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There is a large body of decision making theory but little agreement on what constitutes a 'fair decision'.

• While the research brief outlined by the GMC concerned 'fair' decision making, this term was found to be absent or inconsistently applied in the literature and by interviewees.
• In consultation with the GMC, the analysis instead focused on indicators of 'fair decision making': objectivity, consistency, reliability, transparency, accountability and evidence-based decision making.

Decision makers across sectors appear to face a range of challenges, including:

• Ensuring consistency across an organisation;
• Recording decisions and capturing lessons learned;
• Keeping pace with legislative changes;
• Avoiding bias in decision making;
• Managing available information effectively; and
• Ensuring that staff use the tools available.

The study identified more than 30 decision making tools, practices and processes available to regulatory professionals.

• The GMC is already using most of the identified tools, processes and practices.
• Additional methods including automated decision making and improved assessment of competences can further strengthen GMC decision making practices.
• The effectiveness of these methods is linked to organisational culture, structure and leadership.