When coaching a person for their PMP exam, a discussion emerged emphasizing that consensus meant alignment of expectations! Early in my career, I understood the expression, "the elephant in the room," where everyone in a collective setting fail to address a controversial issue despite the knowledge of its obvious existence. The comfort of not addressing it, bringing it to the surface due to the sensitivity of the issues, or even be labelled a naysayer for acknowledging it publicly were a few things I had observed are risks that impede value delivery! To me, silent agreement or unanimous consensus without any discussion is frequently a possible indication that important knowledge is not visible into the room and subsequently never makes it into the decision-making.
That realization pushed me toward structured consensus techniques, not because I love process, but because I had seen what unstructured collaboration does under pressure. So, I explained three techniques, in particular, that have stayed with me over the years in light of a product that once I managed: These are the Nominal Group Technique (NGT), Delphi, and Wideband Delphi. Each earned its place through practical scars and are not juts theory.
Sometime around 2012, I was developing an innovative first-responder mobile application for a pharmaceutical client. The application integrated with portable ECG collectors connected to an iPad and used in an ambulance. The goal was to capture ECG data from unconscious or incoherent patients, detect critical cardia conditions in real time and transmit actionable insights to hospital before arrival enabling immediate treatment including invasive interventions if needed.
Developing this application was not just a product. It was a medical device ecosystem operating under clinical, technical, regulatory, and ethical constraints. I found out that everyone was competent and were knowledgeable but not everyone spoke the same language. Medical experts dominated the dialog about the criticality while engineers optimized the solution prematurely. Neither factored the regulatory risks until those members were specifically engaged. So, it was apparent to me that the 'unknown unknown' stayed unspoken sometimes due to the deference to the sensitivity or criticality of impact.
Here is where I used the Nominal Group Technique (NGT). The goal was to get more breadth of features and risks to delivery without getting into the solution mode! I facilitated the interaction face-to-face in a combined setting using silent data generation (dot voting, brainstorming), undebated round-robin (brainwriting, Yes-And scenario writing), facilitated inter-group clarification (forming multiple teams of clinical, engineering, and regulatory members working together) to prioritize among diverse requirements. The advantage of this technique is that it is encouraged diverse participation and promoted consensus. It was not quick but picked up on many constraints, assumptions, risks, and dependencies. I particularly saw this NGT facilitation led to increased collaboration. For example:
- Clinicians highlighted most critical ECG patterns to focus on such as ventricular fibrillation, elevated myocardial infarction and a few others
- Engineers emphasized battery drain and securing against signal interference risks
- Designers questioned about the ambulatory users to design for stability and UX considerations when first responders were operating in a stressful environment with gloves and moving vehicles
- Compliance specialists named medical, legal, and regulatory considerations for approval
Obviously, NGT didn't give us all the answers but it shaped the product needs better leading to the prioritization of minimum viable product. We diverged first across the problem space before converging on solution space. But, as the solution began taking space with more people involved, I found some began identifying requirements soon after the meetings were over. I found that dominant personalities in the room or the absence of anonymity were challenging for people to speak up in these facilitated settings. Here is where I found the Delphi technique come to the rescue.
The Delphi technique required people to raise their concerns in anonymous surveys and questionnaires. These surveys and questionnaire required careful design to avoid double-barred and leading questions but focused on identifying those risks across the lifecycle, regulatory and ethical edge cases, and most importantly the assumptions people were willing to challenge anonymously but not publicly. I would say that the anonymity brought known unknowns and unknown knows. Designing the survey and questionnaire took time working with expert sometimes to ensure they collected the qualitative and quantitative data correctly and working iteratively to understand some answers.
The Delphi technique didn't remove disagreements when the new risks and challenges unidentified in public settings were brought up. But, it removed the fear of identifying them and the bias associated with group thinking. As the development of the solution emerged, the focus shifted to ensuring that our solutions were built in such a way it maximized the regulatory approval and learning from the piloted first responders. Here is where I found the Wideband Delphi helpful.
The Wideband Delphi is a hybrid technique. It combined the best of both the NGT and the Delphi technique. No longer was the focus on diverging to understand the problem space and converging to focus on solutions! No longer was the focus on power imbalances or biased interpretations leading to further risks as all the team members were in a 'performing' stage! But, as first responders identifying needs such as the UX needs to be simpler (fewer bigger buttons to click rather than nested menus) and iterative regulatory focus emerged (agreements on the details behind the ECG patterns), a mini Delphi approach to product backlog (missed documentation, design considerations) from experts along with a discussion to prioritize and estimate them followed. The planning poker and PERT are all Wideband Delphi techniques to facilitate them in a light-weight setting.
It was wonderful to retrace my earlier product development experience to reconnect with these techniques on how we need to unearth risks. All these techniques have been time-tested and practiced in various settings whether or not we know them by their names! But, ignoring their benefits and thinking silent consensus is team alignment is not acknowledging the elephant in the room.
The person I was coaching felt very grounded and satisfied. What do you think? What other techniques have you used or benefitted from?
