Table 2.

The Bridging the Chasm Community Consensus Process and Skills: Active Listening, Summarizing, and Synthesis^*

Steps to Consensus	Conference Day 1	Conference Day 2	Year 2: Advancing the Consensus Process
Step 1: Introduce/clarify the issue(s) to be decided. 1. Share relevant information. What are the key questions? 2. Build sense of community and trust between participants.	Issue framing: the four components of the chasm were introduced; keynote speakers shared perspectives from advocates, patients, clinicians, and health care system innovators. In storytelling exercises, led by a team of drama coaches, experiences as recipients and providers of clinical care became shared narratives, building cohesion and trust.	Day 1 homework: participants were tasked with re-visiting a review of the literature and asked to bring in three ideas for change. Assignment to different groups and networking during lunch allowed cross-communication. Small group leaders (SELC members) facilitated participation.	Snowball recruitment identified additional experts consistent with the BtC mission. Discussion with the SELC resulted in formation of 7 working groups (WGs) drawn from 11 Day 2 topics. We reviewed literature (peer and gray) on WG topics and developed a portal to exchange information, build consensus, and work collectively.
Step 2. Explore the issue, look for ideas, and refine. 1. Gather thoughts, issues, and concerns. 2. Collect/write down problem solving ideas. 3. Hold a broad-ranging discussion of pros & cons; decide as a group to eliminate some ideas and short list others.	12 participants volunteered to share their stories on video with the large assembly. These narratives became a reference point against which to evaluate potential strategies for Bridging the Chasm for relevance and significance.	Roundtables–World Café 1: Small groups mixed by roles and regions used flipcharts and large sticky notes to generate a list of ideas, with brainstorming based on insights from experience (Day 1) and data (annotated bibliography).	35 conference calls over 5 months resulted in a problem statement, a synthesis of existing literature on the WG topic, a menu of strategy options with rationale for the importance of each strategy, and strategy generation.
Step 3. Look for emerging proposals (synthesis). 1. Weave together the best elements of the ideas presented and discussed. 2. Look for solutions that address key concerns.	The group was struck by the commonality and intensity of the emotions expressed in stories, and the huge impact of pregnancy complications and lack of post-delivery care on storytellers’ lives (patients and clinicians).	Ideas were clustered into 11 topic areas by leadership, with extensive group discussion. Some topics were renamed, proposed strategies were refined, and some ideas were shifted from one topic to another.	Each WG selected and prioritized 3 strategies with rationales, and evaluated each strategy for stakeholders, potential collaborators, related initiatives, supportive factors, challenges, and action steps.
Step 4: Discuss, clarify, and amend. 1. Ensure that remaining concerns are heard and that everyone can contribute. 2. Amend to enhance consensus. Step 5. Test for agreement. 1. Check for blocks, stand-asides and reservations.		World Café 2: 11 small groups (self-selected) identified, discussed, and refined three ideas for equity, innovation, feasibility, and effectiveness. Results were reported out to the assembly and discussed. No blocks nor stand-asides occurred, and there were few reservations.	In a Qualtrics survey the WGs prioritized and evaluated strategies against the 4 criteria of equity, innovation, feasibility, and effectiveness. WG facilitators and BtC leadership refined and bundled the options and surveyed WG members to assess for priority and consensus.

^*Adapted from: A Consensus Handbook: Co-operative Decision-Making for Activists, Co-ops and Communities, Seeds for Change, 2013. ISBN: 978-0957587106 (www.seedsforchange.org.uk/handbookweb.pdf).