OUTLINE: When making decisions concerning the care of patients, the team must ensure patients’ best interests are kept in mind. To ensure that the best decisions are being made, we will be looking at two psychological theories that consist of the main phenomena observed in the decision-making process and how they can be applied practically.
GROUP POLARISATION THEORY (MOSCOVICI AND ZAVALLONI, 1969)
‣ In 1969, psychologists Moscovici and Zavalloni observed the tendency of members of a group engaged in the decision-making process to shift their initially held views to a more extreme position after a group discussion.
‣ THIS LEADS TO riskier decisions being taken by the group and potentially going against the best interests of patients.
‣ WHY DOES THIS HAPPEN? It has been suggested that this could be the result of a combination of two factors, here described by corresponding theories: social comparison theory, where we compare ourselves against others in order to pursue conformity, and persuasive arguments theory, where arguments brought forward are more likely to reinforce existing views of other members of the group. (Isenberg, 1986).
‣ PLEASE REMEMBER, of course, that taking a more polarised view does not imply that the decision is necessarily wrong.
GROUPTHINK THEORY (JANIS, 1972)
‣ In 1972, Irving Janis identified a phenomenon that was observed in group decision making where members’ desire to reach a unanimous agreement overrides the motivation to pursue a proper and rational decision-making process.
‣THIS LEADS TO the members having the illusion that the group is “invulnerable, moral and unanimous”, thus encouraging policing of the group to ensure conformity among themselves and others.
‣ WHY DOES THIS HAPPEN? Because not all available options are being properly and fully evaluated by the group whilst also being unaware that discussions and evidence brought forward are more likely to further the dominant view.
‣ ALTHOUGH empirical research on the concept has produced overwhelmingly equivocal support for the groupthink model, it is something to consider when reaching a decision as a team.
HOW CAN THIS BE ADDRESSED?
Methods for overcoming groupthink and group polarisation:
• Be impartial – don’t endorse any specific position.
• Assign a devil’s advocate.
• When possible, subdivide the group occasionally and reunite to air differences.
• Consult outside experts or colleagues.
• Call a ‘second chance’ meeting before implementing decisions.
HOW CAN YOU TRY TO ENSURE THAT DECISIONS ARE MADE IN THE PATIENTS’ BEST INTERESTS?
The decision-making process must include provisions for ensuring that focus remains on patients’ best interests. As the two theories mentioned above have shown, it is with ease that members of groups may inadvertently fall into the trappings of seeking social conformity, thus leading astray from the desired outcome. A systematic and structured approach to this process is, therefore, recommended when undertaking the tasks of making decisions as a group, ensuring that all options are adequately considered and evaluated so that the patients’ best interests are kept paramountly.
Isenberg, D.J. (1986) ‘Group polarization: a critical review and meta-analysis’, Journal of Personality and Social Psychology, vol. 50, no. 6, pp. 1141–51.
Janis, I.L. (1972) Victims of Groupthink: A Psychological Study of Foreign Policy Decisions and Fiascoes, Boston, MA, Houghton Mifflin.
Janis, I.L. (1982) Groupthink, 2nd edn, Boston, MA, Houghton Mifflin.
Moscovici, S., and Zavalloni, M. (1969) ‘The group as a polarizer of attitudes’, Journal of Personality and Social Psychology, vol. 12, no. 2, pp. 125–35.