Authors say uncertainty can improve high-stakes decisions

A Fortune commentary says leaders facing high-pressure decisions may improve outcomes by delaying premature action and studying uncertainty more deliberately. The authors argue that surgeons and executives face a similar pull from patients, families, boards and markets to act before the situation is clear.

James G. Naples, an assistant professor at Harvard Medical School and surgeon at Beth Israel Deaconess Medical Center; Wendy K. Smith, a University of Delaware professor and author of Both/And Thinking; and Scott D. Anthony, a clinical professor at Dartmouth’s Tuck School of Business and author of Epic Disruptions, describe the idea as the “uncertainty paradox.” In their framing, decision-makers can gain more confidence by spending more time with unresolved facts rather than rushing to close them down.

Naples cites a case involving a patient with a serious infection who expected surgery. According to the authors, he chose monitoring over an immediate operation after weighing the risks, and the patient recovered without surgery.

The authors use that episode to argue that inaction can be an active decision when it is deliberate and closely watched. They compare that pressure with the business setting, where boards and peers may demand a plan even when the best response is to wait, test assumptions and bring in dissenting views.

Three practices from surgery

The commentary lays out three practices the authors say can help leaders work through uncertainty: move toward the uncomfortable facts, keep adjusting between competing risks, and pause when a room is moving too quickly toward agreement.

For the first practice, the authors point to the development of cochlear implants. They say early resistance came from doctors concerned about outcomes, patients who did not want to be treated as test cases, and members of the public who feared the technology represented a step toward “bionic” humans. The authors say cochlear implants later became widely accepted and helped deaf children and adults hear, learn to speak and enter settings that had been closed to them.

They also cite neurosurgeon Harvey Cushing, who approached pituitary tumors through the nose at a time when other surgeons used more established methods. According to the authors, Cushing’s route reduced deaths compared with the accepted practice and helped set a new standard.

In business, the authors point to Zita Cobb, the former chief operating officer of JDS Uniphase, who returned to Fogo Island in Newfoundland and backed a luxury inn as part of a rural development effort. The authors say Cobb faced local resistance and the risk that global attention could damage the culture she hoped to support, but they credit the project with helping the island’s economy and serving as a model for rural community building.

Pausing before consensus

The second practice, which Smith calls “tightrope walking,” centers on constant adjustment between risk and reward. The authors use Gord Lambert’s work creating the Canadian Oil Sands Innovation Alliance as an example, saying he pushed competing companies to share intellectual property, pool research and invest together in environmental innovation while trying not to alienate CEOs in the industry.

The third practice is a deliberate pause. The authors cite a story about former General Motors chief Alfred Sloan, who reportedly delayed a decision after hearing unanimous agreement so the board could develop disagreement and better understand the issue.

The commentary also cites an analysis of more than 100 German CEOs after the European Union’s 2004 enlargement. According to the authors, executives who paused and approached the change with detached curiosity outperformed more action-oriented peers by considering more options, including more varied voices and responding with more novel measures.

The authors conclude that uncertainty is not just something leaders endure. In their view, resisting the institutional demand for instant resolution can produce better decisions in medicine and business.

This story draws on original reporting from Fortune.