For an extended care’s quality: the building of consensus

The consensus’ achievement (“Cum-séntire”, listen together, comply with) it’s the result of a decision process about a specific controversial topic that begins with the active listening (séntire) of all the figures (cum) involved and representative of the different interests to reach a verdict preferable to all the group.

Achieve the consensus isn’t about obtain a numeric majority, but means, through a specific methodologic approach, find out a deal to solve or diminish the objections of the minority and obtain the most shared decision.

So move from the simple poll logic to the resolution one that is characterized by a focused analysis of data and of the available studies, the comparison of the knowledge, the creation of rational and emotional argumentations about why support choices instead of others, until the achievement, for iteration, of the limitation or the sacrifice of particular interests for a collective interest.

Obtain an “agree into the disagree” starting from position that sometimes aren’t just different but conflicted, to contribute, at the end of the process, at the achievement of a high degree of an agreement, or even unanimity.

This approach, inserted into the healthcare reality, means a creation of recommendations, results of a multidisciplinary working-team representative not only of technical skills (clinicians, scientific societies, healthcare foundations) but representative also of the will of patients-families and of the citizenry.

Thinking about the consensus assume a meaning even more relevant when the theme concerns the clinical practice, not only of a singular healthcare reality but, in a systemic vision, the procedure’s harmonization of many hospitals, inside a unique Region, inside more Region, above all the national territory. In this case the consensus’ method helps the meeting with an expert organization, able to fertilizes the ones barely formed and gathers “fresh” ideas, less influenced. This pouring of experiences, ideas and skills could help the development of a shared mode of our actions, without standardise, make all equal nullify the context’s variability, but with the respect of specificity.

The Healthcare and Well-being Area of ISTUD Foundation in those years worked upon the construction of consensus in several settings:

  • ALMA project that involved the Italian Spinal Unities that manage people with spinal trauma to define recommendations about aspects of care’s harmonization;
  • Project in collaboration with sections of oncoematology services of AIL (Associazione Italiana contro le leucemie-linfomi e mieloma) at national level to re-examine processes of domestic assistance to achieve a consensus about how make them more functional, with less superimposition of activities, and above all improved for what concern transitions between professionals;
  • Participation at the Steering Committee of “Involving a Citizens’ Jury in Decisions on Individual Screening for Prostate Cancer” project, promoted by the Mario Negri Institute for Pharmacological Research, by the Agency of Scientific Publishing Zadig and by Agenas about consensus regard the recourse of asymptomatic men of the PSA screening;
  • Cescere project, through the making of a qualitative consensus about the good communication practices between healthcare professional and families involved in a therapeutic path for the GH Deficit. The result of this kind of activity provided a material tool of recommendations, from all the subjects directly involved in the ways of care, applicable in the daily clinical practice. This also allowed to move from a generic concept of “compliance” of therapy to a real “agreement” with patient and his family, fundamental prerequisite for the management of a care path durable and effective.

The creation of a consensus conference need an extremely articulated organizational path (see “Methodologic manual about how organize a consensus conference – Superior Institute of Healthcare”) focused upon the kind of topics, of the data, of the jury’s composition, of the recipients of recommendations.

You can here download for free the document (PDF) of the consensus’ conference.

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Luigi Reale

Degree in Political Science, Master in Health Management at SDA Bocconi in Milan. He developed research project, training and consultancy in healthcare organizations. He is professor of organization and health politics. In recent years he focused his interest on sustainability and personalization of care through the narrative approach. He has authored various project research, articles and essays on these topics. He is Director of the Health Area of the ISTUD Foundation, member of the Board of the Italian Society of Narrative Medicine.

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