Cultural influences in crisis decision-making: an emergency operations centre case study in Qatar

Healthcare facilities operate in multi-risk locations and certain of these risks may arise as a result of environmental, technological, or societal causes such as fire, flooding, power outages, or violent crime. Such unplanned events may impact healthcare functioning and cause substantial disruption to normal operations or serious harm to people, property, or the environment. Emergency response and recovery arrangements are therefore an essential component of safeguarding healthcare facilities and personnel from the effects of such unplanned events. Similarly, this case study is situated at a healthcare campus located in Qatar and considers how that organisation addresses its response to various onsite incidents by means of an emergency response and recovery team (ERT).

The ERT at the case site comprises a migrant workforce with specialized training to react to complex workplace incidents and operate in a dynamic risk environment. They are the first to arrive at the scene of an incident and are required to resolve events as quickly and effectively as possible to minimise impact to people, the environment, or property. This case study highlights that while the ERT diligently respond to workplace incidents, their role is daunting as they routinely experience staff and bystanders who are uncooperative and at times openly hostile to their instructions. This situation has an adverse influence on ERT decision-making behaviour and effectiveness, due to their perception of not only situational, but also personal risk. This risk perception can be understood as the way ERT personnel handle risk within a specific social context. It is a highly personal process and decision-making is based on an individual’s frame of reference developed over their lifetime.

For the case site then, it is essential to understand the relevant factors of risk culture and their interaction in order to enhance ERT risk competence and decision-making capability. Hence, this case study considers not only the source of the uncooperative behaviour by looking into the dimensions of individuals (Stanovich, West & Toplak, 2008; Glazer & Karpati, 2014; Yates & de Oliveira, 2016), but also the social interactions (Kahneman, 2011), and organisational structures (Nientied et al, 2019; Bonet, 1997) which exert their influence on crisis decision-making behaviour.

A sample of 17 individuals within the ERT occupation were included for the purpose of this case study. The participants were made up of firefighters, security officers, hazmat responders, control centre operators, and emergency medical services.

The case study recognises that the influence of culture on decision-making is carried out primarily through shared beliefs and values that form a stable set of underlying assumptions among members of a specific group. Thus, the multi-cultural nature of the case site overlays an inquiry of the human factors associated with cognition, cultural diversity, and ideological supports which are representative of decision criteria influencing individual judgement (Ramlall, 2008; Boin & 't Hart, 2003). In this way the case study examined the following themes,

(a) The unique coordinated social behaviour or identity, associated with membership of a specific racial and ethnic group,
(b) The influence of cultural signals and norms in shaping how individuals construct and impose meaning on a situation,
(c) The assigning of probability weights to a problem, in order to form a personal judgment,
(d) The role of self-esteem as enabler of workplace engagement and effective decision-making.

By means of semi-structured interviews and applying reflexive thematic analysis the case revealed numerous factors related to a national dominant culture that directs the norms, beliefs, and basic social processes, due to its economic and power means to impose them. This has in turn revealed a wide range of affective, cognitive, contextual, and individual factors influencing how ERT personnel process information, perceive risk, and make judgments (Klein, 2003; Nutt, 1998; Simon, 1991).

Implications and suggestions for future research are discussed, including the requirement for additional ERT training that consider the situation of first responders as well as the need for workplace awareness and trainings to promote positive social change.