Ask the expert: Should we use consensus or majority rule when voting at medical staff meetings?

Medical staffs are collegial bodies. They want, by and large, to rule by consensus. However, at the end of the day, majority rule prevents an issue from getting stuck in debate. Working toward consensus is a goal of all leaders and there are some tools for reaching a consensus among department members. Take a look at the following scale that department chairs can use in collecting votes:

• +3: We must do this
• +2: We should do this
• +1: I support this
•   0: I’m neutral
• -1: I don’t support this but won’t oppose it
• -2: We should not do this
• -3: We must not do this

Everyone gets a vote. Count the number of each type of vote. Determine where to draw the line for whether consensus is achieved. In most cases, the voting average should be above -1 or higher; this means everyone is in support, neutral, or won’t oppose it. That’s as good a consensus as you are going to get.

This week’s question and answer are from Department Chair Essentials Handbook by Richard A. Sheff, MD; and Robert J. Marder, MD.