How to identify and mitigate against groupthink in breastfeeding medicine (or in any part of the health system)

Humans are hardwired to want to belong

Homo sapien's primate brain is fundamentally shaped by the evolutionary need for group belonging.

Our extraordinary gift for the development of collective intelligence is passed down the generations as accumulated cultural knowledge. We create this knowledge by working together in groups, inventing, innovating, protecting the wellbeing of our families and communities. The collective genius of our species has ensured not only our survival but our astonishing flourishing, on a planetary scale.

However, a downside to our powerful human desire to belong in a group is the easy slip into 'groupthink', intially developed as a psychological concept by Yale psychologist Irving Janis in 1971, who coined the term. (I worry that the word 'groupthink' can sound judgemental, and might be better referred to as 'a shared belief system based upon exclusion of the Other' - not quite as succinct though!)

Groupthink occurs when the human desire for unanimity and belonging overrides realistic and critical appraisal of alternatives. Groupthink displays the following characteristics:

• Exclusion of those who dissent, appear different, or otherwise appear to not belong

• Compromised group decision making

• Depersonalisation and dehumanisation of the excluded outsider or sub-group (scapegoating, negative projection, gaslighting) in private conversations on the side, including perpetuating false narratives about the outsider

• Refusal to discuss the outsider ('cancelling') withinn the group, with the outsider framed as a trouble-maker who needs to be ignored in order to preserve group harmony

• Disrespectful communications to the outsider, which range from obfuscation, plausible deniability, gaslighting, to psychological abuse or physical violence

• The silence of those in the group who are uncomfortable with the groupthink but who wish to belong within the group and protect themselves from the pain of exclusion. These individuals, if they have time to think about it, might experience cognitive dissonance.

DiPierro et al 2022 adapt recommendations to mitigate against groupthink for healthcare settings

The following are recommendations for the mitigation of groupthink in health care organisations, drawn from the work by DiPierro et al 2022. DiPierro et al acknowledge the groundbreaking work by Janis. Their study aimed to examine groupthink in health care. The authors conducted a systematic review of eight databases for articles focussing on groupthink among health professional teams and included 22 articles.

Although their research focused on clinical teams, I have borrowed key concepts here to make recommendations for organisations in health care such as lactation medicine non-profits, which are professional groups for clinicians many of whom might otherwise work alone. I have also changed the order in which DePierro et al have placed these characteristics.

They are the health-giving, inclusive processes we are embedding within The NDC Institute, as our social enterprise grows.

DiPierro's recommendations adapted for lactation non-profits and other organisations which represent clinicians

1. Members of leadership within the organisation are responsible for promoting inquiry, constructive criticism, and debate without fear of penalty, and should also reinforce neutrality by hiding bias (Christensen, 2019; Gambrill, 2005; Hollinger, 2019; Heinemann et al., 1994; Mannion & Thompson, 2014).

2. The organisation should seek outside expertise, including new perspectives from other disciplines or external institutions (Allen, 2007; Gambrill, 2005; Harmon et al., 2019; Heinemann et al., 1994).

3. The organisation should appoint and rotate the role of 'devil's advocate' within its groups (Cleary et al., 2019; Gambrill, 2005; Heinemann, 1994).

4. Individuals within the organisation should engage or be appointed as 'critical evaluator' to encourage candidness and frank feedback (Christensen, 2019; Cleary et al., 2019; Gambrill, 2005; Mannion & Thompson, 2014).

5. Groups within the organisation should aim to decrease group insulation. Reactions from the trusted outside party should be reported back to the group (Heinemann, 1994; Mannion & Thompson, 2014).

6. All professionals within the organisation should hold greater accountability for sharpening critical thinking skills and bolstering moral awareness, and are responsible for being wary of latent groupthink (Cheshire, 2017; Snell, 2009).

7. Rotating organisation members through leadership roles can help minimise groupthink (Christensen, 2019; Cleary et al., 2019; Mannion & Thompson, 2014).

8. The organisation should establish standing task groups or subcommittees that convene on critical decisions (Christensen, 2019; Cleary et al., 2019; Gambrill, 2005; Heinemann et al., 1994; Mannion & Thompson, 2014).

9. The organisation should implement an educational program or feedback exercises to mitigate bias, such as role play, to ease tension in real practice (Degnin, 2009; Heinemann et al., 1994; Hollinger, 2019; Snelgrove, 2011).

The collective belonging of the future within breastfeeding medicine organisations and other lactation non-profits

Groupthink is radically different to collective belonging, which invites in and is curious about dissent, difference, and debate. Collective belonging brings an intelligent, nuanced, and science-based perspective to conflict of interest, and acknowledges contexts (e.g. Australian primary health care as a small business model) in which innovators and other health professionals operate. A kind, inclusive lens, using university and medica journal based ethical norms concerning conflict of interest, is applied.

In my view, curiosity about difference (whether it's the different person, or different theoretical models and clinical management - as long as the latter is intelligently and credibly argued) is a quality which needs to be actively cultivated in order to buffer our organisations and our own brain against the destructive, growth-limiting nature of groupthink. It feels easy and good to take up pure ideological stances which align within the groupthink, but the hidden damage done to the very population (e.g. breastfeeding families) who need science-based dissent and different researcher and clinician perspectives is currently profound, and measurable.

Related resources

Possums Breastfeeding & Lactation articles which address lactation non-profits, ideology, and harm

References

DiPierro K, Lee H, Pain KJ. Groupthink among health professional teams in patient care. Medical Teacher. 2022;44(3):309-318. doi: 310.1080/0142159X.0142021.1987404.

The citations are found in Dipierro et al's article, here.