Facilitative leaders guide their team through information-sharing, problem-solving, and decision-making. In this article, we look at why ineffective decisions are made, explore five decision-making options, provide two tools for determining the extent of agreement among team members, and describe some of the common pitfalls associated with this important group process.

 

Many physicians express concern about how departmental or broader organizational decisions are made or implemented. Here are some common workplace refrains. “We took a vote on this issue and yet no one is following through.” “I thought this was decided already. Why are we rehashing it?” “It’s always the same people who monopolize the conversation.” “I was asked for my opinion and I feel like I was ignored.” “They’ve already made their decision and are pretending to get our input.”

 

In an earlier article,1 we described the practice of basic facilitation, the conscious focusing of the leader’s attention on guiding the group through three processes: sharing relevant information, problem-solving, and decision-making that builds long-term commitment. Top

 

Both divergent and convergent thinking (see text box for definitions) are necessary for group decision-making (Fig. 1). Decision-making that results in commitment follows the sharing of information (facts and data along with personal biases, values, perspectives, and assumptions) and time dedicated to exploring all options. The inverted triangle represents the amount of time that should be committed to each of these processes. If 80% of the team’s time is allocated to sharing information and problem-solving, then the team is more likely to reach agreement and make decisions that all team members are able to “own.” Top

 

Facilitating meetings effectively requires clarifying up front how decisions will be made and what will happen in the event that agreement cannot be reached. This step is typically part of the broader conversation when a team is developing a team behaviour charter or meeting guidelines.

 

Knowledge of decision-making processes is essential for facilitative leaders if they truly want productive meetings and meaningful commitment. An old adage, “People tend to support what they help create,” implies that if team members do not participate in a meaningful way and own the solution to the problem, commitment to the decision will be mediocre at best. In addition, a decision that does not reflect what is important to team members may contribute to a sense of apathy or cynicism with respect to the future work of the team. Top

 

Symptoms, causes, and cures for ineffective decisions

 

If team members are expressing frustration with the decision-making process or if they are unable to reach agreement, then it makes sense to apply a diagnostic approach, as summarized in Table 1.

 

The five decision-making options

 

The longer the time taken to make the decision, the greater the commitment to following through (Fig. 2).

 

A few words about consensus

A common misconception is that consensus means everyone has to agree. Instead, all team members must feel that they have been consulted and involved in a meaningful fashion, so that even though the final solution is not necessarily the one they would have chosen individually, they can readily “live with it.” Top

 

Determining the extent of agreement among team members

 

Option 1

A scale developed by Sam Kaner4 (Fig. 3) makes it easier for team members to be honest in declaring their less than whole-hearted support without fear that their comments will be misinterpreted as a veto. The scale can be modified to fit any context; for example, some committees do not allow members to abstain so the “abstain” column may be eliminated. The scale can be used in a variety of ways. For example, if there is ambiguous or meagre support for a decision, the leader may ask:

 

• What prevents you from supporting this idea/solution?
• What changes, revisions, or additions would make this an idea/solution that you could live with?

 

We have often witnessed these two questions stimulate deeper dialogue and, when members’ reservations or concerns have been explored without judgement, then trust and commitment increase. Top

 

Option 2

When the leader believes the team is ready to make a decision, he or she clearly states the decision and then asks to see the thumbs of the team members. All team members are asked to show their thumbs; there is no opting out. Thumb up means “Yes, I agree and I will actively participate in the implementation of the decision”; thumb to the side means “I can live with it and I won’t get in the way of implementing the decision”; thumb down means “No, I don’t agree and I may, in fact, interfere with the implementation of the decision.” Top

 

In this option, consensus is achieved when all thumbs are up or to the side, i.e., all members agree to the decision or can live with it. Consensus is not achieved when one or more thumbs are down. In that case, the leader is advised to ask those with their thumbs down, “What would it take to get your thumb to the side.” In our experience, often a minor modification to the decision is all that is needed to move those thumbs from down to the side. Top

 

Common problems encountered in group decision-making

 

Moving too quickly

Most teams attempt to bring discussion to a close too quickly. This often occurs in situations where there appears to be an obvious solution, where issues are too complex to be resolved with current thinking or responses, or where the meeting environment does not support new perspectives and thus inhibits input. As a general guideline, teams should spend 80% of their time in the information-sharing and problem-solving stages; then only 20% of the team’s time will be needed for reaching agreement and making a decision (Fig. 1). Unfortunately, this ratio is most often reversed.

 

The handclasp decision

The leader proposes a decision and one or two team members indicate their agreement. This is then interpreted as agreement shared by the entire team. In this case, the leader is encouraged to use either of the options described above to probe and determine more accurately the extent of agreement. Top

 

Silence

When a proposed decision is met with silence, this may be falsely interpreted as agreement. If this case, the leader is encouraged to ask, “How should I interpret this silence?”

 

Lack of clarity about the group’s decision-making processes

When the leader is using a consultation approach (Table 2), team members may believe they are engaged in achieving consensus. A team leader who chooses consultation must be clear about this process at the outset, i.e., at the beginning of the information-sharing phase. Similarly, leaders sometimes believe that obtaining input from team members is achieving consensus. Obtaining input is the first step to achieving consensus, but it is not consensus. Top

 

Pseudo-consultation

The leader has made a decision, but chooses to seek input from the team members in an effort to help them feel as if they have been involved in the decision-making process. The use of the phrase “buy-in” is sometimes indicative of a pseudo-consultation process. Although it is okay for leaders to make decisions, he or she must be clear about that with the team. The team may still be engaged in providing input with respect to implementing the decision.

 

Mistaking majority vote for consensus

Majority vote is not consensus. It means that up to 49% of team members may not agree with the decision, and this might impede any action that follows the decision. Top

 

Lack of attention to creating an environment of psychological safety

Leaders should create an environment in with team members feel safe in saying what is truly important to them. Decisions can and should be influenced by facts and data. However, decisions are also influenced by values, biases, perspectives, and feelings. Leaders who make it safe for team members to “tell their truth” create an environment in which agreement is more likely to occur, thereby enabling the team to make decisions they will support.Top

 

References

1.Olsen M, Yates M. Designing engaging and productive meetings. Can J Physician Leadership; 2015;Winter:16-9.

2.Olsen M, Yates M. The facilitative leader: keeping the discussion on track. Can J Physician Leadership 2015;Spring:14-9.

3.Bens I. Facilitating with ease! Core skills for facilitators, team leaders and members, managers, consultants, and trainers (2nd ed.). San Francisco: Jossey-Bass; 2005.

4.Kaner S, Lind L, Toldi C, Fisk S, Berger D. Facilitator’s guide to participatory decision-making.  Gabriola Island, BC: New Society Publishers; 1998.

 

Authors

Monica Olsen, MHRD, is principal of Olsen and Associates Consulting. Her current focus is on leadership development in the health care sector through customized education programs, facilitation, and coaching. She has been a long-standing faculty member of the CMA’s Physician Leadership Institute.

 

Mary Yates, MEd, is principal of Align Associates, offering expertise in the areas of leadership development, team effectiveness, performance management, meeting and retreat facilitation, human resources management, curriculum design, and quality improvement. She has been on the faculty of the CMA’s Physician Leadership Institute for the last 16 years.

 

Correspondence to: olsenandassociatesconsulting@rogers.com or marytyates@alignassociates.com

 

This article has been reviewed by a panel of physician leaders.

Top