Investigating Ohio Health Commissoners' Perceptions and Experiences with Respect to Decision-Making During the COVID-19 Pandemic

Abstract

Background: Public Health (PH) leaders debate the effectiveness of their decisions on controlling the COVID-19 pandemic. Varying decisions across states and localities illustrate the difficulty of decision-making when confronted with complex and unexpected challenges in PH. Psychologists often frame decision-making as reflecting one of two systems. System 1 is based on experience and instinct. System 2 is based on data and analysis. In PH, many efforts are directed toward supporting evidence-based decision-making; however, scholars confirm that skills and experience play a substantial role in shaping decisions. Skills and experiences appear to become more influential in decisions associated with high-stakes situations, where individuals will depend more on their cognitive, interpersonal, and behavioral skills and less on data because of uncontrollable constraints, such as time, information, and uncertainty. The purpose of this study is to generate a better understanding of the decision-making processes used by Ohio local health commissioners (HCs) as they were dealing with COVID-19 high-stakes situations.

Study aims include: examining the thinking styles of expert and novice Ohio HCs regarding decision-making in the context of COVID-19-associated high-stakes situations; identifying factors that impact the decision-making preferences and practices during these situations; and exploring the contextual factors that HCs consider when faced with COVID-19 decisions.

Methods: The study applied a convergent mixed-method approach. Quantitative methods were applied to a cross-sectional survey data where the Rational-Experiential Inventory-40 survey was used to measure individual differences and their relationships with expressed preferences for using System 1 and 2 thinking. An ANOVA and paired t-test were used to assess differences between Public Health Officials’ (PHOs) experience levels and preferred decision-making systems. Multiple linear regression analysis was used to identify factors associated with preferred system thinking. The Critical Decision Method, a semi-structured interview protocol, was used to discover contextual factors that influence the decision-making process of HCs in COVID-19 situations. A thematic analysis was used to analyze the qualitative data.

Findings: This study found that Ohio HCs prefer using rational over experiential thinking during COVID-19 situations. There were no consistent documented differences between novices and experts except for the reported status of their networks and relationships. The study also identified contextual factors that appeared to influence HCs’ decision-making processes. Themes that emerged from the interviews in relations to these factors included vagueness and uncertainty, senses of urgency, regulation and guidance, autonomy and sense of responsibility, prior experience, networks and relationships, effective communication and teamwork, cognitive skills, and personality traits.

Implications: The results inform scientific knowledge and can be used to aid development of hazard-focused training programs and PH curricula. Equipping the PH workforce with necessary leadership competencies to face high-stake situations is an important protective factor to help counteract other uncontrollable factors that arise within the PH sector, including lack of information, time, and budget. The work presented here may be used to improve PHOs' performance, which can lead to better service delivery. Results from this study are also available to preparedness planners to assist in LHDs’ After-Action Reviews/Improvement Plans.