Criteria For Agreement When Conducting Local Consensus Discussions: A Qualitative Study.

IF 3.4 Q1 HEALTH POLICY & SERVICES
Journal of Healthcare Leadership Pub Date : 2025-05-05 eCollection Date: 2025-01-01 DOI:10.2147/JHL.S522784
Lisa Pagano, Janet C Long, Emilie Francis-Auton, Andrew Hirschhorn, Jeffrey Braithwaite, Gaston Arnolda, Mitchell N Sarkies
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引用次数: 0

Abstract

Purpose: Healthcare is a complex, multi-layered team environment where effective change often requires reaching consensus among relatively autonomous stakeholders. Although conducting informal consensus discussions is a frequently used implementation strategy in real-world clinical settings, limited information exists about what defines consensus when using these methods. Specifying the criteria for consensus is important, as it can shape the design of consensus-building strategies. This study aimed to identify and define the key domains of consensus used in local consensus discussions to standardise healthcare practices.

Patients and methods: A qualitative study was conducted in one private hospital in Australia using a modified, grounded theory methodology. Clinical, non-clinical and leadership staff involved in developing standardised perioperative pathways using informal consensus discussions were recruited. Data were collected via semi-structured interviews and naturalistic participant observations between February 2023 and May 2024. Data collection and analysis occurred concurrently until theoretical saturation was achieved. Data were analysed using open coding with constant comparison, focussed and theoretical coding to develop theoretical concepts.

Results: Sixteen hours of observations with 31 participants and nine semi-structured interviews were conducted. Analysis identified four distinct consensus criteria: i) unanimous consensus, ii) delegated consensus, iii) assumed consensus and iv) concessional consensus. While unanimity was the preferred outcome, other consensus types emerged as viable alternatives when unanimous agreement was challenging to achieve. Each criterion had differing factors and mechanisms which influenced reaching the consensus criterion, underpinning assumptions, and considerations for practice, which formed four domains of consensus.

Conclusion: These domains provide a structured framework for classifying consensus criteria when conducting local consensus discussions in healthcare. The findings broaden our understanding of consensus in local healthcare discussions, moving beyond a singular focus on unanimity. By clearly defining consensus types, organisations can strategically select consensus methods that best support decision-making and intervention implementation.

在进行地方共识讨论时达成一致的标准:一项定性研究。
目的:医疗保健是一个复杂的、多层次的团队环境,其中有效的变更通常需要在相对自主的利益相关者之间达成共识。尽管在现实世界的临床环境中,进行非正式的共识讨论是一种常用的实施策略,但在使用这些方法时,关于共识的定义的信息有限。明确协商一致的标准是重要的,因为它可以影响建立协商一致战略的设计。本研究旨在确定和定义共识的关键领域,用于本地共识讨论,以标准化医疗保健实践。患者和方法:在澳大利亚的一家私立医院进行了一项定性研究,采用了一种改进的、扎根的理论方法。招募临床、非临床和领导人员参与制定标准化围手术期路径,采用非正式共识讨论。在2023年2月至2024年5月期间,通过半结构化访谈和自然参与者观察收集数据。数据收集和分析同时进行,直到达到理论饱和。数据分析使用开放编码与不断比较,集中和理论编码,以发展理论概念。结果:对31名参与者进行了16小时的观察和9次半结构化访谈。分析确定了四种不同的协商一致标准:1)一致协商一致,2)授权协商一致,3)假设协商一致,4)让步协商一致。虽然一致同意是首选结果,但当一致同意难以实现时,其他共识类型也成为可行的替代方案。每个标准都有不同的因素和机制,这些因素和机制影响达成共识标准,支持假设和实践考虑,形成了四个共识领域。结论:这些领域为在医疗保健领域进行局部共识讨论时分类共识标准提供了一个结构化框架。这些发现拓宽了我们对当地医疗保健讨论共识的理解,超越了单一的一致关注。通过明确定义共识类型,组织可以战略性地选择最能支持决策和干预实施的共识方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Healthcare Leadership
Journal of Healthcare Leadership HEALTH POLICY & SERVICES-
CiteScore
5.40
自引率
2.30%
发文量
27
审稿时长
16 weeks
期刊介绍: Efficient and successful modern healthcare depends on a growing group of professionals working together as an interdisciplinary team. However, many forces shape the delivery of healthcare; changes are being driven by the markets, transformations in concepts of health and wellbeing, technology and research and discovery. Dynamic leadership will guide these necessary transformations. The Journal of Healthcare Leadership is an international, peer-reviewed, open access journal focusing on leadership for the healthcare professions. The publication strives to amalgamate current and future healthcare professionals and managers by providing key insights into leadership progress and challenges to improve patient care. The journal aspires to inform key decision makers and those professionals with ambitions of leadership and management; it seeks to connect professionals who are engaged in similar endeavours and to provide wisdom from those working in other industries. Senior and trainee doctors, nurses and allied healthcare professionals, medical students, healthcare managers and allied leaders are invited to contribute to this publication
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