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ACEP Now: Vol 40 – No 08 – August 2021

Figure 1. When using Argyris’ Ladder of Inference, team members share the subset of data they used and how it was interpreted to make inferences, judgments, and conclusions. This focuses debate on data interpretation and the thought process that went into creating a recommendation. After taking action, new data inform future decisions.

Agreed-upon frameworks, such as Argyris’ Ladder of Inference (see Figure 1), help teams appraise claims on the basis of objective data and the decision-making process.⁴ When evaluating a claim using Argyris’ Ladder, team members identify the objective data and underlying assumptions used to draw conclusions. Team members then explain the decision-making process used to decide on a course of action based on those data and assumptions. By seeing how team members arrive at their conclusions, the team as a whole can better evaluate claims and come to agreement as to a course of action. This framework has the benefit of being recursive, as outcomes from one round of inquiry lead to additional data and further conclusions.

Kantor’s four-player model (see Figure 2) focuses on the “who” of a team, characterizing individuals based upon their roles in the decision-making process: movers (propose, steer), followers (support, build on), opposers (critique, change), and bystanders (observe, ask questions).5 While seemingly simplistic, this methodology highlights distinct functions within all decision-making teams. In the absence of these functions, decision making may suffer, so team leaders should consider assigning roles up front before starting the process.

Figure 2. Kantor’s four-player model proposes that a more productive discussion comes from healthy debate. A team leader can facilitate debate by assigning roles to approach a proposal from different viewpoints. This ensures the proposal is thoroughly evaluated before approval.

Devil’s advocacy and dialectical inquiry are two other time-honored forms of structured debate (see Figure 3).² Both methods empower team members to evaluate objective data, identify underlying assumptions, and assess potential outcomes. With devil’s advocacy, specific team members are assigned to critique the current leading recommendation, eliminating the emotional charge required to be a lone dissenter when the team’s efforts are focused on moving forward. Dialectical inquiry involves forming small groups to critically assess two or three different proposals in parallel, with each group evaluating another group’s recommendation. Regardless of method, when debate closes, the team as a whole should emerge with a shared set of facts and assumptions from which a final recommendation can be made.