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Cognitive biases in fitness to practise decision-making: from understanding to mitigation

10 Jun 2021 | Leslie Cuthbert
  • Research Papers

We might believe our conscious mind is in the driving seat when we are making decisions - but there are all sorts of factors coming into play behind the scenes - cognitive biases. We asked an expert to look at cognitive bias specifically in fitness to practise - read his advice in this report.

What do we mean by cognitive bias?

‘Cognitive biases are mental shortcuts which reduce the cognitive load on an individual but bias the way attention is then allocated in processing data the individual receives.’ They play a huge part in how we, humans, make decisions, and that is why we’re interested in them in the context of fitness to practise decision-making. 

How can they affect fitness to practise decision-making?

In healthcare regulation, concerns about the behaviour or practice of professionals could be dealt with differently in the future. Currently the majority of fitness to practise cases are decided by a panel in a set-up resembling a court room, with the professional and witnesses being questioned. A decision is then made on the professional's fitness to practise by the panel following private deliberations.

There are proposals to introduce a new process - called 'accepted outcomes' where concerns about the behaviour or practice of professionals could be dealt with by one or two employees of the regulator, in an entirely paper-based exercise, reaching an agreement with the professional. The panel model will continue to exist for cases that are disputed by the professional, or if it isn’t possible to make a decision on the paperwork alone.

These are two fundamentally different methods for reaching a decision in in the fitness to practise process, and we believe that in order for the new approach to work, we need to understand what we are dealing with. 

Why did we commission this advice?

We decided to commission an expert on bias in decision-making to consider the two different potential models specifically focusing on what cognitive or social biases would be involved in both, and how they might affect each approach. 

 Specifically, we asked Leslie to think about what biases might come into play, compared with the panel model, when decisions are made:

  1. Consensually with the professional
  2. On the papers alone
  3. Without deliberating as a group
  4. Behind closed doors.

The different models

Accepted outcomes

The AO model is a paper-based process where decisions about the conduct and competence of health and care professionals are made by one or two members of staff, who, having considered the findings of an investigation, can decide on a sanction and offer it to the registrant. If the registrant refuses, the case is referred to a panel for adjudication.


The Panel model involves a hearing where evidence is heard by a panel of usually three or more panellists consisting of a mix of lay and members from the regulated profession, with either a legally qualified chair or legal adviser assisting them. The panellists deliberate in private, but the proceedings are usually held in public.

Key findings and recommendations

The report sets out the different types of bias that could be present for each model. The report also outlines how the regulators could mitigate against potential bias in each approach to dealing with fitness to practise cases, including checklists and mindsets.