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  • Lauren Tufton

High Stakes Decisions: Riding the Waves of Surgery, Stocks, and Sailing.


In a high-stakes environment, the ability to process information quickly, make accurate assessments and fast decisions is crucial to success, and in the medical world, the stakes don’t get any higher than the operating theatre. Surgeons are meticulous in their preparation for an operation. A preoperative plan is drawn up with outcomes predicted, then follows the pre-performance routine - gowned, gloved and scrubbed, they enter a spot lit theatre, every instrument, every machine, positioned and ready for action. The habituation of this process leaves the surgeon free to attune themselves to their specific task; repair the body on the table. Every fluctuation in heart-beat, every tissue, nerve, and muscle, the surgeon is sensitive to every detail. Each surgery is conducted as a continually cyclical process of assessment, reconciliation, and implementation between the surgeon and the immediate environmental constraints. The body provides feedback to the strategies implemented by the surgeon, and sometimes imposes unexpected challenges to the plan. When this occurs, an expert surgeon draws upon a catalogue of experience whilst gaining and transforming new information, to make fast complex decisions about how to proceed, but at the same time, retains the foresight and clarity of the big picture.

An expert stock trader too, always has one eye on the futures. Anticipation of market behaviours is an essential skill on the trading floor. Through pattern recognition and experience, the wise trader creates a memory bank of strategies, constraints, and behaviours for future reference. A wider awareness of seemingly extraneous affordances that may inform the markets and determine buyer behaviour, is vital to remain ahead of the competition. Interestingly though, recent decision making research has brought its focus a little closer to home. Interoception is the ability to sense physiological signals in the body as indicators of novel situations, or in plain English, it simply means listening to your guts. Targeting some of the most primitive and instinctive elements of the brain, the production of testosterone and adrenaline alerts the body to unpredicted or irregular events, and the effect of cortisol on dopamine receptors in the brain creates a high-induced state of flow. An individual’s sensitivity to interoception is believed to be a strong indicator of effective decision making performance, as it accelerates awareness of potential changes to environmental constraints.

Heightened awareness and response to the fluidity of an environment, epitomises great sailing. In elite sport, expert performers calibrate their movements to negotiate through the environmental constraints and cross the finish line first. Whilst the wind and the waves pose a considerable force and create a highly changeable ecological system, expert sailors use these environmental forces to their advantage, subjecting the elements and competitors to their will, as Sir Ben Ainslie said in London 2012, “you don’t want to make me angry”. Self-awareness is as crucial as situational awareness at critical moments where you must decide whether to fly or to fight.

How can we apply this to our organisation?


In reality, the context and skill-set of these three domains are very different, but when it comes to making decisions, as in any high-performance environment, the same rules apply. Why? Because whether you are choosing to tack, sell, or cut, the process involves a mutuality and reciprocity between person and environment, where information is gained and transformed, at speed, to action a successful outcome.

How can we develop people to become effective decision makers?


One of the biggest challenges as a manager, coach, or company director is to relinquish control and let other individuals in your team make important decisions. The fear of the potential consequences that may ensue, overrules any inclination or faith you may have in your team to make the right decision. However, in elite sport, as in many contexts, when the whistle blows they’re on their own, so it is important that they learn how to make effective decisions. Psychologists have identified six factors that influence effective decision making; prior knowledge and experience, the context of the environment, known strategies and tactics, skill competence of the individuals involved, behavioural predisposition of the individuals involved, and the strengths of the individual within the context of the domain.

Within the realms of the decision making process there are three key coaching opportunities to improve decision making ability, the first of which is the implementation of strategies to develop the individual with respect to the above influencing factors. Awareness of self, as one half of this ecological system is essential to the decision making process, the individual must know what they bring to the table. As a coach or manager, recognising the competencies, skill-sets, and character strengths of each individual in your particular domain, and bringing those attributes into the individual’s awareness is essential. For both parties, nothing inspires confidence more than high perceived self-efficacy. As a cautionary note, however, it is prudent to recognise limitations too. For example, over-confidence without the affordances to support the action taken, in high-stakes situations, can be as equally risky as the impotence to act in the first place.

How can we create a training and performance environment that facilitates effective decision makers?


Our second coaching opportunity is the development of perceptual awareness. Whilst an expert may appear to use less information than most to formulate a decision, it is more likely that their ability lies in only filtering through to their consciousness, task-relevant information. However, those learning to become effective decision makers, must first learn to expand their perceptual bandwidth and the breadth of information gleaned from the environment. Counter-intuitively, the key to improving pattern recognition and informational processing is to make the training environment more complex. The more potential outcomes and decision making opportunities, the more scenarios are stored in the catalogue of experiences. Most importantly, the training environment allows the individual to reflect and assign meaning to the environmental cues. Whether the decision they made was successful or not, ask them to consider;

  • Why was this option the best choice?

  • What were the other options at that moment?

  • Why didn’t I choose one of the other options?

  • What are the consequences of this action?

  • Were these consequences an acceptable level of risk?

  • Would I make the same decision again, under the same conditions?

When conducting training in decision making, particularly in a high-stakes environment, it is important that the environmental constraints are as realistic to performance as possible. Whilst pattern recognition, tactics and strategies will be your bread and butter, a great football manager once said “forwards win cup matches, but defences win leagues”; the ability to cope with the unexpected is our third coaching opportunity. Through creative manipulation of the environmental constraints at unanticipated moments and then applying the same practice of action and reflection, individuals can learn the flexible adaptation required to meet novel situations in a performance environment with confidence and success.


In conclusion, a high-stakes environment relies on intuition for effective decision making. Intuition is simply a combination of interoception and experience, but when experts gain new information, they learn from it. To facilitate effective decision making, we must develop strategies to enable individuals to learn like experts.

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