Decision-making by consensus can be a powerful team-building tool. However, it requires that all members of a group agree to the decisions that the group is making. This means, however, that one member of the group can effectively block a decision. Decision making by consensus, therefore, can work only if the group is truly committed to developing real consensus, each member has a full opportunity to express his or her view (and is heard) and each member agrees not to act unreasonably in blocking a decision. Additionally the members must have an opportunity to feel that something has been agreed to.

This was not the case with the Wiseman Committee. The treatment given to Youngson and McGilton made it clear that nurses' views about medical issues would not be accorded much weight. Additionally, they would clearly have gained the impression that they would not be allowed to block decisions agreed upon by doctors. Furthermore the manner in which minutes were kept and circulated-and apparently never discussed, let alone agreed to-indicates that there was no proper decision-making process.

As a result of these shortcomings, communications at the committee were not forthright; nor were decisions (as reflected by the chairperson) reflective of the true feelings of some of the committee members.

As the program returned to full service, the conflicts and concerns of the spring re-emerged. Tragically, the program continued to be plagued with serious morbidity and mortality. These conflicts and problems eventually led to the full suspension of the program and the appointment of an external review, a decision that should have been made in May 1994, rather than in December of that year.