A novel approach for assessing bias during team-based clinical decision-making

Area of Science:

• Healthcare Quality and Safety
• Health Services Research
• Medical Education

Background:

• Multidisciplinary clinical decision-making is common, but evaluating implicit bias within these groups is challenging.
• Implicit bias can compromise the equitable delivery of evidence-based interventions and negatively affect patient outcomes.
• Novel methods are needed to detect and analyze implicit bias in collective clinical decision-making processes.

Purpose of the Study:

• To introduce the de Groot Critically Reflective Diagnoses Protocol (DCRDP) as a data analysis tool.
• To evaluate group dynamics as a foundation for understanding how interactions introduce bias into collective clinical decision-making.
• To demonstrate the DCRDP's utility in identifying and addressing team-based bias in healthcare settings.

Main Methods:

• The DCRDP assesses six criteria: challenging groupthink, critical opinion sharing, research utilization, openness to mistakes, feedback exchange, and experimentation.
• A numerical scoring system (1-4) was developed based on the strength and frequency of coded exemplar quotes for each criterion.
• The DCRDP was applied as a coding scheme to transcripts of recorded group decision-making meetings.

Main Results:

• The DCRDP proved to be a practical tool for examining bias in group decision-making processes.
• The protocol provides a numerical score reflecting team interactivity, reflectivity, functioning, and equity.
• Application to meeting transcripts demonstrated its feasibility for analyzing group dynamics.

Conclusions:

• The DCRDP is an effective tool for recognizing team-based bias in clinical settings.
• The protocol can inform the design and testing of implementation strategies to improve equity.
• The DCRDP supports reflexivity and monitoring of long-term outcomes for more equitable healthcare decision-making.