Frequently Asked Questions



Is this guide only appropriate for the healthcare context?

The approach and process can be equally useful in a variety of situations – really anywhere that system-level decisions are made.



What healthcare context is this intended for?

The tool can be used in any healthcare context, from public health and home care to residential and acute care settings.



In what contexts has this approach been used?

This process has been used in healthcare and non-healthcare contexts. Within healthcare, it has been used in a variety of programs from mental health & addictions and public health & primary care, to nephrology and maternal & child health. Outside healthcare it has been used in private enterprise and civil society arenas to guide questions concerning organizational structure, organization core values, facility use guidelines, and resource allocation criteria.



How quickly can we do this? How much time will this take?

It will likely take two meetings of between two and three hours each to get to a preliminary decision. Three more meetings, with engagement and communication along the way, will probably be required before the team will be ready for implementing the decision. (See the suggested schedule for a sense of what is involved.)



Must we use the entire process?

This depends on how good a decision you want. Using the process up to Step 7 will likely still offer a team improvement from most existing methods of decision-making. The Engagement piece is necessary to maximally achieve the benefits of legitimacy and compliance. The follow- up steps are necessary to achieve the benefits of effectiveness, especially in the middle and long term.



When should teams use this tool?

A team might be well-advised to use the tool first on a very important policy decision that must be made but for which a time-horizon of a few months is available. This will allow the group to go through the process carefully and learn without feeling rushed. This first iteration will help teams decide whether and how the process might become part of standard procedure.



What specific types of decisions have past teams made using this process?

The approach has been used to assist teams to determine criteria and processes for allocating resources, to determine practice guidelines for responding to challenging clinical issues, and to assist newly formed programs to determine how they can best work together.



Is this a linear process?

Although the process looks linear, there is much interplay between the steps. For example, it may not be until part way through the process that the key question becomes confirmed. And conversation about values may lead to the identification of new facts or missing information. While it is important that the process be complete, each step need not be completely finished before moving on to the next. (Indeed on some occasions it has made more sense to switch certain steps around.)



Who should be involved in the process and at what point? (i.e. whose values should determine the answer to the question?)

The underlying principle of the approach is that if someone is impacted by a decision or has information that is relevant to the decision, there should be a way for that person to contribute their wisdom. Because of the structure of the process (again, to balance efficiency of decision-making with decision quality), the stage at which someone has the opportunity to share their perspective will depend on the groups they fall into. Groups that should be involved include:
1) the decision team,
2) those engaged in the evaluation of the decision team’s initial decision,
3) those to whom the decision is communicated,
4) those who will need education and support for or as a result of implementing the decision, and 5) those involved in the decision’s implementation and follow up.


Will using this process guarantee a good outcome?

No approach to decision-making can overcome uncertainty. Despite the best and most careful deliberation and planning efforts, the future may not align with assumptions made about it. This process is aimed at offering decision teams the conviction that they have done their best to make as good a decision as possible, all things considered. It assumes that human beings are fallible and recognizes we all will grow in both factual and moral knowledge.



Why should we use this process? What are the benefits?

The current work climate is often harried. We are pushed to make decisions quickly. In addition, we live and work with people who are different than we are – who see the world differently than we do. And we operate in hierarchical contexts where there are significant differences in power – differences that do not necessarily correlate to levels of wisdom.

These factors together can lead to decision-making that fails to take into account the best evidence, that is unclear about what should be most important within the context of the work, and that inappropriately privileges the views of some perspectives over others.

This approach is designed to assist leaders to gain trust amongst the community the decision is for, quality in terms of the actual decision made, effective implementation of the decision, legitimacy in that the views of relevant individuals are considered in the decision process, and greater likelihood of compliance with the decision even when people disagree with it.