Decision Making under Pressure: From Emergency Rooms to Space Missions, Many Decision-Making Situations Allow No Room for Error. an ER Physician Reflects on What Went Wrong as Flight Managers Assessed the Potential Damage on the Space Shuttle Columbia

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I was working a late night shift as an emergency-room physician in February 2003, shortly after the space shuttle Columbia disaster that resulted in the death of seven astronauts. As I reflected on the disaster, one persistent thought troubled me: If the best and brightest of NASA management could not avoid such disastrous outcomes from their decision making, what hope was there for me and my decision skills in the emergency room? What could I learn from this disaster?

My "Shuttle Thinking" model resulted from those rare, quiet moments when I would put my feet up on my desk and try to analyze my own decision-making process, searching for ways to improve it. I studied the Columbia disaster and compared it to my own style of making decisions. If the Columbia had been a patient, what would I have done differently? How could I improve my own decision process and then share it with others? "Shuttle Thinking" is what I now call a set of five common pitfalls that I believe undermine our critical decision-making process.

Five Pitfalls in Critical Decision Making

To improve my decision-making process, I now consciously examine the impact of Shuttle Thinking on every high-level decision I make, using the Columbia disaster as an example. Other examples could also serve to illustrate common decision-making pitfalls--the meltdown of large financial institutions, government decisions involving Hurricane Katrina, or the …