Team Decision Making Team Decision Making HINF 371 - Medical MethodologiesHINF 371 - Medical Methodologies

Session 21Session 21

Objective Objective

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

ReferenceReference

Chapman G B and Sonnenbert F A (eds) Chapman G B and Sonnenbert F A (eds) (2000) Chapter 10: Team Medical Decision (2000) Chapter 10: Team Medical Decision Making, in Decision Making In Health Care: Making, in Decision Making In Health Care: Theory, Psychology and Applications, Theory, Psychology and Applications, Cambridge University Press, USACambridge University Press, USA

Eddy D (1993) Broadening the Eddy D (1993) Broadening the responsibilities of Practitioners: The team responsibilities of Practitioners: The team approach, Vol.269, pp.1849-1855approach, Vol.269, pp.1849-1855

Team Based Decision Team Based Decision MakingMaking

The need to pool diverse expertise The need to pool diverse expertise in order to coordinate the actions in order to coordinate the actions of all for a common goalof all for a common goal

A team is a group of people A team is a group of people working in coordination with other working in coordination with other people to achieve a common goal.people to achieve a common goal.

It implies that the team members It implies that the team members suppress their personal objectives suppress their personal objectives in favour of the team’s objectives.in favour of the team’s objectives.

Groups as decision makersGroups as decision makers

Decisions made by groups are Decisions made by groups are superior to the decisions made by superior to the decisions made by individualsindividuals

Groups outperfom individuals Groups outperfom individuals Group decisions do not measure Group decisions do not measure

up up either the decisions made by their either the decisions made by their

most capable member most capable member Or to the statistical aggregates of Or to the statistical aggregates of

individual decisionsindividual decisions

Group Decision Group Decision MeasurementMeasurement

Diagnostic and management Diagnostic and management decisions have gold standardsdecisions have gold standards

Errors in group decision making Errors in group decision making depends on;depends on; Group sizeGroup size Magnitude of individual biasMagnitude of individual bias Location of the biasLocation of the bias Definition of the biasDefinition of the bias Normative idealNormative ideal Nature of group processNature of group process

Information collected by all team members Information collected by all team members are relevant to patient but needs to be are relevant to patient but needs to be woven together to make sense.woven together to make sense.

Patient chart is a common medium for all Patient chart is a common medium for all information but some information might be information but some information might be missing.missing.

Team meeting and decision making is Team meeting and decision making is necessary.necessary.

The objective is to contribute unshared The objective is to contribute unshared information in order develop groups information in order develop groups knowledge base.knowledge base.

Tendency is to talk more about share Tendency is to talk more about share information rather than unsharedinformation rather than unshared

Tendency to use share Tendency to use share information increasesinformation increases The group size increasesThe group size increases The overall amount of problem The overall amount of problem

relevant information increasesrelevant information increases Percentage of shared information Percentage of shared information

held by the members increasesheld by the members increases

ExampleExample

Three physicians are asked to evaluate Three physicians are asked to evaluate two mutually exclusive diagnostic two mutually exclusive diagnostic hypothesis for a particular patienthypothesis for a particular patient

6 symptoms/findings indicate Dx X and 6 symptoms/findings indicate Dx X and three Dx Ythree Dx Y

If all nine known by the team, and If all nine known by the team, and weighted equally, team decides Dx Xweighted equally, team decides Dx X

If each physician know 2 If each physician know 2 symptoms/findings of Dx X and all symptoms/findings of Dx X and all know 3 symptoms/findings of Dx Y, know 3 symptoms/findings of Dx Y, they tend to decide Dx Y.they tend to decide Dx Y.

Team MembersTeam Members

Diverse teams with differences in Diverse teams with differences in socioeconomic, cultural, gender, education.socioeconomic, cultural, gender, education.

High status members must rely on lower-status High status members must rely on lower-status members to obtain informationmembers to obtain information

High status members has more influence over High status members has more influence over decision makingdecision making

Communication directed to high status Communication directed to high status membersmembers

More communication initiated and received by More communication initiated and received by high status membershigh status members

Messages directed to high status members are Messages directed to high status members are more positive than those directed to low status more positive than those directed to low status membersmembers

Low status members are more likely the accept Low status members are more likely the accept opinions and ideas of high status members opinions and ideas of high status members

Team MembersTeam Members

Information management role of Information management role of group leaders is crucialgroup leaders is crucial

Most successful group leaders Most successful group leaders are likely to are likely to Take a facilitator role and Take a facilitator role and

encourage all team members to encourage all team members to share information share information

Reiterate information and opinions Reiterate information and opinions that have previously been that have previously been discusseddiscussed

Team MembersTeam Members

Historically there is a belief that men Historically there is a belief that men perform better in team environment.perform better in team environment.

In parallel the number of males in a team, In parallel the number of males in a team, decision quality increaseddecision quality increased

All female teams outperformed the all-All female teams outperformed the all-male teams.male teams.

However, homogenous groups are more However, homogenous groups are more likely to be effected by groupthinklikely to be effected by groupthink

Culturally diverse groups may make less Culturally diverse groups may make less risky decisions than culturally risky decisions than culturally homogenoushomogenous

GroupthinkGroupthink

Prevention of GroupthinkPrevention of Groupthink

Leaders should assign each member the role Leaders should assign each member the role of “critical evaluator”of “critical evaluator”

Higher-ups should not express an opinion Higher-ups should not express an opinion when assigning a task to a groupwhen assigning a task to a group

Several independent groups, working on the Several independent groups, working on the same problemsame problem

All effective alternatives should be examinedAll effective alternatives should be examined Each member should discuss groups ideas Each member should discuss groups ideas

with a trusted member outside the groupwith a trusted member outside the group Outside experts should be invited into the Outside experts should be invited into the

meetingsmeetings One should get the role of “devil’s advocate”One should get the role of “devil’s advocate”