July 12, 2011 | | Comments 0
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This ain’t the summer of love (but maybe it could be…)

One of the universal challenges facing Environment of Care/safety committees is the task of actually getting things done in the way of meaningful improvement, generally for the more controversial issues an organization might encounter. Sometimes it’s because opinions and interpretations are sufficiently diverse that common ground is tough to even imagine, or it could be that there is an agreement that a problem exists, but the solution resides within the more stratospheric pay grades.

One of the most useful means of breaking these deadlocks (I was going to say filibuster, but that sounds way too congressional—I don’t want to paint anyone with that brush) is by adopting a process for obtaining consensus from the group. Consensus provides a framework that allows for some disagreement (and ideally helps moderate those disagreements), but arrives at a work product that is acceptable to the group at large and allows things to move forward (you and I both know that every once in a while there will be a topic of conversation that never, ever goes anywhere—it just keeps burbling along in the minutes and frustrates the heck out of everyone in the room when the topic rears its ugly little head).

Now, consensus shouldn’t be confused with majority rule. In fact, majority rule, if you have strong personalities involved, can be a recipe for stalemate (the old saw regarding physicians: What do you call a medical staff vote of 99 to 1? A tie!) as can be impossible to move beyond those peculiar sticking points.

A nifty (that word doesn’t get used enough anymore, if you ask me) tool to help move towards this type of decision-making looks a little something like this:

+3   We must do this

+2   We should do this

+1   I support this

0    I’m neutral

-1    I don’t support this but won’t oppose it

-2    We should not do this

-3    We must not do this


So, for those thorny issues, everyone has a position, and in all likelihood, that position is represented somewhere on this continuum. As you can see the “decision point” for moving something forward is actually at -1, with everything below being clearly indicative of a stopping point. So, the process works like this: one person, one vote (I think the founding fathers would like that). My preference, but it is entirely up to you, would be for everyone to participate—and I do mean everyone—but that’s one of the ground rules you can (and, to my mind, should) establish. It’s not exactly like not going to bed angry, but it provides a framework (there’s that word again) for moving something forward or moving something off the board (you should also consider in the rules of engagement whether something is being moved off the board permanently or whether it can come back, given certain conditions).

I would encourage you to consider using this tool—and I would encourage you even more strongly to share with the safety community your successes (and failures—everything is a learning opportunity).

Try to keep cool!

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Steve MacArthur About the Author: Steve MacArthur is a safety consultant with The Greeley Company in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Briefings on Hospital Safety. Contact Steve at stevemacsafetyspace@gmail.com.

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