In this paper, we expand theory on how groups collectively negotiate their group decision making approaches by inductively interpreting data from an 18-month ethnographic study of physicians through the combined lenses of theory on team process and team diversity. We specifically focus on the overarching tension between efficiency and participation in tandem with specific paradoxical tensions that our participants faced in their daily work. The degree to which the latter comes up in their decision-making process—rather than the proxy tensions of power disparities or separation between subgroups in the team—is a signal that effective group decision making is occurring.
