From a Team of Experts to an Expert Team in Congenital Cardiology: Making Distributed Expertise Usable

Congenital heart disease care depends on specialised expertise distributed across clinicians, disciplines, patients and families. But bringing knowledgeable individuals together does not guarantee that their distinct contributions shape a decision. In complex congenital heart disease, multidisciplinary deliberation must reconcile anatomy, physiology, procedural feasibility, longitudinal risk and patient priorities, often amid uncertainty. We distinguish a team’s possession of expertise from its collective capability to make that expertise usable. This distinction affirms, rather than questions, individual clinical judgement, professional responsibility and shared accountability for patients. We propose a testable conceptual framework in which relevant expertise becomes accessible, is expressed and understood, receives appropriate weight, and can revise the team’s understanding or decision. Congenital cardiology examples include choices between catheter-based and surgical intervention, anticipation of intensive-care needs, and consideration of treatment burden and family goals. Constructive disagreement may reveal overlooked information or competing interpretations, while patients and families contribute essential knowledge about daily life and acceptable trade-offs. Existing team-science research supports the framework’s rationale, but its ability to improve congenital heart outcomes has not been demonstrated. We outline a developmental cycle—map, observe, practise, review, adapt and re-map—through which programmes might examine how expertise enters decisions, identify missed contributions and learn across changing membership. Evaluation should combine prospective measures of decision quality and implementation with appropriately risk-adjusted clinical outcomes, patient and family experience, and longer-term trajectories. The objective is not consensus for its own sake, but better use of knowledge already available to care teams.