Leading Under Pressure: Decision-Making Strategies for Health Care Leaders in Asia Pacific

In today’s rapidly evolving health care landscape, leaders are facing unprecedented challenges. Rising patient demand, limited resources, complex organizational structures, and the pressures of public accountability are converging to create an environment where every decision carries high stakes. For health care leaders across Asia Pacific, these challenges are compounded by diverse political, social, and economic contexts that demand agility and clarity from leaders more than ever before.

Yet, despite the critical nature of decision-making under pressure, many health care leaders have not received formal training in this essential competency beyond the clinical or operating room setting. While physicians are trained to act quickly for individual patients, the broader skill sets required to lead teams, manage potential crises, and navigate strategic complexities often remain underdeveloped. This gap creates the risk of leaders reacting emotionally or hesitating in moments that require decisive thinking, according to Eric J. McNulty, associate director of the Harvard T.H. Chan School of Public Health’s Program for Health Care Negotiation and Conflict Resolution, and a faculty member in the Leadership in Medicine: Asia Pacific program. McNulty has spent years studying and training leaders who operate in high-stakes environments—from hospitals and corporate boardrooms to national emergencies and disaster zones.

Cultivating Decision-Making Under Pressure

McNulty explains that decision-making under pressure is not an innate talent, but a skill that can be cultivated and refined. “It’s like going to the gym. You can build muscle memory so that when you’re under pressure, you default to your training and habits instead of reacting from emotion.”

For health care executives in Asia Pacific, developing this muscle memory is vital. Decisive modernization of health systems and increasing demands require leaders who can maintain composure, focus on core values, and guide their teams effectively—even when crises arise unexpectedly. McNulty stresses that effective crisis decision-making is grounded in deliberate preparation, practice, and reflection. “Leaders must be prepared,” he says. “They need the skills in advance to respond confidently when pressure hits.”

Key Conflict Resolution Practices

Leaders can look to crisis management and conflict resolution training as powerful sources of insight. These fields offer proven principles and habits that, when internalized, enable leaders to respond effectively under pressure. McNulty shares eight key competencies drawn from conflict resolution practices that can significantly enhance health care leaders’ decision-making capabilities: 

1. Separate the people from the problem.
Under pressure, emotions escalate quickly, and it’s easy to mistake personal frustrations for the actual issues needing resolution. “If you start pointing fingers in the middle of a crisis, it creates fear, stifles initiative, and clouds judgment,” warns McNulty. Leaders must deliberately separate interpersonal dynamics from the substantive problem, focusing discussions on the challenge itself rather than the personalities involved.

In health care settings, this means depersonalizing conflicts to reduce defensiveness and foster collaboration. For example, when resources are scarce, instead of accusing departments of hoarding, frame the conversation around shared goals such as patient safety to encourage joint problem-solving. This practice creates psychological safety and encourages open communication that will be more productive.

2. Focus on interests, not positions. 
Under pressure, leaders often default to defending fixed positions—which can limit creativity and stall progress. Effective leaders, however, look beneath those positions to uncover the underlying interests: the motivations, concerns, and needs that truly matter. “When people don’t know who is in charge or who is supposed to do what, decision-making falters,” McNulty says, adding that clarifying interests, roles, and expectations helps define priorities and opens paths to compromise.

3. Develop options for mutual gain. 
McNulty encourages leaders to avoid zero-sum thinking and instead “think beyond win-lose games” by creating options where all stakeholders benefit. This requires creativity and openness to new approaches.

4. Use objective criteria. 
Under pressure, decisions risk being swayed by politics, biases, or emotional reactions. McNulty highlights the importance of anchoring choices in objective criteria—such as data, evidence, ethical principles, or organizational values. “The best decisions come when people feel the process is fair and grounded in facts,” he says.

5. Practice active listening. 
Active listening is often overlooked but is fundamental to effective decision-making under pressure. McNulty stresses that “when people feel heard, they are more willing to collaborate and share critical information, even under stress.” This involves not just hearing words but also seeking to understand underlying concerns and perspectives without rushing to judgment.

6. Acknowledge emotion without letting it drive the process.
 Emotion in crisis is inevitable, but McNulty warns against letting it control decision-making. He advises leaders to “acknowledge the feelings without letting them hijack the process.” Validating emotions such as anxiety or frustration creates connection and trust, but maintaining composure ensures clarity and focus.

7. Create psychological safety. 
Psychological safety—the assurance that team members can speak up without fear of punishment—is crucial for candid communication and initiative during crises and day-to-day operations. “Leaders who create this safety encourage honest communication, which improves decision-making under pressure,” McNulty says.

8. Plan for follow-up.
Finally, McNulty emphasizes that decisions are part of an ongoing process, not one-time events. “Leaders should be humble enough to say, ‘We made a decision based on what we knew at the time. We’ve now learned more, so we’re changing course,’” he advises. Establishing mechanisms to monitor outcomes, collect feedback, and adjust plans keeps responses effective and relevant.

Prepare to Lead Decisively

By mastering these eight competencies and embedding them into daily leadership practice, health care leaders across Asia Pacific can build the confidence, clarity, and resilience required to lead decisively. In a region where the pace of change is accelerating and uncertainty is constant, McNulty offers a timely challenge: “Will you be ready when the moment chooses you?”