Expert Delphi: Mastering the Delphi Technique for Structured Communication and Consensus Building

The Delphi method or Delphi technique (/ˈdɛlfaɪ/ DEL-fy; also known as Estimate-Talk-Estimate or ETE) is a structured communication technique or method, originally developed as a systematic, interactive forecasting method which relies on a panel of experts.[1][2][3][4][5] The technique can also be adapted for use in face-to-face meetings, and is then called mini-Delphi. Delphi has been widely used for business forecasting and has certain advantages over another structured forecasting approach, prediction markets.[6]

Expert Delphi

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Delphi is based on the principle that forecasts (or decisions) from a structured group of individuals are more accurate than those from unstructured groups.[7] The experts answer questionnaires in two or more rounds. After each round, a facilitator or change agent[8] provides an anonymised summary of the experts' forecasts from the previous round as well as the reasons they provided for their judgments. Thus, experts are encouraged to revise their earlier answers in light of the replies of other members of their panel. It is believed that during this process the range of the answers will decrease and the group will converge towards the "correct" answer. Finally, the process is stopped after a predefined stop criterion (e.g., number of rounds, achievement of consensus, stability of results), and the mean or median scores of the final rounds determine the results.[9]

Special attention has to be paid to the formulation of the Delphi theses and the definition and selection of the experts in order to avoid methodological weaknesses that severely threaten the validity and reliability of the results.[10][11]

Experts were asked to give their opinion on the probability, frequency, and intensity of possible enemy attacks. Other experts could anonymously give feedback. This process was repeated several times until a consensus emerged.

The following key characteristics of the Delphi method help the participants to focus on the issues at hand and separate Delphi from other methodologies: in this technique a panel of experts is drawn from both inside and outside the organisation. The panel consists of experts having knowledge of the area requiring decision making. Each expert is asked to make anonymous predictions.

The initial contributions from the experts are collected in the form of answers to questionnaires and their comments to these answers. The panel director controls the interactions among the participants by processing the information and filtering out irrelevant content. This avoids the negative effects of face-to-face panel discussions and solves the usual problems of group dynamics.

The person coordinating the Delphi method is usually known as a facilitator or Leader, and facilitates the responses of their panel of experts, who are selected for a reason, usually that they hold knowledge on an opinion or view. The facilitator sends out questionnaires, surveys etc. and if the panel of experts accept, they follow instructions and present their views. Responses are collected and analyzed, then common and conflicting viewpoints are identified. If consensus is not reached, the process continues through thesis and antithesis, to gradually work towards synthesis, and building consensus.

First applications of the Delphi method were in the field of science and technology forecasting. The objective of the method was to combine expert opinions on likelihood and expected development time, of the particular technology, in a single indicator. One of the first such reports, prepared in 1964 by Gordon and Helmer, assessed the direction of long-term trends in science and technology development, covering such topics as scientific breakthroughs, population control, automation, space progress, war prevention and weapon systems. Other forecasts of technology were dealing with vehicle-highway systems, industrial robots, intelligent internet, broadband connections, and technology in education.

The guidance for developing reporting guidelines in 2010[28] recommended using the Delphi method for developing reporting guidelines. However, less than 30% of the reporting guidelines were developed with the Delphi method according to the systematic reviews in 2015[29] and 2020.[30] The Delphi approach has been successfully employed to improve agreement between experts in iterative rating exercises on clinical test results using inter-rater kappa statistics as an outcome measure.[31]

A number of Delphi forecasts are conducted using web sites that allow the process to be conducted in real-time. For instance, the TechCast Project uses a panel of 100 experts worldwide to forecast breakthroughs in all fields of science and technology. Another example is the Horizon Project, where educational futurists collaborate online using the Delphi method to come up with the technological advancements to look out for in education for the next few years.

A particular weakness of the Delphi method is that future developments are not always predicted correctly by consensus of experts. This shortcoming concerning the issue of ignorance is important. If panelists are misinformed about a topic, the use of Delphi may only add confidence to their ignorance.[6]

Methods: After a scoping review of the literature, semi-structured interviews with experts in PSRS were conducted. Based on these findings, a survey-based questionnaire was developed and subsequently completed by a larger expert panel. Using a Delphi approach, consensus was reached regarding the ideal role of PSRSs. Recommendations for best practice were devised.

Conclusions: We obtained reasonable consensus among experts on aims and specifications of PSRS. This information can be used to reflect on existing and future PSRS, and their role within the wider patient safety landscape. The role of PSRS as instruments for learning needs to be elaborated and developed further internationally.

Objectives: To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions.

Textbook outcome is a novel composite measure combining the most desirable postoperative outcomes into one single measure and representing the ideal postoperative course. Despite a recently developed international definition of Textbook Outcome in Liver Surgery (TOLS), a standardized and expert consensus-based definition is lacking.

This is the first study providing an international expert consensus-based definition of TOLS for minimally invasive and open liver resections by use of a formal Delphi consensus approach. TOLS may be useful in assessing patient-level hospital performance and carrying out international comparisons between centers with different clinical practices to further improve patient outcomes.

A two-round web-based Delphi study was conducted. 297 international experts were invited to participate. In round one they were asked to 1) give an individual rating on a nine-point-scale on relevance and clarity of the dimensions, 2) add missing dimensions, and 3) prioritize the dimensions. In round two, experts received feedback about the results of round one and were asked to reflect and re-rate their own results. The cut-off for the validation of a dimension was a median

The local Ethics Committee of the Medical Association Hamburg (Germany) was consulted for ethical approval. They informed us that ethical approval was not necessary because no patients were enrolled in the study. Nevertheless, ethical principles were followed throughout the examination and the study was carried out in accordance with the Code of Ethics of the Declaration of Helsinki. The experts were informed on the data collection and analysis. Participation was on a voluntary basis, and data protection rules were considered.

We conducted a Delphi survey, as it is the method of choice for a structured group discussion technique with the aim to reach a high group consensus [24]. This method is widely used, e.g. in the development of clinical practice guidelines [25] and healthcare quality indicators [26]. The Delphi method employs a series of rounds to collect information from and transmit information to participants [26]. A web-based Delphi survey has the advantage of enabling individuals from different locations to converge anonymously and discuss their expert opinions [26]. The procedure mainly followed the recommendations proposed by Boulkedid et al. (2011) [26].

In this study, a two-step web-based rating process was used to reach consensus and prioritize the dimensions of patient-centeredness in terms of their importance and to rate each dimension separately on the criteria relevance and clarity. The Delphi survey was conducted between February and April 2013. The survey was structured in two rounds and international experts (clinicians, patient representatives, researchers and quality managers) on this topic were invited to participate. In the first round, the experts were asked to rate these dimensions individually, and in the second round they were asked to reflect and rerate their results from the first round.

We aimed to include a broad range of experts in the field of patient-centered care. We therefore invited clinicians, patient representatives, researchers and quality managers from different countries to participate in this study. They were recruited through several strategies: a) identification and invitation of key authors on patient-centeredness, b) identification and invitation of representatives of institutions associated with the field of patient-centeredness, and c) through personal knowledge (e.g. collaboration partners). The survey was available in German and English.

In the initial step of the Delphi survey, the selected experts were invited via email and received a link to the survey. The web-based survey contained a list of the 15 dimensions of patient-centeredness identified in the literature review, and a short description of each dimension [23]. Every panel member was instructed to rate the dimensions on a nine-point scale on the criteria of relevance and clarity (1 = not relevant/ not clear to 9 = very relevant/ very clear), (e.g. To what extent would you consider the dimension "Patient as a unique person" relevant/clear?). Furthermore, they were invited to prioritize the five dimensions they considered most important out of the 15 dimensions (Please rate the five most important dimensions in your understanding of patient-centeredness). Finally, the experts were asked to add, if necessary, further dimensions of patient-centeredness, which were not included so far (If you think any dimensions in your understanding of patient-centeredness are missing in our identification, please name them here). Additionally, the survey included questions on demographic and professional characteristics of the experts. The experts were also asked to rate how well informed they consider themselves to be in the field of patient-centeredness, using a five-point response scale ranging from 1 = not at all well to 5 = very well. 2ff7e9595c