Consensus Methods

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Consensus Methods

• Professor Wesley Vernon PhD
• Head of Podiatry Service and Research Lead,
  Sheffield PCT
• Visiting Professor, Staffordshire University

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Value for Podiatrists

• Produce agreed/robust
• Clinical standards.
• Protocols.
• Diagnostic criteria.
• Clinical priorities.
• Best treatment
• Education priorities.
• Research needs.
• Vision and strategy.
• Planning needs.
• Patient requirements.
• Etc etc etc

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Previous Uses in Podiatry

• Research priority determination.
• Research vision creation.
• Research strategy creation.
• Management priority determination.
• Forensic podiatry standards.
• Diagnostic criteria agreement.
• Footwear in diagnosis.
• Workforce planning in podiatry.
• Standards for healthy footwear.

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Action Research Definitions

•  .
• "A small scale intervention in the functioning of
  the real world and a close examination of the
  effects of such an intervention" (Cohen L.,
  Manion L., Morrison K., Research methods in
  education, 5th edition, 2000, p. 226-7).
• "A form of self-reflective enquiry by
  participants, undertaken in order to improve
  understanding of their practices in context with
  a view to maximising social justice" (Carr W.,
  Kemmis S., Becoming Critical, 1986, p. 162.).
• "Action research is a process by which change and
  understanding can be pursued at the one time"
  (Dick B., Action learning and action research ltOn
  linegt), 1997.
• "Action research is a research paradigm which
  allows you to develop knowledge or understanding
  as part of practice" (Dick B., and Swepson P.,
  Action research FAQ "frequently asked questions"
  file ltOn linegt, 1997.

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Action Research Model
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Simplified Action Research Model
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History of Action Research

• Founded by Kurt Lewin, 1948.
• Used by Stephen Corey 1950s.
• Criticism in1950s' from quantitative researchers.
• Rediscovered in 1970s by educationalists.

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Strengths of Action Research

• Simple and cost-effective.
• Tool for change.
• Communication benefits.
• Learning process.

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Criticisms/Limitations

• Not necessarily generalisable.
• Can be time consuming.
• Not seen as real research by some authorities.

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What Are Consensus Methods?

• The focus of consensus methods lies where
  unanimity of opinion does not exist owing to lack
  of scientific evidence or where there is
  contradictory evidence on an issue. The methods
  attempt to assess the extent of agreement
  (consensus measurement) and to resolve
  disagreement (consensus development)
• (Jones and Hunter, 1995)

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How Are Consensus Methods Used?

• Commonly used as an Action Research approach.
• Use the insights of appropriate experts (Jones
  and Hunter, 1995).
• Follow a structured process to collect and
  analyse information provided by participants in
  order to produce immediate solutions to problems
  (Fink et. al., 1984).
• Used where unanimity of opinion does not exist
  owing to lack of scientific evidence, or where
  there is contradictory evidence on an issue.
• Used to investigate complex problems, such as
  those commonly encountered in health care.

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Types of Consensus Method

• Glasers State-of the Art Approach
• Staticised Groups
• Social Judgement Analysis
• The Consensus Development Conference
• The Nominal Group Technique
• The Delphi Technique

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Glasers State-of the Art approach

• Only used by Glaser (1980)
• Facilitated groups of physicians
• Series of rounds
• External reviewers

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Staticised Groups

• Individuals collectively, but independently work
  on a specific problem
• No interaction
• Results collected to present a group view
• Superficial analysis only

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Social Judgement Analysis

• Form of feedback given to participants
• Said to be useful when trying to understand why
  there is no consensus
• Focus on the logic behind judgements

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The Consensus Development Conference

• National Institute for Health (USA). 1977
• Kings Fund (U.K.)
• Does not use homogenous expert groups
• Chaired over several days
• Consider evidence presented from non-group
  members

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The Nominal Group Technique (NGT)

• Delbecq and Van de Ven (1971)
• Group of experts in a structured meeting
• Up to 12 experts usually involved
• Facilitated
• Two rounds, with inter-round discussion

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Procedure for NGT

• Participants independently record their
  ideas/views
• Views collected by the facilitator and presented
  to group
• Views discussed one by one
• Rank/vote for each point
• Results collated and re-presented
• Further discussion and final ranking

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The Delphi Technique

• Devised by the RAND corporation (1948)
• Used in nuclear strike prediction (1950s)
  (Linstone and Turoff, 1975)
• Series of questionnaire rounds
• Group of experts

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Delphi Procedure

• 1st round, group introduced to the issue.
• Group provide individual opinions on this issue.
• Opinions collected and re-presented with
  statistical feedback on previous round response.
• Rounds continue until pre-determined consensus
  levels, stability of opinion, or the number of
  intended rounds have been reached.

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Delphi Procedure

• Level of consensus often pre-set at 70 (range
  50 - 100)
• Stability of opinion - static level of agreement,
  or oscillation /- 15 of mode
• Usually 3 or 4 rounds (reported range 2 - 25
  rounds)
• Expert panel sizes frequently 12 20 (but panels
  sizes from 4 to over 2,500 reported previously)

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Modified Delphi Variations in Approach

• Reactive Delphi
• Original modified Delphi (participants brought
  face to face)
• Real-time Delphi
• E-Delphi

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Strengths Nominal Group Technique
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Nominal Group Technique - Strengths

• Single meeting
• Face to face contact (may be an advantage.)
• Reduces inhibition (through formalised structure)
• Promotes the generation of a wide range of ideas
• Some studies suggest that Nominal Group
  Techniques can produce a more robust consensus
  than Delphi

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Strengths Delphi
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Delphi Technique - Strengths

• Can produce agreements when other methods may not
  be possible.
• Time for reflection, improving the strength of
  opinion.
• Greater acceptance of Delphi results than other
  consensus methods.
• Learning and motivating experience for
  participants.
• Highly cost-effective.
• Anonymity can be guaranteed.

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Delphi Technique - Strengths

• Gives access to groups of widely dispersed
  experts .
• Studies have shown Delphi to produce more robust
  findings than nominal Group Techniques.
• Allow a high degree of flexibility in approach.
• Participants have an equal say.
• Through consensus, the agreeing participants have
  already signed up to the value of the findings.

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Weaknesses/ Disadvantages Nominal Group
Technique
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Nominal Group Technique

• Does not allow complete anonymity, which may
  inhibit opinion.
• More studies have shown Delphi rather than NGT to
  be the most robust technique.
• Less frequent and less stable consensus than
  Delphi.
• Reliant on the quality of the facilitator.
• Reliant on the the acceptability of the
  environment.

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Weaknesses/Disadvantages Delphi
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Delphi Technique

• Lack of face to face interaction could be a
  disadvantage.
• Past validity debate.
• Can be extremely time consuming fro participants.
• Can take long periods of time to complete.
• Real-time Delphis difficult to perform in a
  single day.

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Delphi Technique

• Ambiguity regarding panel size and consensus
  levels required.
• Fatigue tendency.
• Care needed avoid facilitator bias.

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Common Pitfalls NGT and Delphi

• The choice of expert is absolutely critical
• Consensus does not necessarily mean truth

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Published Uses in Podiatry

• Ashford R.L. Chiropodial competencies identified
  by the Delphi technique, JBPM, 47, 7, July 1991,
  p. 123-126.
• Wood W.A., Wayne J., Office-based surgery in
  podiatry JAPA 71, 11, Nov. 1981, p. 591-594.
• Vernon W., Parry A., Potter M., Consensus
  obtained in a Delphi study of shoe wear pattern
  experiences amongst podiatrists , JFI, Vol. 53,
  No. 1, Jan./Feb 2003, p. 15-41.
• Vernon W., Parry A., Potter M., Moving towards
  consensus The first draft of an evaluative
  instrumental grid to interpret shoe wear
  patterns, JFI, Vol. 49, No. 2, Jan./Feb. 1999,
  p. 142-173.
• Preliminary findings in a Delphi study of shoe
  wear marks/ JFI, 48, 1, Jan/Feb 1998, p. 22-35
  and Moving towards consensus The first draft of
  an evaluative instrumental grid to interpret shoe
  wear patterns.
• Vernon W., Campbell J., The establishment of an
  ultra-long-term plan for podiatric research,
  BJP, 9, 3, August 2006, p. 72-76.
• Vernon W., Borthwick A., Priorities for podiatry
  workforce planning and development BJP, Vol. 9,
  No. 1, Feb 2006, p. 29-36.
• Vernon W., A Delphi Exercise to Determine
  Research Priorities in Podiatry, BJP, Vol. 8,
  No. 1, 2004, p. 11 - 15.

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References Overview Reading

• Fink A., et.al., Consensus methods
  Characteristics and guidelines for use, AJPH,
  1984, Vol. 74, No. 9.
• Jones J., Hunter D., Consensus methods for
  medical and health services research, BMJ, Vol.
  311, Aug 1995.
• Murphy M.K. et. Al., Consensus development
  methods, and their use in clinical guideline
  development. Health Technology Assessment, Vol.
  2, No. 3, 1998.
• Mckenna H.P. The Delphi technique a
  worthwhile research approach for nursing? J Adv.
  Nursing, Vol. 19, 1994, p. 1221-1225.
• Linstone H.A., Turoff M., The Delphi Method
  Techniques and applications, (London Addison
  Wesley)1975.

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THE END

• wesley.vernon_at_sheffieldpct.nhs.uk

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