Vol. 2 No. 1 (2019)

Do Representatives Represent you?

Lemmens S
Maastricht University, Netherlands
Lopes van Balen V
Maxima Medical Center, Netherlands
De Vries R
Research Center for Midwifery Science Maastricht, Center for Bioethics and Social Sciences in Medicine, Netherlands
Scheepers L
Maastricht University Medical Center, Netherlands
Spaanderman M
Maastricht University Medical Center, Netherlands

Published 2019-10-29


  • Representatives,
  • Representation,
  • Decision making,
  • Agreement


Introduction: Representation by a small group of chosen representatives is a common used strategy for decision making within a large heterogeneous group of people. In hospital and first-line setting, we measured the level of representatives-peers agreement for representatives that were selectively chosen by peers and those that were randomly selected.
Method: Professionals working in hospital-obstetric and first-line midwifery domains, 23 representatives and 114 represented peers, gave their opinion on obstetric topics by ranking 681 statements on a 10-point Likert scale. Correlations between representatives and peers scores were assessed with Bland-Altman difference plots. Level of agreement was evaluated by area under the curve (AUC) of the difference in statement score.
Results: Statement scores of chosen representatives correlated well with their peers (r = 0.91). Fifty percent of representatives and peers scores differed less than 1.9 point. The average representative-peers agreement was 77%. Selectively chosen gynecologists and midwives showed comparable levels of agreement (gyn AUC 0.77 vs. mid AUC 0.75, p = 0.105), whereas randomly selected professionals tend to differ in professional view (gyn AUC 0.80 vs. mid AUC 0.74, p = 0.052). The selection method led to no differences within the group of gynecologists (chosen AUC 0.77 vs. random AUC 0.80, p = 0.220) and midwives (chosen AUC 0.75 vs. random AUC 0.74, p = 0.859).
Conclusion: Decision making by representatives within a diverse group of professionals, largely reflects the opinion of their peers. The selection method of representatives and the professionals’ working environment do not statistically affect the level of representative-peers agreement.