Team Decision Making

1. Team Decision Making HINF 371 - Medical Methodologies Session 21

2. Objective • To understand the role of teams in medical decision making and explore benefits and harms.

3. Reference • Chapman G B and Sonnenbert F A (eds) (2000) Chapter 10: Team Medical Decision Making, in Decision Making In Health Care: Theory, Psychology and Applications, Cambridge University Press, USA • Eddy D (1993) Broadening the responsibilities of Practitioners: The team approach, Vol.269, pp.1849-1855

4. Team Based Decision Making • The need to pool diverse expertise in order to coordinate the actions of all for a common goal • A team is a group of people working in coordination with other people to achieve a common goal. • It implies that the team members suppress their personal objectives in favour of the team’s objectives.

5. Groups as decision makers • Decisions made by groups are superior to the decisions made by individuals • Groups outperfom individuals • Group decisions do not measure up • either the decisions made by their most capable member • Or to the statistical aggregates of individual decisions

6. Group Decision Measurement • Diagnostic and management decisions have gold standards • Errors in group decision making depends on; • Group size • Magnitude of individual bias • Location of the bias • Definition of the bias • Normative ideal • Nature of group process

7. Information collected by all team members are relevant to patient but needs to be woven together to make sense. • Patient chart is a common medium for all information but some information might be missing. • Team meeting and decision making is necessary. • The objective is to contribute unshared information in order develop groups knowledge base. • Tendency is to talk more about share information rather than unshared

8. Tendency to use share information increases • The group size increases • The overall amount of problem relevant information increases • Percentage of shared information held by the members increases

9. Example • Three physicians are asked to evaluate two mutually exclusive diagnostic hypothesis for a particular patient • 6 symptoms/findings indicate Dx X and three Dx Y • If all nine known by the team, and weighted equally, team decides Dx X • If each physician know 2 symptoms/findings of Dx X and all know 3 symptoms/findings of Dx Y, they tend to decide Dx Y.

10. Team Members • Diverse teams with differences in socioeconomic, cultural, gender, education. • High status members must rely on lower-status members to obtain information • High status members has more influence over decision making • Communication directed to high status members • More communication initiated and received by high status members • Messages directed to high status members are more positive than those directed to low status members • Low status members are more likely the accept opinions and ideas of high status members

11. Team Members • Information management role of group leaders is crucial • Most successful group leaders are likely to • Take a facilitator role and encourage all team members to share information • Reiterate information and opinions that have previously been discussed

12. Team Members • Historically there is a belief that men perform better in team environment. • In parallel the number of males in a team, decision quality increased • All female teams outperformed the all-male teams. • However, homogenous groups are more likely to be effected by groupthink • Culturally diverse groups may make less risky decisions than culturally homogenous

13. Groupthink

14. Prevention of Groupthink • Leaders should assign each member the role of “critical evaluator” • Higher-ups should not express an opinion when assigning a task to a group • Several independent groups, working on the same problem • All effective alternatives should be examined • Each member should discuss groups ideas with a trusted member outside the group • Outside experts should be invited into the meetings • One should get the role of “devil’s advocate”