Moving Beyond Compromise: Enhancing Research Impact through Effective Consensus Building
Consensus at the cost of compromise is a low win/win situation. It is more like a lose/lose situation. 'Compromise means that 1+1=1.5.' This was the viewpoint of Stephen Covey, who wrote the Seven Habits of Highly Effective People. Despite having read Covey's book in early adulthood, I promptly forgot about his perspective on compromise when I started to be involved in collaborative innovation projects. I eagerly learned about consensus processes such as Delphi.
For the past 17 years, I have spent most of my time thinking about collaborative innovation in the medical and life science field. Time and time again, people roll their eyes when building a consensus comes up as a possibility. Most of us working in medical and life science innovation have experienced drawn-out consensus processes, mostly for clinical guidelines. These often take 2-3 years to produce. This is often because consensus means compromise.
The problem is that much of the progress in life sciences innovation relies on the ability to align large groups of researchers, clinicians, regulators, patients, payers, and the list goes on. For example, if a wider community cannot agree on the most important outcome marker for a disease or a biomarker, that field will be stuck as it will be difficult to accumulate the critical mass of evidence on any given topic to definitively know what is correct. Yet there is an aversion to building consensus.
Coming to a consensus could be a simple solution. If it turns out that everyone is aligned but does not know it, then surveying and then defining the points of consensus is useful. The problem arises when alignment is not 100%. When there is misalignment, the push for consensus leads to either compromise or just leaving the area where consensus could be found off of the table. Those that advocate for consensus are attracted to the potential simplicity of just finding common ground by looking for it.
Consensus can also be used as a way to approach problems beyond resolving conflicting opinions. A consensus approach is sometimes used to define the landscape of interests. An example is defining the most important variables for a registry or a clinical study. However, this can also be challenging if a wide group of individuals all have their own favorite variable. You could end up with a wide array of variables, creating a bloated data capture system that is not structured in a way to help you answer research questions. The list of variables to capture is only a fraction of the structure of a good data capture process. If the variables captured are not well-defined or reducible to a harmonized set of values, such as a medication list, then they are adding complexity but little research value. Such a process is, in the end, a compromise. To please everyone, variables are being included that are not necessary. Yet, a study that never gets done because the clinic visits take too long and the patients are not willing to fill in a long set of questions is a form of compromise. It's also likely that new and innovative variables are the most difficult to achieve consensus around and, therefore, at risk of being excluded.
Consensus does not guarantee a sense of ownership. In fact, there is a real risk that with consensus at the cost of compromise, no one has a sense of ownership. Take, for example, the development of a standard definition of a disease. If the broader disease community cannot come to an agreement on the definition, the compromise may be to simplify the definition to appease everyone. The result is a definition that is too broad, making it difficult to target therapies to specific subpopulations.
The biggest problem is that consensus often means not deciding, which is a form of compromise. There is no consensus on this point, so it will be left out of the guideline or new definition. However, when you are trying to develop a set of variables or a clinical study, you cannot just not decide. Thus, consensus becomes equated with a drawn-out process of conflict resolution. Most of us would rather avoid conflict, which is a predilection that only fuels the aversion to consensus processes.
The problem may be a tendency to equate consensus with unanimity. As Randy Schutt points out, consensus and unanimity are not the same:
"Many people think of consensus as simply an extended voting method in which everyone must cast their votes the same way. Since unanimity of this kind rarely occurs in groups with more than one member, groups that try to use this kind of process usually end up being either extremely frustrated or coercive. Decisions are never made (leading to the demise of the group), they are made covertly, or some group or individual dominates the rest. Sometimes a majority dominates, sometimes a minority, sometimes an individual who employs 'the Block.' But no matter how it is done, this coercive process is not consensus.” - Randy Schutt (1).
Aversion to consensus-making can also create an aversion to engaging stakeholders. If consensus by compromise is seen as the only model for engaging stakeholders, there will be reluctance to involve stakeholders at all. The thinking becomes that it is best to engage a small group and let them decide leaving a wider group of stakeholders out.
However, obtaining a wide array of input from stakeholders is valuable as it helps to define the range of possibilities, is one of the best ways to quickly solve problems, and contributes to creating the critical mass needed to bring about change. How can we move beyond equating consensus with unanimity and overcome the default to compromise? Perhaps we should look to the field of negotiation.
Learning from high stakes negotiations
William Ury, one of the world's most prominent negotiators, has been involved in several high-stakes negotiations on a global scale. He recently described in the Tim Ferriss podcast (2) what he calls a 'one text' process.
The one text process is about going through many iterations, asking the opposing parties for criticisms of the one text. Then, at some point, putting forth that it is as best as it can be. The decision then becomes take it or leave it. Building up the one text as a series of iterations meant that both parties could clearly see what they were going to get in return. The key is that the negotiation team worked on the one text document, knowing the deeper interests of either party. Instead of asking for a compromise, they use an iterative creative process to reach a solution that is acceptable to all parties. They also work to develop empathy on both sides of the negotiation. They ask each party to write the other's victory speech. A one text is like a set of strategic recommendations. It is a way to put forth ideas for solutions that achieve the interests of both parties. It goes beyond traditional agree or leave it out consensus making.
In my experience, backing up and taking the time to understand the fundamental interests of different stakeholders is key to stakeholder participation in life science research and innovation projects. One of the most dramatic demonstrations of this was when taking the time to understand their driving interests, their why, led to the first time payers engaged in a forum on the use of biosimilars. Once the clinicians, patients, and industry realized that the payers were driven by a desire to help patients but focused on keeping the healthcare system viable, it created an opening for further discussions. This is what Covey describes as seeking the third way.
Another process that Ury describes is the devising seminar. The devising seminar is a regular meeting where the topic of discussion is what one thing a given world leader could do tomorrow to make progress on a difficult issue. The devising seminar is like a consortium meeting that we always aim to include in consortium projects - the project integration team. It is a consortium meeting with the purpose of working to creatively solve problems. A devising seminar or a project integration team meeting is like the Kaizen of problem-solving, doing something to improve or move forward by just 1%. It is about making progress at all costs, even if you think that one step of progress will be meaningless or mostly meaningless. This approach is one of the five principles of highly interactive consortia that I described in Assembled Chaos.
It was best illustrated by the fast mover project in SHARP, which was used to build a federated analysis platform. To overcome skepticism, we helped SHARP run a simple process of conducting a manual analysis of multiple different centers. They just had to fill in a table of averages and standard deviations of a set of variables. Many did not believe that it would produce meaningful results, but it did, leading to a high-impact publication (3). More importantly, the enthusiasm for building out a federated analysis platform then rose exponentially, and that enthusiasm was necessary because creating such a system meant overcoming multiple barriers.
How can these negotiation strategies be used to increase research impact?
One of the best structures for forming a consortium, a community, or an ecosystem is using a hub and spoke structure. If you look at the anthropology, psychology, and computer science literature, it turns out that one of the best organizational systems for a large group is a hub and spoke, where smaller clusters work to create new ideas and then periodically bring those ideas to a wider group. This is how you can align the focus of a critical mass of like-minded people to work together to make a real difference. In a hub and spoke structure, you get the benefit of both small team working and access to a diversity of thinking. This is exactly how some of the seemingly unsolvable math solutions were solved. The long tail of the internet, a wide array of people, came together in response to a blog post by a mathematician who then took one of the ideas forward to develop the solution.
Like the devising seminar described by Ury, we often structure consortia as a cluster of work packages reporting to a centralized hub we call a project integration team. The key to making this work is using a process not unlike the one text. Listening to those reporting into the project integration team to identify problems and then thinking about and proposing solutions that are a simple step towards the solution, like the one thing that can be done tomorrow discussed in a devising seminar, serves as a low-risk test of what could be part of the solution. The point is to leverage these approaches to access the collective intelligence of a diverse group to develop creative solutions to problems and then use the collective resources of that group to build awareness and make a change. When this is done well, everyone benefits both in the short term and the long term by being engaged in a collaboration. Problems get solved more rapidly, and an aligned critical mass of stakeholders is able to achieve more meaningful change.
Don't let the difficulties of building consensus turn you away from working collectively. Consensus building that focuses on achieving a win/win while continuously making small incremental gains has the potential to utilize both collective and strategic thinking. This approach is valuable for engaging diverse stakeholders in strategic planning and in developing and implementing consortium projects that deliver exponential returns. It requires investing thought and effort to develop creative win/win solutions by working together with an incremental 'what can we do tomorrow' mindset.
At BioSci Consulting, we specialize in facilitating interaction to ensure that consensus building leads to better strategic plans and more successful consortium projects. Our goal is to improve fundraising by expanding research impact. If increasing research impact and improving fundraising are important to you, feel free to reach out for a free initial strategic advice consultation.
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"Schutt, Randy (13 June 2016). 'Consensus Is Not Unanimity: Making Decisions Cooperatively'. www.vernalproject.org. Retrieved 27 February 2024."
van Bragt, Job JMH, et al. "Characteristics and treatment regimens across ERS SHARP severe asthma registries." European Respiratory Journal 55.1 (2020).
