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ACEP Now: Vol 40 – No 08 – August 2021

Figure 3. FIGURE (left). Devil’s advocacy identifies and critiques the underlying facts and assumptions that must be true for a proposal to achieve its aims. At the end of debate, the team should reevaluate said assumptions and draft a final recommendation. FIGURE (right). Dialectical inquiry critiques the facts and assumptions of two or more proposals. The team then creates a set of shared facts and assumptions that should be used to reshape a current proposal or develop a new one.

Planning Up Front Leads to Productive Debate

Employing a structured framework for debate requires effort up front, but the payoff is higher-quality decision making and a healthier balance of cognitive conflict as opposed to emotional conflict.^2,3 These methods may feel burdensome in the moment, but better decisions and more highly functioning teams save costs—time, money, and effort—down the line.¹

When thoughtful inquiry and open discussion are encouraged, the statement “what’s best for the patient” changes from a conversation stopper to the common ground team members rally around. By focusing on the “why,” interdisciplinary teams can engage in productive conversation and come up with thoughtful solutions that impact not just what’s best for patient but for the entire health care system and for the community.

Dr. Mahan is a clinical fellow in emergency medicine at Harvard Medical School in Boston. Dr. Kosowsky is assistant professor at Harvard Medical School.

References

1. Milkman KL, Chugh D, Bazerman MH. How can decision making be improved? Perspect Psychol Sci. 2009;4(4):379-383.
2. Schweiger DM, Sandberg WR, Ragan JW. Group approaches for improving strategic decision making: a comparative analysis of dialectical inquiry, devil’s advocacy, and consensus. Acad Manage J. 1986;29(1):51-71.
3. Schwenk CR. Effects of devil’s advocacy and dialectical inquiry on decision making: a meta-analysis. Organ Behav Hum Decis Process. 1990;47(1):161-176.
4. Kim DH. Transformational leadership. The leader with the “beginner’s mind.” Healthc Forum J. 1993;36(4):32-37.
5. Kantor D, Koonce R. Consequential conversations. TD Magazine. 2018;72(8):50-55.