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”