Impact of group structure and process on multidisciplinary evidence-based guideline development: an observational study


Dr Claudia Pagliari Lecturer in Psychology (R&D) Tayside Centre for General Practice University of Dundee Kirsty Semple Way Dundee DD2 4AD UK E-mail:


Rationale, aims and objectives This paper presents selected results from a study investigating the impact of small group processes on the development of clinical practice guidelines by multidisciplinary panels. Observations of one panel developing a guideline for primary care over several months are reported here. Methods Non-participant observation with content analy-sis of transcripts aided by field notes. Results Bales’s interaction process analysis was used to categorize interactions in terms of their task-oriented or socioemotional qualities. This revealed a well-functioning, task-oriented group characterized by predominantly positive social behaviours. However, a breakdown of dialogue by speaker indicated a marked effect of professional role and status on the level of contribution to group discussions. This, and marked changes in panel composition across meetings, has implications for the multidisciplinarity of decision-making in such groups and hence for the acceptance and implementation of their outputs. Conclusions These findings are likely to generalize to other health care settings in view of the growing emphasis on multidisciplinary decision-making and the clear status hierarchies inherent within the medical and allied fields.