Comparing the Delphi Method and the Nominal Group Technique (NGT)

Comparing the Delphi Method and the Nominal Group Technique (NGT) for Healthcare Decision-Making

In the dynamic and complex landscape of healthcare, decision-making processes are often collaborative and rely heavily on the input of multiple stakeholders. To navigate this complexity, structured techniques for generating consensus are invaluable tools, enabling healthcare professionals, policymakers, and researchers to arrive at well-informed decisions. Two popular methods for consensus-building in healthcare are the Nominal Group Technique (NGT) and the Delphi Method. While both approaches aim to gather and synthesize expert opinions, they differ significantly in structure, process, and applicability.

This blog compares these two techniques in the context of healthcare decision-making, exploring their strengths, weaknesses, and ideal use cases.

1. Overview of the Nominal Group Technique (NGT)

The Nominal Group Technique is a structured, face-to-face group discussion method designed to facilitate the generation of ideas and prioritize them through a democratic voting process. It typically involves a small group of participants (8–12 people) and follows a clear set of steps:

1. Introduction and Explanation: The facilitator introduces the topic or problem that needs to be addressed.
2. Silent Idea Generation: Participants silently generate ideas or solutions related to the issue.
3. Round-Robin Sharing: Each participant shares one idea at a time, usually in a round-robin fashion, until all ideas have been presented.
4. Discussion and Clarification: The group discusses each idea for clarity, ensuring all suggestions are well understood.
5. Voting and Ranking: Participants individually rank the ideas based on their preferences or importance, and the highest-ranked ideas are used to form a consensus. 

Strengths of NGT in Healthcare

• Equal Participation: NGT ensures that each participant has an opportunity to contribute, avoiding dominance by any single individual. This is particularly useful in healthcare settings where hierarchies might inhibit free discussion.
• Efficiency: Because NGT is highly structured and time-limited, it can be completed within a single session. This makes it ideal for time-sensitive decisions such as urgently required treatment protocols or emergency response planning. 

Weaknesses of NGT in Healthcare

• Limited Group Size: NGT is typically restricted to smaller groups, which may limit the diversity of viewpoints in large-scale healthcare decision-making processes.
• Groupthink Risk: Despite the structured format, the face-to-face nature of NGT can lead to pressure to conform to group opinions, reducing the diversity of ideas.
• Scope: As the format is delivered during a single session with a group of experts and requires a significant depth of discussion, NGT is not suited to projects where large numbers of key items or questions (>3-5) are addressed.

Ideal Use Cases in Healthcare

• Clinical Guidelines Development: NGT can be used to gather input from healthcare providers and specialists to develop practical, evidence-based clinical guidelines.
• Patient Care Protocols: In multidisciplinary teams where various healthcare professionals need to align on treatment strategies or patient care protocols, NGT facilitates quick, structured decision-making.
• Local Policy Decisions: Hospitals or local healthcare institutions may use NGT to address specific operational or patient care issues, allowing direct input from relevant stakeholders.

2. Overview of the Delphi Method

The Delphi Method is a structured communication technique that relies on a series of questionnaires, or “rounds” sent to a panel of experts. Unlike NGT, it does not involve face-to-face meetings. Instead, participants provide feedback independently, typically through email or an online platform. The process includes several key steps:

1. Initial Insight Generation: This may be achieved in different ways; via initial literature review, a broad, open-ended questionnaire distributed to experts, discussion with a steering group of core experts, or a combination of these. The  aim is to achieve insights on the given topic and identify how a defined problem may possibly be addressed.
2. Survey Development: The inputs from this insight generation are used to create a focused survey questionnaire, usually asking responders to react to statements on a likert scale (often ranging from agree to disagree).
3. Testing Rounds: Qualified expert participants receive the survey, review the feedback from the previous round (following round 1), and provide revised opinions. This process continues for 2+ rounds until a consensus is reached or diminishing returns are evident.
4. Final Analysis: The final round concludes with a synthesis of the group’s collective opinion, which is then used to inform decision-making. 

Strengths of the Delphi Method in Healthcare

• Anonymous Participation: The Delphi Method allows participants to express their views anonymously, reducing the influence of dominant personalities and minimizing groupthink. This is especially valuable in hierarchical healthcare environments.
• Flexibility and Geographic Reach: As the Delphi process is conducted remotely and over time, it allows participation from experts across different regions or countries, making it ideal for large-scale or global healthcare decisions.
• Iterative Feedback: By providing feedback in multiple rounds, participants can refine their opinions based on the input of others, leading to more considered and thoughtful consensus.

Weaknesses of the Delphi Method in Healthcare

• Time: The Delphi Method can take a number of months to complete due to the multiple rounds of questionnaires. This makes it less suitable for highly urgent healthcare decisions.
• Participant Attrition: As the process is iterative, there is a risk of participant fatigue or attrition, potentially skewing the results if only a small subset of the original panel completes all rounds.
• Complexity in Facilitation & Synthesis: The iterative nature of the Delphi Method requires skilled facilitators to synthesize responses and craft subsequent questionnaires effectively.

Ideal Use Cases in Healthcare

• National or Global Health Policies: For large-scale policy decisions that require input from a diverse, geographically dispersed group of experts, the Delphi Method provides a robust framework for gathering consensus.
• Emerging Healthcare Issues: The Delphi Method is particularly useful for addressing emerging healthcare topics, such as the evaluation of new technologies, establishing future needs, or assessing innovative approaches.
• Healthcare Research Prioritization: In research settings, the Delphi Method is often used to prioritize research agendas, determine funding allocations, or identify areas of greatest need for clinical trials.

3. Key Differences Between NGT and Delphi Method

While both NGT and the Delphi Method aim to build consensus, their differences make them suited to different contexts in healthcare.

4. Conclusion

In summary, both the Nominal Group Technique (NGT) and the Delphi Method are effective consensus-building techniques in healthcare decision-making, each with its own strengths and ideal applications. NGT is best suited for rapid, small-scale decisions where real-time feedback and interaction are important, such as in clinical settings. On the other hand, the Delphi Method excels in large-scale, long-term decision-making processes that benefit from expert input without the constraints of geography or time.

Choosing between NGT and the Delphi Method depends largely on the context of the decision, the number of stakeholders involved, and the time available for reaching a consensus. For healthcare companies, healthcare professionals and policymakers, understanding these tools’ unique characteristics allows for more informed, strategic decisions that can ultimately improve patient outcomes and advance healthcare systems.

Triducive are leading providers of structured consensus including both NGT and the Delphi Method. Contact us to learn more or if you need help.