1. List
   
   • What we know for sure about the context.
   • The evidence we have to base this on.
   • The information that is missing, but that we can find out (and who will do this research).
   • The information that is missing, that we cannot know.
2. Develop a shared understanding of the context, including areas
   that may be unsettled or controversial.

3. Discuss the evidence:
   
   • Is there agreement about the sources of evidence?
   • Is there agreement about how this evidence is interpreted?
4. Ask specifically if there are any assumptions people believe are
   being made that are contentious or unclear and make these explicit.

5. Identify the source(s) of the disagreement and if consensus is possible.

Tips for Success

• Ensure that you list beliefs about the world (things that are true or false – often declarative sentences) and not values (what is important to us – often imperatives – “we should”…).

• Remember that reasonable people can understand what reality looks like and how to interpret evidence differently.

• If someone states a belief that is contentious, ask probing questions to understand the source of disagreement.

• Use qualifiers (e.g. sometimes, in most cases) to get to a statement everyone can live with.

• List disagreement about a fact as a fact itself (e.g. there is disagreement amongst the team about the standard of practice.)

• Create subheadings for the facts, if useful.
  
  • Examples include: About the patients and families affected; the system (relevant laws, policies, and processes); the team members involved; the community.

Download

To download the Clinical Decision Process Workup, please click here.