Consensus-building Process Research Articles

Toward a gender transformative change perspective for smallholder agricultural commercialization: building consensus among experts

While smallholder agricultural commercialization has been posited as a catalyst to bring about broad economic benefits, evidence demonstrates that commercialization efforts that are gender blind can exacerbate inequalities. This study employed a consensus-building process for gender and agricultural development experts to formulate a perspective for informing the design and implementation of gender transformative smallholder agricultural commercialization interventions. A three-round Delphi process was used to systematically achieve agreement among 23 experts who address gender issues and implement gender transformative approaches (GTAs) in smallholder agricultural systems. Over the three rounds, the experts systematically generated and prioritized 58 intended changes and conceptual considerations for design and implementation into a final set of 23 statements that were categorized as: GTA design and implementation fundamentals, potential target changes in smallholder agriculture, and standard gender integration measures. Unlike many Delphi studies, we also highlight expert statements that did not achieve consensus in both rounds as well as the qualitative divergence. Key themes based on the agreed upon findings include involving diverse actors in co-development of GTAs, applying an intersectional lens, tackling root causes of power relations in the value chain, addressing constraining norms, increasing women’s access to and control of resources, and strengthening agency and solidarity.

A Delphi method approach to consensus - based translation of ‘Second Victim’ definition into German

Abstract Background Healthcare providers involved in unanticipated adverse patient events, unintentional healthcare errors, or patient injuries, and who become negatively impacted, are defined as ‘Second Victims’. The term Second Victim has gained substantial attention since its inception around 2000, yet lacks a standardized definition in the German context. This study addresses this gap by proposing a consensus-based translation of the term into German, aiming to foster understanding and facilitate research comparability. Methods A Delphi method approach was employed, engaging a panel of German-speaking, clinically and scientifically active Second Victim experts. The study was conducted using an online survey and commenced with the reference of the consensus- and evidence-based definition from the European Researchers’ Network Working on Second Victim (ERNST) published in 2022. Results Nine out of eleven invited experts participated in the study, contributing to a robust consensus-building process. Through three Delphi rounds, a consensus rate of 90% was attained for the translation of the international definition of a Second Victim. The resulting definition provides a comprehensive understanding of the term within the German context. Conclusions This Delphi study establishes a formal consensus among recognized experts, delivering a German-language, evidence-based definition of the term Second Victim. It serves as a crucial foundation for understanding and further researching the Second Victim phenomenon within the German-speaking healthcare community. Key messages • Consensus-based German translation of Second Victim enhances clarity in healthcare discourse. • Delphi method with German experts yields unified definition, promoting the coherence of patient safety research.

Core set of indicators to evaluate healthcare workers support programmes: a consensus-based approach

Abstract Objectives Considering the widespread implementation of support programmes for healthcare workers (HCWs), there is an urgent need to establish a standardised set of indicators for their ongoing assessment. This study seeks to develop a consensus framework for evaluating interventions aimed at supporting HCWs affected by patient safety incidents (PSIs) or other distressing situations, commonly referred to as second victims (SVs). Having a core set of indicators it is crucial for facilitating comparative analyses across different organisations and time periods. Methods A qualitative study was conducted from June 2023 to March 2024. The study involved a multidisciplinary group of members part of the European Researchers Network Working on Second Victims. The consensus-building process utilised insights from a scoping review (phase 0) and a nominal group technique (phase 1) to develop a questionnaire for Delphi Rounds (phase 2). Indicators were rated on a scale of 1-5, with consensus reached if over 70% of participants rated an indicator as both feasible and sensitive scoring above 4. A consensus conference was subsequently organised. Results From an initial pool of 91 indicators, 55 were rated online, with 35 progressing to the Delphi rounds. A total of two Delphi rounds were performed and achieved response rates exceeding 60% and 80% respectively, resulting in consensus on 11 indicators for evaluating SV’ support programmes. These indicators encompass various aspects such as awareness and activation of the programmes, organisational processes and structures, institutional training provisions and assessment of the impact of the programme in the SVs. Conclusions This study endeavors to provide guidance for future SVs’ programs namely in the critical areas of programme’s awareness and activation, structural and process enhancements, and programme’s impact on SVs. Moreover, these indicators are suitable for multiple healthcare contexts and levels of implementation. Key messages • The priorities for evaluation of second victim programmes’ include their impact on healthcare workers, awareness and activation, organisational processes and structures and institutional training. • Utilizing a multidisciplinary consensus approach, we defined a set of indicators that are adaptable to diverse contexts that provide care and varying levels of second victim support implementation.

Defining medical deserts—an international consensus-building exercise

Abstract Background Medical deserts represent a pressing public health and health systems challenge. The COVID-19 pandemic further exacerbated the gap between people and health services, yet a commonly agreed definition of medical deserts was lacking. This study aims to define medical deserts through a consensus-building exercise, explaining the phenomenon to its full extent, in a manner that can apply to countries and health systems across the globe. Methods We used a standard Delphi exercise for the consensus-building process. The first phase consisted of one round of individual online meetings with selected key informants; the second phase comprised two rounds of surveys when a consensus was reached in January 2023. The first phase-the in-depth individual meetings-was organized online. The dimensions to include in the definition of medical deserts were identified, ranked and selected based on their recurrence and importance. The second phase-the surveys-was organized online. Finally, external validation was obtained from stakeholders via email. Results The agreed definition highlights five major dimensions: ‘Medical deserts are areas where population healthcare needs are unmet partially or totally due to lack of adequate access or improper quality of healthcare services caused by (i) insufficient human resources in health or (ii) facilities, (iii) long waiting times, (iv) disproportionate high costs of services or (v) other socio-cultural barriers’. Conclusions The five dimensions of access to healthcare: insufficient human resources in health or; facilities; long waiting times; disproportionate high costs of services and; other socio-cultural barriers, ought to be addressed to mitigate medical deserts. The term medical deserts might not be the most appropriate term for defining areas with insufficient access to health services as it excludes essential domains, such as access to public health and preventive services. Key messages • Medical deserts directly and negatively impact the health outcomes of the people living in it. • Medical deserts might not be the most appropriate term for defining areas with insufficient access to medical services, as it excludes public health and preventive services.

Whose forest, whose values? Planning for Atlanta’s “South River Forest”

ABSTRACT Atlanta, Georgia's (USA) proposed South River Forest (SRF) is a 3,500-acre area straddling southeast Atlanta and parts of neighboring DeKalb County that would include non-contiguous greenspace and developed land uses. Catalyzed by the 2017 Atlanta City Design process, the SRF concept recognizes the ecologically rich, urban forest patches in this predominantly African American part of the metro area. SRF advocates point to the climate and environmental equity benefits of green space conservation for underserved communities and the personal benefits of having wildland-like outdoor recreation areas within the city. To gauge public perceptions of the SRF, promoters conducted the South River Forest Consensus Building & Stakeholder Engagement process in 2022, which included an online survey querying respondents' interactions with and personal relationship to the SRF. The findings showed overwhelming support for the preservation effort; however, eighty percent of respondents identified as white and just nine percent as black. This composition contrasts sharply with most SRF neighborhoods, which question whether black ways of being in nature were captured by the engagement process. Our analysis also brings attention to an alternative, black-led vision for the area that was not reflected in the engagement process and the implications of this erasure for recognition justice.

Redefining professionalism to improve health equity in competency based medical education (CBME): A qualitative study.

There is a pressing need to address all forms of anti-oppression in medicine, given systemic harm and inequities in care and outcomes for patients and health care professionals from equity-deserving groups. Revising definitions of professionalism used in competency-based education can incorporate new professional competencies for physicians to identify and eliminate the root causes of these inequities. This study redefined the CanMEDS Professionalism definition to centre perspectives of equity-deserving groups. In this qualitative study there were two phases. The authors conducted individual semi-structured interviews with participants representing equity-deserving population groups to understand their perspectives on and iteratively build a definition of medical professionalism. Then, the authors undertook a consensus-building process, a modified nominal group technique, using focus groups with community members from equity-deserving groups and healthcare providers to verify findings and arrive at an updated definition of medical professionalism. Four main themes were identified: 1) healthcare at the margins; 2) equity-oriented domains of professionalism; 3) structural professionalism; and 4) supporting improved professionalism. These themes were incorporated into a consensus-based definition of medical professionalism, with a focus on anti-oppression, anti-racism, accountability, safety, and equity. The authors propose a new definition of medical professionalism that embeds anti-oppression, including anti-racism, as critical competencies in clinical practice and education.

Consensus-Building Processes for Implementing Perioperative Care Pathways in Common Elective Surgeries: A Systematic Review.

To identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries. Systematic review. Five databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023. Two reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions. The initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full-text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions. Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented. Advancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals. These findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. No patient or public contribution. CRD42023413817.

Vocal consensus building for collective departures in wild western gorillas.

The ability to coordinate actions is of vital importance for group-living animals, particularly in relation to travel. Groups can only remain cohesive if members possess a cooperative mechanism to overcome differences in individual priorities and social power when coordinating departures. To better understand how hominids achieve spatio-temporally coordinated group movements, we investigated vocally initiated group departures in three habituated groups of western gorillas (Gorilla gorilla) in the Central African Republic. The large sexual dimorphism of gorillas has led to the untested assumption that the silverback males are the sole decision-makers in gorilla groups, although there are also observations that suggest otherwise. To address this, we analysed the direction and timing of group departures and found that high-ranking individuals (silverbacks and high-ranking females) were more successful in indicating the direction of future travel than others, but that the timing of departure was the apparent result of a cumulative vocal voting process among all adult group members. Our findings illustrate that even in species with a large sexual size dimorphism, travel decisions can be taken collectively via a consensus-building process.

Consensus on innovations and future directions of community first responder schemes in United Kingdom: a national nominal group technique study

AimWe aimed to achieve consensus among NHS and community stakeholders to identify and prioritise innovations in Community First Responder (CFR) schemes.MethodsWe conducted a mixed-methods study, adopting a modified nominal group technique with participants from ambulance services, CFR schemes and community stakeholders. The 1-day consensus workshop consisted of four sessions: introduction of innovations derived from primary research; round-robin discussions to generate new ideas; discussion and ranking of innovations; feedback of ranking, re-ranking and concluding statements. Innovations were ranked on a 5-point Likert scale and descriptive statistics of median and interquartile range calculated. Discussions were recorded, transcribed, and analysed thematically.ResultsThe innovations found were classified into two categories: process innovations and technological innovations. The process innovations included six types of innovations: roles, governance, training, policies and protocols, recruitment, and awareness. The technological innovations included three aspects: information and communication; transport; and health technology. The descriptive statistics revealed that innovations such as counselling and support for CFRs (median: 5 IQR 5,5), peer support [5 (4,5)], and enhanced communication with control room [5 (4,5)] were essential priorities. Contrastingly, innovations such as the provision of dual CFR crew [1.5 (1,3)], CFR responsibilities in patient transport to hospital [1 (1,2)], and CFR access to emergency blue light [1 (1,1.5)] were deemed non-priorities.ConclusionsThis article established consensus on innovations in the CFR schemes and their ranking for improving the provision of care delivered by CFRs in communities. The consensus-building process also informed policy- and decision-makers on the potential future change agenda for CFR schemes.

A reflection on the use of virtual nominal group technique in health policy and research priority consensus studies.

Nominal group technique (NGT) is widely used in healthcare research to facilitate decision-making and consensus-building. Traditional NGT requires face-to-face interaction and its limitations include potential biases, logistical challenges and high costs. The COVID-19 pandemic necessitated a shift to virtual methods, which led to the development of virtual nominal group technique (vNGT). Aim To reflect on the use of vNGT, particularly in the context of Ghader et al (2023 ), to understand its effectiveness in overcoming the limitations of traditional NGT and on its applicability in pandemic-affected scenarios. This paper reviews and discusses literature on the use and effectiveness of NGT compared to other consensus-building methods and examines the emergence of vNGT in overcoming the limitations of traditional NGT. The authors also reflect on their use of vNGT in a study to identify cardiovascular research priorities in the UAE and provide details of its implementation. vNGT bridges the gap between the localised nature of traditional NGT and the global reach of the Delphi technique. It allows for the inclusion of diverse participants, saves costs and offers time-efficiency. The study demonstrated vNGT's adaptability, with participants engaging in idea generation, discussion and prioritisation using online tools. However, challenges persist with vNGT, including reduced accessibility for certain demographics, timing issues across time zones and technical difficulties. vNGT successfully integrates the interactive, consensus-building aspects of NGT with the broad reach of Delphi. It can be valuable in research and decision-making, especially in an era of increased remote collaboration. vNGT can significantly impact healthcare research and policy formulation by enabling more inclusive, cost-effective and timely consensus-building processes. However, considerations for accessibility and technical support are crucial for its wider adoption and effectiveness.

Time to Consensus in International Negotiations

Contemporary international relations, anchored in the principles of multipolarity, frequently employ consensus-based decision-making, which prioritizes respect for all negotiating parties and ensures that the views of all participants are considered equally. While consensus remains a core mechanism for many international organizations, such as the World Trade Organization (WTO), it has increasingly come under criticism for its inefficiency and substantial time requirements. This highlights the importance of examining the factors that influence the time needed to reach consensus. Utilizing formal mathematical modeling based on a modified DeGroot model, this article explores how variables such as the size of the negotiating group, the level of authoritativeness, dominance dynamics within the group, and coalition formation affect the time required to achieve consensus. The findings indicate that an increase in group size, on its own, results in only a minor increase in the time needed to reach consensus, becoming a significant factor only when paired with high levels of authoritativeness among the participants. Conversely, the presence of a highly authoritative member within a negotiating group significantly prolongs decision-making time, even in smaller groups, and the formation of coalitions (e.g., due to multiple highly authoritative members) can make reaching consensus impossible. The "consensus minus k" rule, intended to break deadlocks, is found to be ineffective for international organizations with numerous participants and divergent interests. In hierarchical structures, consensus is typically achieved through preliminary negotiations within subgroups, which further prolongs the consensusbuilding process.

CMAA–AHP: combinatorial multicriteria acceptability analysis with the analytic hierarchy process

AbstractCombinatorial multi-criteria acceptability analysis (CMAA) is a framework for supporting multicriteria group decisions that provides both a detailed analysis of the effects of individual decision-maker inputs as well as interactive guidance for a consensus-building process. The analytical hierarchy process (AHP) is a widely-used model of decision-maker evaluations that is based on pairwise comparisons. The goal of this work is to show how CMAA can be integrated with AHP in order to make its benefits available to AHP users. We use a minimal input format for AHP which avoids a problem with inconsistency and also reduces the cognitive load on the decision-makers. We extend the CMAA method by introducing new judgement and preference sensitivity variables, which provide helpful insights for the facilitator of the group decision. An example illustrates the combined CMAA–AHP method and its ability to deliver consensus in a very small number of iterations. Monte Carlo simulation is used to study the convergence behavior of the method for a range of problem dimensions. It was found that the mean number of steps to reach consensus grows linearly with the number of alternatives and criteria. We consider two previously published group decisions that use the standard AHP approach of averaging decision-maker judgements and preferences. In both cases, CMAA–AHP delivers the same rankings based on the original input. However, the new method also provides insight into each decision and would have been able to guide each group to consensus within a small number of resolution steps.

Sez4Feasibility Criteria for the Designation of Intergenerational Contact Zones. A Proposal

ABSTRACT Intergenerational Contact Zones (ICZ) are a relatively recent concept pertaining to spaces and the opportunities they provide for interaction between generations. This paper puts forward a series of validated criteria with which to assess the feasibility of intergenerational spaces that could potentially be designated ICZ. To develop these validated criteria, a consensus-building process following the Delphi method was carried out. This approach minimizes uncertainty and aids the decision-making of the participants, who in this case were 11 international experts. Statistical procedures were used to analyze quantitative information gathered in the process to ensure that the combination of assessments resulted in a unified and mutually accepted set of criteria. The 16 criteria presented herein do not constitute a closed list but rather a proposal based on expert consensus that it is consistent with the different dimensions explored. Overall, these criteria can help to advance ICZ applications and conceptual clarity.

Reaching consensus amongst international experts on the use of high importance-rated antimicrobials in animals – a Delphi study

In Australia, antimicrobials are given an importance rating by the Australian Strategic and Technical Advisory Group on antimicrobial resistance. High importance antimicrobials are those essential for the treatment or prevention of infections in humans, where there are few or no treatment alternatives. In this study we consulted with experts from across human and animal health using the Delphi consensus-building process to establish the circumstances under which antimicrobials with high importance to human health could be used in animals in Australia. We used three rounds of online surveys. Group responses were provided to participants in each subsequent round to facilitate convergence of opinion. Consensus was defined as 80 % or more of respondents selecting the same option for a question. By the end of the third round, consensus was achieved on eight items. This included the use of high importance antimicrobials being appropriate if culture and sensitivity testing indicated the organism was resistant to low- and medium-rated antimicrobials that could be used to treat the case. If any high-importance antimicrobials are prescribed for animals there was also agreement that a clear indication for this use and justification for antimicrobial choice must be recorded in the medical history, along with the dose rate, route of administration, the duration and the time point for review of the condition and associated antimicrobial therapy.Appropriateness of use of high importance antimicrobials in critically ill animals where culture and sensitivity results are not available is still undefined. Further work is also required to establish which particular organisation should be notified of the use of high importance antimicrobials not registered for use in animals. The Delphi process was valuable in facilitating consensus amongst international experts from a broad range of health backgrounds and experience.

Understanding key priority areas of mental health among queer asylum seekers and refugees in Australia through the lens of structural violence: A modified Delphi method study

Abstract Queer asylum seekers and refugees (QASaR) are more likely to have poor mental health compared to non-QASaR. This paper examines key priority areas for refugee services to improve mental health outcomes of QASaR in Australia. The key priority areas were identified through a modified Delphi method (DM), comprised of two stages: a scoping review of literature and three rounds of consensus building process. In the second stage, twenty-one participants were involved, including QASaR, health/social care professionals, and people in policy/funding-related roles. Drawing on Farmer’s understanding of structural violence, our consensus suggests QASaR’s poor mental health is primarily produced by the asylum system, further exacerbated by the lack of safe queer-inclusive refugee services, and can be improved by supporting QASaR-led organizations. Greater investments in QASaR-led organizations and initiatives are needed to improve cultural safety of refugee services and achieve systemic change.

Statistics as a Social Activity: Attitudes toward Amalgamating Evidence.

Amalgamation of evidence in statistics is conducted in several ways. Within a study, multiple observations are combined by averaging, or as factors in a likelihood or prediction algorithm. In multilevel modeling or Bayesian analysis, population or prior information is combined with data using the weighted averaging derived from probability modeling. In a scientific research project, inferences from data analysis are interpreted in light of mechanistic models and substantive theories. Within a scholarly or applied research community, data and conclusions from separate laboratories are amalgamated through a series of steps, including peer review, meta-analysis, review articles, and replication studies. These issues have been discussed for many years in the philosophy of science and statistics, gaining attention in recent decades first with the renewed popularity of Bayesian inference and then with concerns about the replication crisis in science. In this article, we review the amalgamation of statistical evidence from different perspectives, connecting the foundations of statistics to the social processes of validation, criticism, and consensus building.

Towards Auditing Firm Success: Factors That Reduce Auditors’ Intention to Leave

This study investigates the factors that reduce an auditor’s intention to leave the company, thereby addressing the challenges of hiring experts and the great resignation that may jeopardize auditing firm success. We surveyed 63 auditors regarding the impact of their membership esteem and status on the decision-making and consensus-building process and their intention to leave the auditing firm. While higher membership esteem is linked with increased expression of disagreements between the auditor and the lead engagement reviewer, higher status is associated with higher decision-making consensus. Although the auditors’ decision-making consensus does not relate to their intentions to leave the auditing firm, a higher status increases their likelihood of leaving. In contrast, higher membership esteem is associated with lower intentions to leave the company. Our findings underscore the importance of developing higher membership esteem among auditors to reduce auditor attrition.

Representing science: diversity on the President’s Council of Advisors on Science and Technology

Abstract Federal advisory committees related to science and technology are important mechanisms for connecting policy-makers with independent experts and the broader public. The balance of represented expertise and viewpoints shapes a committee’s intended advisory role, consensus building processes, and the quality and impact of its policy recommendations. This paper presents the first historical analysis of the President’s Council of Advisors on Science and Technology (PCAST) and examines its changing balance of social and professional perspectives from 1990 to 2023. We demonstrate that PCAST’s balance has shifted to be more inclusive of different social groups and professional backgrounds over time, particularly under President Biden. We conclude with recommendations for future White House science policy advisory bodies to ensure they are adequately representative of the diversity of perspectives in the US research enterprise and the overall US population.

The principles and guidelines on human rights and public health emergencies

Launched by the Global Health Law Consortium and the International Commission of Jurists in 2023, the Principles and Guidelines on Human Rights and Public Health Emergencies (the ‘Principles’) clarify and affirm international law and correlative standards on human rights and the rule of law in the context of public health emergency prevention, preparedness, response, and recovery. The Principles were developed through a three-year deliberative and consensus-building process between more than 150 individuals from around the world, including international legal scholars and practitioners, human rights defenders, civil society advocates, public health researchers, health workers, and others bearing relevant insights and expertise. Spanning 28 interrelated provisions, they aim to guide the decisions and actions of governments, civil society, and other stakeholders who are at the forefront of efforts to address public health emergencies.

2023 Society for Academic Emergency Medicine Consensus Conference on Precision Emergency Medicine: Development of a policy-relevant, patient-centered research agenda.

Precision medicine is data-driven health care tailored to individual patients based on their unique attributes, including biologic profiles, disease expressions, local environments, and socioeconomic conditions. Emergency medicine (EM) has been peripheral to the precision medicine discourse, lacking both a unified definition of precision medicine and a clear research agenda. We convened a national consensus conference to build a shared mental model and develop a research agenda for precision EM. We held a conference to (1) define precision EM, (2) develop an evidence-based research agenda, and (3) identify educational gaps for current and future EM clinicians. Nine preconference workgroups (biomedical ethics, data science, health professions education, health care delivery and access, informatics, omics, population health, sex and gender, and technology and digital tools), comprising 84 individuals, garnered expert opinion, reviewed relevant literature, engaged with patients, and developed key research questions. During the conference, each workgroup shared how they defined precision EM within their domain, presented relevant conceptual frameworks, and engaged a broad set of stakeholders to refine precision EM research questions using a multistage consensus-building process. A total of 217 individuals participated in this initiative, of whom 115 were conference-day attendees. Consensus-building activities yielded a definition of precision EM and key research questions that comprised a new 10-year precision EM research agenda. The consensus process revealed three themes: (1) preeminence of data, (2) interconnectedness of research questions across domains, and (3) promises and pitfalls of advances in health technology and data science/artificial intelligence. The Health Professions Education Workgroup identified educational gaps in precision EM and discussed a training roadmap for the specialty. A research agenda for precision EM, developed with extensive stakeholder input, recognizes the potential and challenges of precision EM. Comprehensive clinician training in this field is essential to advance EM in this domain.