Decision Making Blog #5: Reaching disagreement

Two starting points:  

1. High quality decision making is fuelled by a diversity of perspectives. Disagreement is healthy and necessary;
2. In our wider culture we are getting worse at disagreement. We identify people with views, struggling to separate criticism of the opinion from an attack on the person. Shades of grey are out; black and white is the preferred palette; war is the prevalent metaphor. 

To the extent that these starting points hold, decision making is in trouble. I think they hold. And not only that, I think the NHS has particular problems that tighten the knot and make decision making even harder.  

This is not true everywhere, but the typical NHS management culture privileges hierarchy. The prevailing assumption is that the more senior people are, the more likely they are to be right. HIPPOs* rule.  

In this culture dissenting from a leader’s view is seen as ‘dangerous’: so dangerous that we then talk about the need for ‘psychological safety’ when approaching disagreement. HIPPOs are dangerous.  

These are systemic problems. I suspect they follow largely from our reliance on nationally driven, top-down approaches. Waiting for this to be fixed would be a counsel of perfection (and despair).  

So are there things we can do in the meantime? Are there simple methods and approaches we can use to foster a healthy culture of debate and diversity?  

Ian Leslie’s book ‘Conflicted’ is a fine source here. The book details practical approaches adopted by organisations (and couples…) around the world to surface, explore and resolve disagreement. It’s well worth a read.  

Taking inspiration from Leslie, and many others in this field, the Midlands Decision Support Network offers practical advice in our ‘Thinking Tools for Decision Making’ training workshops. Three such tips can be used almost immediately: 

1. Start quietly and individually. If your group needs to discuss something contentious, then carefully (and neutrally) outline the topic before asking everyone to reflect quietly, before writing their views down. Then open discussion. If you are the leader, do not give your view first.  
2. If you are the leader, act as a ‘Decision Guardian’. Decision quality is a function of the decision process. Your best contribution is not likely to be your view, but to ensure that a high quality process is used.  
3. Use a Devil’s Advocate. Some of us enjoy debate; but most of us see disagreement as stressful and negative. So, if you know that diversity of view is needed, then consider giving someone the job of Devil’s Advocate. They should ensure that arguments are kept honest; that assumptions are explored; and that any consensus is real, rather than low energy squidge.   

These three tips won’t change the tide: far larger forces are needed for that. But they could help your teams to swim against it. If we are to harness the creative and clarifying power of divergence, then we have to learn to reach disagreement.  

* HIPPO = HIghest Paid Person’s Opinion.