This section outlines some of the key barriers to appropriately supporting and inducting GC chairs, and some proposed solutions, based on the NICE model. The section is presented as a series of questions and answers.
What is the relationship between a GC chair’s facilitation skills and their topic expertise? Is there a potential for tension between these 2 functions?
Although there are clear advantages to recruiting GC chairs with highly developed facilitation skills, NICE recognises that these can sometimes go hand in hand with expertise in a particular topic area. However NICE’s policy on declaring and managing interests does not generally support the recruitment of topic expert chairs. NICE’s current position is that its chairs are recruited for their facilitation skills, and that a ‘topic adviser’ with expertise in the topic under discussion should be recruited to work alongside the chair. This ensures the chair is more likely to be objective about the evidence the committee considers.
To facilitate inclusive group dynamics and support lay members, there are distinct advantages in having a well-informed chair with highly developed facilitation skills, but one who is not an expert in the guideline topic. These advantages include:
- Being able to ask naive questions of the topic experts and technical staff in order to clarify things for everybody, especially the patient/public members. A topic expert chair will either not realise that there might be a problem understanding something or not be prepared to lose face by asking. These may be genuine questions because the non-expert chair does not understand or might be deliberately asked to help the patient/public members and other committee members.
- Non-expert chairs are less likely to engage in esoteric arguments with specialists about details of the condition or intervention, or the evidence, and forget their chairing responsibility of engaging everyone in the discussion.
- They are more likely to be seen as impartial and someone to whom the patient/public members can turn for support, advice and comment, either in the meeting or in breaks or other informal settings.
We recognise that other guideline development organisations may wish to recruit chairs with expertise in the topic under discussion. The key to identifying an appropriate approach is to be clear about the role of the chair in running the GC. There will need to be measures in place for managing any conflicts of interest that arise for a ‘topic expert’ chair, because the goals for facilitating discussion and debate on the evidence within the group may not always coincide with the desire for a particular approach to the guideline topic.
Should induction for GC chairs be compulsory?
Chairs should be encouraged to take advantage of any induction or training on offer. NICE’s experience is that GC chairs who have been through the induction are more likely to run functional and successful groups.
The NICE guidelines manual states ‘Anyone appointed as a committee chair is required to attend the chairs ‘induction session’ (NICE 2014, section 3.7). But a strong recommendation from a senior member of the guideline organisation’s staff about the value of induction will encourage newly recruited chairs to attend them. It is also important to encourage chairs to attend refresher sessions if they have worked with the guideline agency for many years. This will ensure they are up to date with organisational processes, the policy context, and other relevant changes.
Is there a ‘one-size-fits-all’ approach to developing and delivering an induction programme for GC chairs from different guidance-producing organisations?
Induction programmes for chairs need to be tailored to the specific context, methods and processes of the guidance-producing organisation. Induction programmes also need to be constantly refined and modified in light of external changes (for example, political priorities and legislation), organisational changes, developments in guideline methods, and in response to feedback from participants. However, there are likely to be common themes that apply across differing processes for guideline development. See, for instance, the generic guidance listed in the Resources section.
How do those offering the induction for GC chairs take account of the differences between guideline topics, between chairs, and between guideline groups?
There are inevitable differences between the topics, chairs and groups, and this variation is entirely appropriate.
The induction sessions include a lot of time for open discussion. This is an opportunity for participants to think about NICE’s guideline development methodology, and their particular topic. For instance, in the presentation about NICE guideline methodology, the first section on scoping ends with time for participants to reflect on and discuss themes relevant for their particular guideline topic, using prompts such as those in Box 1:
BOX 1 Chairs’ induction – discussion prompts
Each topic has unique characteristics
Will there be problems in managing the expectations of GC members about the limitations of scope, time, and resources?
Taking into account patient and public perspectives:
• are there some topics specific to this guideline? (information, psychosocial issues, support, alternative or complementary treatments)
• are there any population sub-groups of patients who might need specific consideration? |
In the induction sessions, it is crucial to have input from someone with previous experience as a GC chair for the same guideline development organisation. Their experience of having been through the process enables them to provide practical tips for the newly recruited chairs on how to be an effective chair in this very specific environment. Feedback from GC chairs who have attended the NICE induction session consistently rate the session with an experienced GC chair as the most valuable aspect of the induction session.
Will someone who is a good committee chair automatically be a good GC chair?
Not necessarily – the skills needed to chair a formal committee may not meet the requirements for chairing and facilitating a dynamic, reactive, and discursive GC. A skilled GC chair will be expected to run the practical aspects of the group (for example, keeping to time and process) and also to foster debate and discussion among group members. They will also need to be able to draw together discussions about research evidence into practical recommendations for practice, taking into account all group members’ input.
What is the role of the chair in relation to GC processes and methodologies?
The GC chair needs to be familiar with the ‘rules’ (of methods and process). Induction sessions are an ideal opportunity for these rules and expectations to be clearly outlined. The GC chair needs to fully understand the methodology and the rules, and both champion and follow them during GC meetings. The induction session should be a chance not only to explain them but also to discuss them with methodologists and support staff.
Might the new chairs find the idea of an induction patronising?
This is quite possible and needs to be recognised. But it is very important that a new chair is able to successfully work with a small group that includes patient/public members, while following a specific methodology.
How do you address the fact that the GC chairs may or may not be used to working with patient/public members?
As part of the induction, there needs to be an exploration of the chairs’ experience in working with groups, including patient/public members. Their questions and concerns about this can be addressed and shared in a safe environment. At NICE, experience of working with groups, including patient/public members, is now an expectation of a chair’s experience and is explored as part of their recruitment.
Providing the chairs with good practice examples (such as those cited in Cartwright and Crowe [2011] and TwoCan Associates [2010]) can give them practical tips to help them support the patient/public members of the GC. It is important for them to understand and recognise that the individual patient/public members of the GC may have quite different knowledge, experience and self-confidence. Some may be very experienced professionals with specialist knowledge of a small topic area, but others may be working on a committee at a national level for the first time.
How do you ensure that the GC chairs get the best possible experience from the induction?
One of the key things that NICE has identified as enriching the induction experience for GC chairs, is to ensure the participation of more than one new chair at the induction session. This allows them to share their concerns and issues, and provides them with a small peer group with whom they can share experiences and discuss problems.
It should be possible for several guideline development organisations to pool resources for chairs’ induction sessions, especially with the use of video-conferencing. But care would be needed to take account of different methodologies if these sessions involved the discussion of anything more than the involvement of patient/public members.
How do you address the issue of scheduling of inductions and the chairs’ availability to attend?
The stage of the guideline development process at which the chairs have their induction is crucial. Ideally there needs to be enough time and resources available for chairs to have access to induction before their first GC meeting. But it may be difficult to arrange induction sessions with enough notice for chairs to attend, and also to convince some of the value of attending an additional meeting. Induction should be arranged at regular intervals to enable groups of newly appointed chairs access as early as possible. Details of these scheduled sessions should be included in recruitment materials in order to give a clear message that they are expected to attend and to allow them to plan. Other options are online training resources and induction sessions via videoconference.
Although chairs should ideally attend an induction session before their first GC meeting, it can be helpful to have people at different stages of the development process coming at the same time so that they can describe their different issues and experiences. A newly appointed chair might have chaired a previous GC and feel that an induction session would be a waste of time for them. However, because guidelines methodology and political circumstances are constantly changing, they should still be encouraged to attend.
How do you address the need to provide the chairs with ongoing and additional training opportunities throughout the guideline development process?
NICE offers its GC chairs the opportunity to attend a workshop specifically on the health economics aspects of guideline development. Staff supporting each committee also provide training to GC chairs and other GC members on specific methodological issues (for example, systematic reviewing, meta-analyses) as and when required. GC chairs are also offered the opportunity to contact NICE’s methodological and patient and public involvement specialists, or members of the technical team, if they have specific questions.