The plan was agreed in under a minute. That is the bit I keep thinking about. How quickly it happened.
It was an MDT meeting discussion about a frail woman in her late eighties. There was a lot going on and we had to decide whether to put her through a procedure. It might help. It might also be too much for her. The consultant explained the plan. Clear, calm, already fairly settled.
Then the nods started. Sounds sensible. Agree. Yes. Someone said, “No concerns,” which is a phrase I have grown increasingly suspicious of.
Twenty or thirty seconds later, we moved on to the next name. A decision about the rest of someone’s life had taken less time than making a cup of tea.
I nodded too.
I need to say that because it would be easy to tell this story as if I were the one person in the room who could see what was happening. I couldn’t. I went along with it and felt that small sense of satisfaction you get when a meeting is moving well and everyone seems to know what they are doing.
There was a physiotherapist sitting in the corner. She had met the woman at home. She had actually been inside the house. At one point I saw her open her mouth. Then she stopped.
I can’t know exactly what she was thinking, but I have seen that pause often enough. The room had moved on emotionally, even if we were still talking about the same patient. Everyone had agreed. Speaking now meant pulling the whole thing backwards. It meant becoming the difficult person in a room that was pleased with its progress.
So she stayed quiet.
Weeks later, the thing she nearly said turned out to matter. The woman could not cope at home in the way our plan assumed she could. The plan looked sensible in the meeting. It came apart in a house most of us had never seen.
I keep returning to that meeting because it changed how I hear agreement. A room full of nodding people feels reassuring. Nobody is arguing. The decision sounds reasonable. We move through the list. It feels efficient and competent.
But a nod tells you very little. People nod because they agree. They also nod because they are tired, because the senior person has already made their view clear, because lunch was twenty minutes ago, because there are twelve more names on the list, or because speaking up now feels like more trouble than it is worth.
From inside the room, all those nods look the same.
That is what makes fast agreement risky. You can’t tell whether the plan has been properly tested just by looking at the faces around the table. A good decision can feel smooth. A weak one can feel exactly the same.
Somebody has to put pressure on the plan. Somebody has to ask what could go wrong, what we are assuming, and what we might be missing. If nobody does that, all we really know is that the plan sounded acceptable for thirty seconds.
There are understandable reasons why people stay quiet.
Doubt takes effort. You have to reopen a discussion that everybody else wants to finish. You have to risk being seen as awkward. You have to hold your ground while people look at you with that tired expression that says, please don’t make this take longer.
That needs a kind of mental and social energy. I call it Cognitive Oxygen®, or COx.
When people are running low on it, disagreement becomes expensive. Going along with the room is easier. The meeting moves forward and everyone feels relieved.
Relief can feel a lot like agreement when you are tired.
There is also a point in every discussion where the first few nods begin to gather momentum. Each nod makes the plan feel more settled. It also makes speaking against it harder. Disagreeing early might look thoughtful. Disagreeing after eight people have said yes can make you look like a nuisance. Most people don’t want to be the nuisance. I don’t blame them. I didn’t want to be one either.
So sometimes the person with the most useful information says nothing. The room leaves believing it has reached a sound decision, even though one of the facts that mattered never made it into the conversation.
That thought still bothers me. A meeting can end with less useful knowledge than it had at the beginning.
Red Team Thinking® is one way of dealing with this. There are tools and methods involved, but the basic idea is simple. Make disagreement part of the process. Give someone permission to question the plan before the meeting begins. Better still, make it their job.
Then they don’t have to decide whether to become the difficult person. They are simply doing what the room asked them to do.
You can ask: What would have to be true for this plan to fail? What are we assuming here? Who has seen something the rest of us haven’t? Who hasn’t spoken yet?
These questions need to come before the agreement has hardened. Once everyone feels the decision has been made, a question can sound like an attempt to derail things, even when it is exactly the question the room needs. Of course, you can’t pull apart every decision.
A ward, service or board would grind to a halt if every item became an hour-long debate. Some meetings already suffer from the opposite problem. Everything gets questioned, nothing quite gets decided, and one confident person can keep the whole room circling forever.
Sometimes quick agreement is genuine. People have considered the options. They understand the risks. They really do agree.
The useful test is to make space for a challenge and see what happens.
Ask someone to argue against the plan. Invite the quietest person in. Ask what has been left unsaid. If the plan still holds, good. You probably have something solid.
If it begins to fall apart as soon as one person feels able to speak, the earlier agreement wasn’t worth very much.
That physiotherapist had been inside the woman’s home. She knew something the rest of us didn’t, and she almost told us.
The failure was sitting there in that small pause. The information was available. The person holding it decided, probably quite reasonably, that saying it aloud would cost more than staying quiet.
None of us noticed. We had made the conversation so quick and easy that the most important fact couldn’t find a way into it.
So now, when an important decision goes through unusually fast, I get uneasy.
Perhaps everyone genuinely agrees. Perhaps the plan is obvious. But it is worth waiting another minute. Look around the room. Who hasn’t spoken?
Then ask what would make it easier for them to tell you what they know.