The Stacey Diagram: a formative exercise in family medicine

Abstract

Background: Ralph Stacey designed the Stacey diagram in 1995 to help in the analysis of decision-making in situations with different degrees of information, complexity, and uncertainty in management and leadership within organizations. British General Practitioners adapted this model to the medical field, with a focus on more complex and uncertain situations. This article describes a training exercise using the Stacey diagram in a clinical setting. Training objectives: We attempted to critically reflect on the factors that influence the decision-making process in medicine, to analyse the determinants of health problems in General Practice consultations using the Stacey diagram, to discuss the advantages and limitations arising from the use of guidelines and protocols in a training context, to strengthen the trainees’ perceptions of the uniqueness of each person and the need for a reflective and critical attitude to deal with health problems, and to raise awareness of the influence of the personal characteristics of the physician in this process. Description: The exercise consisted of the analysis of the content of 30 sequential consultations in one week in a training program in general practice. The trainee placed each health problem encountered on the Stacey Diagram based on her perceptions and knowledge of available information about the problem and consensus regarding recommended actions. The results were discussed in the training group. Discussion: The diagram obtained illustrates diversity, heterogeneity, and the range of uncertainty and consensus associated with the health problems addressed. Nearly half of the health problems were placed in areas with higher complexity. Only one quarter of the problems were placed in the area that signifies greater certainty and greater consensus. The training group identified the advantages of the exercise, in particular support for the perception of uncertainty and clinical complexity, based on individual factors in some circumstances. This highlights the dynamic and subjective nature of the decision-making process in medicine. The replication of this exercise by a GP-trainee can increase self-awareness about the clinical decision making process and enhance perception of the influences of personal and situational determinants for each health problem. The authors suggests that other training groups should perform and discuss similar exercises as a training method to approach uncertainty and complexity in medicine in general and in general practice in particular.