Combating mediocrity

Perhaps one of the greatest challenges we have faced over the last 25 years was organising and delivering a consensus meeting in 2016 to establish guidance recommendations for constipation in older people.?

Consensus is about compromise, and if everyone is compromising, are you delivering the best product, service, or experience? Clinical consensus statements are agreed opinions formulated by a group of experts on specific clinical challenges. In contrast to clinical practice guidelines, which are based primarily on high-level evidence, clinical consensus statements are more applicable to situations where evidence is limited or lacking, but where there are opportunities to reduce uncertainty and improve quality of care for patients. Members of a contributing team are often well informed and opinionated and discussions can often get caught up in minutiae. When starting the meeting you should identify one member of the team to point out when discussions have gone on too long.

Consensus decision making can be creative and dynamic way of achieving group agreement. Rather than the majority of a group getting their way, consensus seeking solutions require that everyone can get behind. The approach ensures that all opinions, ideas and concerns are considered. The group aims to come up with ideas that work for everyone by first listening to everyone’s opinion. And yet, consensus is neither compromise nor unanimity - it goes further, by combining aspects of everyone's best ideas and addressing important concerns. This process can result in inspiring and creative solutions. However, the process isn’t infallible, being prone to suboptimal compromise, conflict and team demotivation.?

Here a few tips on how to make your consensus meetings run smoothly and produce valuable outcomes taken from our more comprehensive Insider’s Insight [1].

Effective consensus-forming is looking for 'win-win' solutions where no decision that goes against the will of an individual or a minority. Instead, the group adapts to all its members' needs and decision making is based on the concept that power over opinion should be shared by all. This is why it is used widely when seeking the best approach to difficult clinical situations with highly opinionated professionals.

Conducive consensus requires:

• Goals: Everyone in the group needs to share a clear common goal and be willing to work to achieve it. The first step is to clearly define the problem.
• Openness: Attendees should feel safe to openly express their ideas and opinions – including dissenting opinions.
• Time: The process should be given sufficient time to work, including the opportunity to consider all the facts and discussing opinions to make good decisions.?
• Plan: It's crucial to have a clear process for decision making.
• Participation: All attendees need to participate actively - listen to what everyone has to say, voice their thoughts and feelings about the matter and pro-actively look for solutions that include everyone (see the attendees contract below).

Moderation

At the centre of every successful meeting is a talented moderator who ensures that the meeting objectives are achieved: that decisions are made and implemented. A good moderator will help a group to work harmoniously, creatively and democratically. The moderator will take steps to keep the meeting to its agenda, stay focused on its goals and ensure that not just a few opinionated individuals dominate the discussion.?

Find the common ground and any connections between seemingly competing ideas and weave them together to form proposals. Focus on solutions that address the fundamental needs and key concerns that people within the group have.

Recapping

A succinct and accurate summary of what's been said so far can really help a group move towards a decision. Outline the emerging common ground as well as the unresolved differences: "It seems like we've almost reached agreement on that bit of the proposal, but we need to explore this part further to address everyone's concerns." Check with everyone that you've got it right.

Decision making

Discussions often start with the ‘known’ which are best informed with prior briefing and widens out as people bring different perspectives and ideas to the group. This provides the material needed for a broad-ranging discussion which explores all the options and helps people understand each other’s concerns. Given time, conversations move on to synthesise proposals, weeding out the weaker ideas.?

The team members contract

• If you don't understand something, don't be afraid to say so.?
• Be flexible and willing to give something up to reach an agreement.?
• Don’t be afraid to express their ideas and opinions.?
• Explain your own position clearly.?
• Listen actively to what people are trying to say.?
• Give everyone space to finish and take time to consider their point of view.
• Think before you speak, listen before you object.?
• Don't be afraid of disagreement.?
• Disagreements can help a group's decision.
• Stay engaged.

Avoiding mediocrity is your greatest challenge. It is relatively simple to undertake multiple iterative refinements of your consensus statements, incorporating comments from all the participants. Take care not to engineer the teeth out of your position in an attempt avoid contention. Where do new ideas come from? Differences!

Teams can be more effective than individuals, but groupthink can have the opposite impact. If a groups isn’t used to working together to make decisions will often compromise at the lowest common denominator level, resulting in mediocre outcomes. Such conclusions are laden with ambiguity and uncertainty. Establishing a healthy group-working environment will encourage the team and get the best results.

So what of our challenge in 2016? Well we managed to pull the team together and published a set of guidelines – you can find them here, you decide [2].

Tim Hardman?is Managing Director of?Niche Science & Technology Ltd., a UK-based CRO, Chairman of the?Association of Human Pharmacology in the Pharmaceutical Industry, President of the?European Federation for Exploratory Medicines Development?and occasional commentator on science, business and drug development.

References

1.?????Coming to a consensus: An Insider’s Insight.?https://www.niche.org.uk/asset/insider-insight/Insider-Consensus.pdf

2.?????Emmanuel A, Mattace-Raso F, Neri MC, Petersen KU, Rey E, Rogers J. Constipation in older people: A consensus statement. Int J Clin Pract. 2017 Jan;71(1). doi: 10.1111/ijcp.12920.?