David Brooks, The New York Times columnist, recently revived his blog, which you can find here. It’s a great aggregator of new results in cognitive psychology. Anyway, in poring through some of his older posts, I came across this discussion of the concept of group IQ. It’s a concept that’s been around for some time, but that has special application to medical malpractice that I don’t recall seeing anything about.
“Group IQ” refers to the collective IQ of a group of people working together as a team, collaborating on some project (say, a medical operation). What is the measure of a group’s IQ? It might be natural to think that a group’s IQ is simply the average of its individual members’ IQs. You might think that if you have a really smart person in a group or a lot of smart people in a group that the group’s overall IQ would be really high as well.
But the research shows that this rather natural assumption does not hold. Instead, lots of groups show IQ that is much greater than the sum of its team members’ intelligences. There’s a certain gestalt effect within some groups where a collection of average individual intelligences become super-charged and work together astonishingly effectively as a group, enabling them to best a team of Einsteins.
The research shows that the team members of these overachieving groups share certain traits. The team members of groups with high group IQs are good at reading each other’s emotions. They take turns when speaking. Conversation in their groups tends to be widely distributed. There is no overbearing leader dominating everything.
It seems to me that operating rooms are run exactly opposite to what we now know about group IQ. Operating rooms are an example of the old myths about group intelligence: that you let your individual superstar (say a high-IQ surgeon) run the show and get out of his way, instead of looking for ways for everyone to participate. I recently blogged about Dr. James Bagian’s new article on patient safety. In the article, Bagian talks about how operating room culture is a “hero” culture, with the notion being that the surgeon is the hero and that others in the operating room – nurses, anesthetists, medical residents – are his inferiors.
That’s why we shouldn’t be astonished when brilliant surgeons make mind-numbing mistakes (see here). It’s simply the inevitable result of the group dynamics of the operating room, where a nurse does not feel empowered to question a doctor.
A lot of the aviation safety principles that Dr. Bagian urges medicine to adopt are principles that agree with what we know about group IQ. For example, airlines have a “first name rule” – airline crew call each other by their first names so that everyone’s on an equal rank and the captain isn’t some imperious demigod. You can see how this would reinforce some of the traits that high IQ groups have, such as widely distributed conversation and listening.
Reducing medical malpractice doesn’t turn on getting smarter doctors or better technology. It turns on adopting the methods that we know crank up a group’s performance.

This blog in maintained by the Boston medical malpractice lawyers at The Law Office of Alan H. Crede, P.C.