Leadership in Practice: Making Decisions Under Pressure

There are very few perfect decisions in health and social care. Most leadership decisions are made with incomplete information, limited time, competing priorities and the knowledge that someone will probably disagree with you. That isn’t poor leadership. That is leadership.

The aim is not to make perfect decisions every time. The aim is to make considered decisions, communicate them clearly and be prepared to adapt if circumstances change.

Pressure Changes the Way We Think

When we’re under pressure our brains naturally move into survival mode. We become more reactive.

We may rush to solve the first problem we see, delay difficult conversations, or become paralysed by the fear of making the wrong choice. The challenge is recognising when pressure is influencing your thinking rather than the facts.

Sometimes the best decision you can make is simply to pause for five minutes.

Separate Facts from Emotions

Before making any significant decision, ask yourself:

• What do I know for certain?
• What assumptions am I making?
• What information am I still waiting for?
• Am I reacting emotionally or responding professionally?

Separating fact from emotion creates clarity.

It doesn’t remove pressure, but it stops pressure from driving the decision.

You Don’t Need Every Answer

One of the biggest mistakes leaders make is believing they must know everything before deciding. In reality, waiting for perfect information can become a decision in itself, and often the wrong one.

Good leaders gather enough evidence to make the safest and most informed decision possible, while remaining willing to change course if new information emerges. Changing your mind when the evidence changes isn’t weakness. It’s good leadership.

Think Beyond Today

When you’re under pressure it’s tempting to solve today’s problem without considering tomorrow’s consequences. Ask yourself:

• How will this affect the people we support?
• How will this affect my team?
• Will this still feel like the right decision next week?
• Am I solving the root cause or simply relieving today’s pressure?

Sometimes the quickest solution creates the biggest problem later.

Communicate with Confidence

Even difficult decisions become easier for teams to accept when they understand why they have been made. People may not always agree, but they deserve honesty, consistency and transparency.

A calm explanation often builds far more trust than trying to appear certain about something that is genuinely uncertain.

Learn Without Blame

Every leader makes decisions they later wish they had handled differently. The important question isn’t: “Did I get everything right?”

It’s: “What have I learned that will help me next time?”

Experience is built one decision at a time. The leaders people admire most are rarely those who never make mistakes—they are the ones who learn from them.

A Note from the Editor

One lesson that has taken me years to learn is that not making a decision is usually a decision in itself. I’ve spent nights lying awake worrying about getting something wrong, only to realise later that delaying the decision often caused more stress than the decision itself.

I’ve also learned that there is no such thing as pleasing everyone. As leaders, we have to make decisions based on the information available at the time, knowing that new information may emerge tomorrow. That doesn’t mean the original decision was wrong, it means circumstances changed.

Today, when I feel under pressure, I ask myself one simple question: “What is the best decision I can make with what I know right now?”

If I can honestly answer that question, I make the decision, communicate it clearly and move forward.

Leadership isn’t about certainty. It’s about having the courage to decide, the humility to listen, and the confidence to adapt when needed.

Leadership Checklist

DO

✔ Pause before reacting.

✔ Separate facts from assumptions.

✔ Ask for advice when you need it.

✔ Consider the long-term impact.

✔ Be prepared to explain your reasoning.

✔ Accept that some uncertainty is unavoidable.

✔ Review decisions afterwards and learn from them.

✔ Remember that changing direction when evidence changes is a strength, not a weakness.

DON’T

✖ Make important decisions when emotions are running high.

✖ Delay decisions because you’re waiting for perfection.

✖ Assume you have to solve every problem alone.

✖ Let fear of criticism stop you from acting.

✖ Ignore the impact on your team and the people you support.

✖ Defend a poor decision simply because you’ve already made it.

✖ Believe every decision has only one “right” answer.

✖ Forget that leadership is about progress, not perfection.

Stay Connected with The Daily Round

This article is part of our Leadership in Practice series, created to support the people who dedicate their careers to caring for others.

Over the coming months, we’ll be expanding our Lifestyle section with practical advice, expert insights, book and podcast recommendations, money-saving ideas, travel inspiration, health features and everyday wellbeing content designed specifically for those working across health and social care.

Register with The Daily Round to receive the latest articles, wellbeing resources and sector news delivered straight to you.

Most importantly, we want this to be your community. Tell us what matters most to you, suggest topics you’d like us to cover and share your feedback so we can create content that is genuinely useful, relevant and shaped by the people who work in the sector every day. We are always listening at newsdesk@dailyround.news

Have your say, because the best content starts with listening.