1. Fernandez, Claudia Plaisted DrPH, RD, LDN


The Management Moment is a regular column within the Journal of Public Health Management and Practice. Edward L. Baker, MD, MPH, MSc, serves as the Management Moment Editor. Dr Baker is Director of the North Carolina Institute for Public Health, School of Public Health, at the University of North Carolina at Chapel Hill. This column provides commentary and guidance on timely management issues commonly encountered in public health practice.


Article Content

We hear a lot about the importance of diversity in the workplace these days. You may think that having a diverse workforce is just a way to "look like" the population you serve. You may promote diversity because you have to, or because it's politically correct. But the most important reason to promote diversity is because a diverse group of people brings diverse ways of thinking about things. And you can build "thought diversity" no matter who you have at the table.


Thought diversity allows for differing perspectives on ideas and unique insights into problems. It creates opportunities for innovation, entrepreneurship, and partnerships in unexpected places. It allows you to take a "reality check" before plunging into new activities. Most important, it helps you avoid groupthink.


Groupthink occurs when one or two people or personality styles dominate a group's culture so completely that there is no room for those with other styles, perspectives, needs, or beliefs to get their ideas on the table. This can take the form of people hiring only those who think as they do, or of the dominant thinkers badgering others into accepting their ideas, critically downplaying of the value of others' ideas, or simply failing to listen.


In groupthink, conformity reigns supreme. The group will make great sacrifices to simply get along and maintain the peace and harmony within. Often the group overestimates its own power and morality: what they are doing is right, and their track record of success is so strong that they do not consider the possibility of failure.1,2


Public health and public health research are not immune to the problems of groupthink. Whenever we fail to examine a problem from all angles and rigorously question our actions, we invite narrowly thought-out options to rule the day. Whenever we say, "this is the way we've always done it," and fail to encourage open discussion and alternative ideas, we put our organizations at risk of groupthink.


So how does a manager create a thought-diverse organizational culture? Here is a seven-step plan to improving thought diversity.


Seven Steps to Create Thought Diversity and Avoid Groupthink


1. Encourage open discussion


2. Explore all problems from the four-point sequence


3. Assign roles for asking difficult questions (have a devil's advocate)


4. Reward truth speakers


5. Tool your staff for the art of the difficult conversation


6. Invite new perspectives to the discussion


7. Build in time to reflect and revisit tough decisions


First, encourage open discussion. To do this, do not control the discussion or state your outcome expectations at the outset. Explain that the goal of the process is to understand the ideas completely, which requires their thorough examination. To facilitate this examination, I recommend that groups engage in tactic #2: examine issues from a four-point sequence. Point A: Ask questions about the known data, including what facts describe the situation? What can we learn from the past? And what relevant experience do others have that we could learn from? In Point B, the group explores any themes that emerge from the data. Understanding these themes can help your team understand the big picture and also point out possibilities or options for other strategies.


Point C calls for listing the criteria for making a good decision and charting the pros and cons of each option. Acknowledging the most logical solution will be helpful, but don't let that dominate this process. And finally, point D in this process is to brainstorm who else the group must collaborate with or learn from to solve the problem. Analyze how the proposed solutions will affect the stakeholders, both those within the organization and others. Which solution will promote maximum acceptance by stakeholders, including the general public? Following steps A through D will help your team go far in avoiding groupthink.


The third step in encouraging diversity of thought is to assign someone to play the devil's advocate, the person who will ask "reality check" questions. It is uncomfortable to look at worst-case scenarios, but it can be devastating to turn a blind eye to them. Questions might include what if we fail to achieve this goal? What if the current conditions change-and change our resource base? Are we measuring success by the right metrics? What are the undesirable impacts this endeavor will create? This devil's advocate function requires a great deal of bravery on the part of the individual, who might face censure from other group members. Step 4 is to reward those truth speakers and make sure that they have the skills to play the whistleblower tactfully and tastefully.


Step 5 calls on managers and leaders to equip their whole team with the tools to conduct the art of the difficult conversation. Often people can become passionate about their ideas. When they do, they can become personally identified with them, and then hearing criticism of the idea feels like being criticized personally. You, as manager, must set the stage that this process is not about people, but about ideas. The discussions are to strengthen the ideas from within before they become programs or policies that are put into play for the public or organization-wide.


In step 6, if you find that you continue to have the same old discussions, then as leadership and organizational development expert Meg Wheatley states,3 change the people at the table. To create a new culture for discussion you might need to change those sharing ideas. Explore having nonvoting members attend management meetings to represent other views or invite nontraditional community stakeholders to the discussion.


In step 7, the process is to avoid rushing to judgment. Premature closure will end up costing the organization more time and other resources than will giving adequate time for reflection. Difficult choices warrant time for reflection and revisiting the decision-making process. Challenge the decisions made and the processes followed and ensure that no stones were left unturned. In the long run, it is better to answer the difficult questions about your process of decision making than it is to explain the inadequacies in it.


When organizations embrace diversity of thought, it is easier for diversity in all its other forms to follow. Creating an organization culture that welcomes discussion, is respectful of disagreement, and encourages mutual exploration of ideas contributes to creating a learning organization. Furthermore, it positions the organization to be able to capitalize on innovation and partnerships that can keep it where it needs to be: on the cutting edge of discovery and delivery of services.




1. Griffin E. Groupthink. New York: McGraw-Hill; 1997. [Context Link]


2. Rounds J. Groupthink. Published 2000. Accessed May 25, 2007. [Context Link]


3. Wheatley M. How can you maintain leadership direction and focus in these turbulent times? Presented at: the Public Health Leadership Institute; May 2007; Chapel Hill, NC. [Context Link]