Article Text

Evaluating team decision-making as an emergent phenomenon
  1. John Kinnear1,2,
  2. Nick Wilson1,3,
  3. Anthony O’Dwyer2
  1. 1 Anglia Ruskin School of Medicine, Anglia Ruskin University, Chelmsford, UK
  2. 2 Department of Anaesthetics, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
  3. 3 Department of Anaesthetics, Mid Essex Hospital trust, Chelmsford, UK
  1. Correspondence to Professor John Kinnear, Anglia Ruskin School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK; John.Kinnear{at}


Background The complexity of modern clinical practice has highlighted the fallibility of individual clinicians’ decision-making, with effective teamwork emerging as a key to patient safety. Dual process theory is widely accepted as a framework for individual decision-making, with type 1 processes responsible for fast, intuitive and automatic decisions and type 2 processes for slow, analytical decisions. However, dual process theory does not explain cognition at the group level, when individuals act in teams. Team cognition resulting from dynamic interaction of individuals is said to be more resilient to decision-making error and greater than simply aggregated cognition.

Methods Clinicians were paired as teams and asked to solve a cognitive puzzle constructed as a drug calculation. The frequency at which the teams made incorrect decisions was compared with that of individual clinicians answering the same question.

Results When clinicians acted in pairs, 63% answered the cognitive puzzle correctly, compared with 33% of clinicians as individuals, showing a statistically significant difference in performance (χ2 (1, n=116)=24.329, P<0.001). Based on the predicted performance of teams made up of the random pairing of individuals who had the same propensity to answer as previously, there was no statistical difference in the actual and predicted teams’ performance.

Conclusions Teams are less prone to making errors of decision-making than individuals. However, the improved performance is likely to be owing to the effect of aggregated cognition rather than any improved decision-making as a result of the interaction. There is no evidence of team cognition as an emergent and distinct entity.

Statistics from


  • Contributors JK designed the study, wrote the study proposal, carried out the data analysis and wrote the first draft of the manuscript. He is responsible for the overall content as guarantor. NW reviewed the study proposal, administered the questionnaire, collected and analysed the data and reviewed the manuscript. AO reviewed the study proposal, analysed the data and reviewed the manuscript.

  • Competing interests None declared.

  • Ethics approval Faculty Research Ethics Committee of Anglia Ruskin University (FREP 16/17 087).

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.