers.


Dr Julian Huppert is Director of the Jesus College Intellectual Forum, former Member of Parliament for Cambridge and former Deputy Chair of the NHS Cambridgeshire and Peterborough CCG.


  • Dr Gemma Bowsher is a London-based orthopaedic surgeon and Co-Lead for Health Intelligence and Biosecurity, Conflict and Health Research Group at KCL
  • Dr Jonny Hynes is currently an Occupational and Aviation Medicine Doc in the RAF with another specialist interest of Medical Safety. He spent 16 years as fighter pilot in Tornado and Eurofighter aircraft involving multiple overseas ops
  • Dr Chris Adcock is a Consultant in Acute Medicine, Cambridge University Hospitals Foundation Trust, and former Wing Commander, Royal Air Force
  • Karen Daber DL was a Chief Office in the Police, and now NED at the Cambridgeshire and Peterborough NHS Foundation Trust and a Deputy Lieutenant.