What is expected of people who lead meetings where the goal is to reach consensus? A scoping review with implications for improving the quality of health research grant peer review and clinical guideline development

What is expected of people who lead meetings where the goal is to reach consensus? A scoping review with implications for improving the quality of health research grant peer review and clinical guideline development | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search What is expected of people who lead meetings where the goal is to reach consensus? A scoping review with implications for improving the quality of health research grant peer review and clinical guideline development View ORCID Profile Mona Ghannad , View ORCID Profile Anna Catharina V. Armond , View ORCID Profile Jeremy Y Ng , View ORCID Profile Hassan Khan , Dean Giustini , View ORCID Profile Anne Lasinsky , View ORCID Profile Joanie Sims-Gould , View ORCID Profile Paul Blazey , Nadia Martino , Sammy Nag , Adrian Mota , View ORCID Profile David Moher , View ORCID Profile Karim M Khan , View ORCID Profile Clare L Ardern doi: https://doi.org/10.1101/2025.02.03.25320968 Mona Ghannad 1 Department of Family Practice, University of British Columbia , Vancouver, Canada 2 Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa, Canada 3 Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Amsterdam Public Health Research Institute, University of Amsterdam , Amsterdam, Netherlands Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Mona Ghannad Anna Catharina V. Armond 2 Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa, Canada 4 Metaresearch and Open Science Program, University of Ottawa Heart Institute , Ottawa, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Anna Catharina V. Armond Jeremy Y Ng 2 Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Jeremy Y Ng Hassan Khan 2 Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa, Canada 5 School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Hassan Khan Dean Giustini 6 Biomedical Branch Library, University of British Columbia , Vancouver, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Anne Lasinsky 7 School of Kinesiology, University of British Columbia , Vancouver, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Anne Lasinsky Joanie Sims-Gould 1 Department of Family Practice, University of British Columbia , Vancouver, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Joanie Sims-Gould Paul Blazey 1 Department of Family Practice, University of British Columbia , Vancouver, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Paul Blazey Nadia Martino 8 Canadian Institutes of Health Research , Ottawa, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Sammy Nag 8 Canadian Institutes of Health Research , Ottawa, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Adrian Mota 8 Canadian Institutes of Health Research , Ottawa, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site David Moher 2 Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for David Moher Karim M Khan 1 Department of Family Practice, University of British Columbia , Vancouver, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Karim M Khan Clare L Ardern 9 Department of Physical Therapy, University of British Columbia , Vancouver, Canada 10 Centre for Aging SMART, University of British Columbia , Vancouver, Canada 11 Sport and Exercise Medicine Research Centre, La Trobe University , Melbourne, Australia Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Clare L Ardern For correspondence: clare.ardern{at}ubc.ca Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract Background The specific roles and responsibilities expected of leaders of consensus-based decision committees, such as grant peer review panels and guideline development panels, are not well-defined, which makes it difficult to train people to lead well. We aimed to explore, describe and define the roles, responsibilities, and leadership characteristics of leaders of meetings where the goal was to reach a consensus decision. Methods We conducted a scoping review with thematic synthesis, guided by the Joanna Briggs Institute Scoping Review Methodology, and Arksey & O’Malley’s framework for scoping reviews as refined by Levac et al. We searched five bibliographic databases from January 2002-2023 in English: Medline (Ovid), Embase (Ovid), CINAHL (EBSCO) and PsycInfo (EBSCO); Proquest Digital Dissertations and ABI-Inform. We searched grey literature in the fields of health science, biomedicine, education, psychology, management, law, ethics and policy. Abstracts and full-text articles were screened in duplicate to identify eligible studies; data were extracted regarding the roles, responsibilities and characteristics of consensus decision committee leaders. Themes were constructed using reflexive thematic analysis. Results From 6732 electronic database records and 126 grey literature records, we included 24 articles and 16 websites. There were 166 unique statements extracted related to roles and responsibilities. We constructed 4 themes to describe the roles for leaders of consensus-based decision meetings: (1) organizer and/or resource manager , (2) facilitator , (3) adjudicator and, (4) administrator . Conclusion Leaders of consensus committees assumed the roles of organiser and/or resource manager, facilitator, adjudicator and administrator. Better clarification of and training for the expected roles and responsibilities of leading consensus decisions are needed. Establishing the roles and responsibilities can inform a systematic process for evaluating the performance of leaders of consensus decision committees. Introduction Leaders of consensus decision meetings (e.g., chairs of grant peer review or clinical guideline panels) can wield great influence over those they lead. In an analysis of guideline panels’ decision-making, the chair and co-chair combined accounted for two-thirds of the conversations. 1 Developed in the 1980s, the RAND-UCLA approach to reaching consensus about the appropriateness of performing a medical procedure is widely used, including in fields outside medical decision-making. RAND-UCLA’s guidance underscores the crucial role of a leader (moderator) figure in driving the consensus process and influencing decisions. 2 Our research group is interested in the processes of grant peer review—how it is conducted and evaluated—and in the science of how consensus is reached among guideline panel members. 3 – 7 Studying these processes matters because they are used by most national research funders to select which grant applications to fund, 8 8 9 and by guideline panels to make recommendations that influence important healthcare decisions. 10 Yet the integrity of peer review is increasingly questioned and historically prone to bias, and poor quality and reliability of peer review is a problem. 8 9 11 12 The recent ACCORD Guideline emerged from a need to improve reporting standards and rigour in consensus methods, including for developing clinical guidelines. 10 13 Sometimes the loudest voices prevail and the opinions and perspectives of the committee’s leaders (e.g., chairs) are valued more than other committee’s members. 14 We have found it is unusual for leaders of consensus committees to receive structured training. 6 Evaluating the performance of groups that are tasked with reaching consensus decisions, including grant peer review panels, is crucial to improving the quality of consensus. Evaluating and reporting on performance can provide transparency regarding how consensus committees function, and help identify problem areas for which training modules could be developed. To help consensus decision committees succeed, consensus leaders need to know what is expected of them (i.e. roles and responsibilities), and to receive specific training aimed at supporting leaders to fulfill the roles and responsibilities. We suspect that consensus leaders may not receive sufficient/adequate training, and we contend that defining the roles and responsibilities would guide quality improvement efforts. 15 We see at least 3 important questions that are worthy of study as a first step towards creating structures and training to support consensus leaders to deliver a quality, transparent and equitable process: 1) how are the roles and responsibilities of consensus leaders defined and described?, 2) what specific training do consensus leaders need to excel in their roles? and, 3) how should organisations best evaluate the performance of consensus leaders? The aims of our scoping review were constructed to deliver key information to underpin training materials for consensus decision committee leaders. We aimed to: Describe and define the roles of leaders of meetings where the goal was to reach a consensus-based decision. Describe and define the responsibilities of leaders of meetings where the goal was to reach a consensus-based decision Explore the leadership characteristics of consensus decision committee leaders Methods We conducted a scoping review with qualitative synthesis using reflexive thematic analysis, 16 guided by the Joanna Briggs Institute Scoping Review Methodology Group 17 approach, and Arksey & O’Malley’s framework for scoping reviews 18 as refined by Levac et al. 19 The review protocol was prospectively registered on the Open Science Framework. 20 We briefly outline our review methods here, referring to the review protocol; there were no deviations from the protocol as prospectively registered. Our scoping review is reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis – Scoping Review extension guidelines. 21 Searching Evidence regarding the role of committee chairs and consensus is disseminated in academic journals and monographs. 22 23 An experienced medical librarian (DG) guided a comprehensive search strategy of bibliographic databases. We used a combination of subject headings, free-text and keyword phrases. We performed scoping searches to estimate the literature’s size and tested the sensitivity and specificity of the search strategies in monographs (using Proquest Digital Dissertations and ABI-Inform), grey literature, and in 5 bibliographic databases: Medline (Ovid), Embase (Ovid), CINAHL (EBSCO) and PsycInfo (EBSCO). A gold standard search was developed for Medline and adapted to the other databases (Appendix 1). To supplement the bibliographic database search, we searched the Web of Science Core Collection and Scopus citation indices for relevant papers using the major concepts, and used forward and backward referencing of relevant systematic reviews to identify any further relevant literature. Our pragmatic approach to balancing the sensitivity of the search with the capacity of the research team meant that we limited our searches to studies published from January 2002 in English. The searches were first run on 6 January 2023, and updated on 29 October 2024. We searched the grey literature in March 2023 (Appendix 2). We performed keyword searches using the native search functions on the homepages of the world’s 50 largest biomedical research funders (as determined by amount of annual research funding available, and listed at https://www.healthresearchfunders.org/ ), including government and philanthropic organisations. We searched the websites of other academic bodies (e.g., learned societies) and relevant web sources (e.g., management research organizations) that we expected might have published relevant research characterising the roles and responsibilities of organisational chairs and management leaders. The search terms (keywords) were: “leaders”, “chair”, “scientific officer”, “roles”, “responsibilities”. Eligibility criteria Our search focused on identifying studies that reported on leadership roles within grant peer review committees, journal peer review committees, and decision committees across small or large for-profit and not-for-profit organisations. We sought data from empirical studies from the disciplines of: health science, biomedicine, education, psychology, management research, law, ethics, and policy. 24 Inclusion criteria We included articles, interviews, reports, or other digital documents, including statements, guidance, mandates, or policies, that reported on 1) roles, 2) responsibilities, 3) criteria for evaluating the performance of consensus committee leaders, or 4) characteristics of effective leadership of consensus meetings. Consensus decisions are reached when a group of people work towards agreeing on a course of action prior to finalising a decision. 25 We included records that described consensus decision committees, where the committees followed a similar process to grant peer review: comprising approximately 10-30 members (this number is an approximation and was not used as a selection criterion as journal peer review committees may have fewer members), with a designated primary and secondary leadership role (e.g., chair and vice chair/scientific officer) managing and facilitating the meeting, where the goal was to reach a decision within a group setting. We included social network analysis (SNA), as these records offered value in understanding leadership roles in consensus decision-making committees. Exclusion criteria We excluded literature that was not published in English; editorials, commentaries or opinion papers, case reports (n-of-1 studies), conference proceedings, and narrative reviews. We excluded legislative debates or legal/court of law arguments, reports of advisory groups (where the decision-making focus was on allocating tasks), or meetings between adversary groups (e.g., political campaigns). We excluded literature where executive committees of only high-ranking members (e.g., chief officers, governors, directors or trustees), or where all members held equal positions of authority and there was no designated committee leader. We also excluded teaching materials and courses offered in leadership and management research, as they focused on how to lead, not on the decision process. Study selection Search results were downloaded and saved in EndNote 20.4 (Clarivate Analytics, PA, USA) , then deduplicated 26 and uploaded to Covidence (Veritas Health Innovation, Melbourne, Australia) for screening. We piloted the selection criteria using a random sample of 50 records (titles and abstracts) of studies obtained from the search by two independent reviewers. We aimed for agreement of at least 90% during the pilot screening phase. After piloting was complete, pairs of independent reviewers screened the titles and abstracts to identify potentially eligible studies. For full text screening, pairs of reviewers independently screened all potentially relevant full-text records for eligibility. Disagreements were resolved by consensus or by a third member of the research team, as required. Data extraction Data were extracted by one reviewer and verified by a second reviewer using a custom Microsoft Excel template. 20 Conflicts were resolved by consensus or when necessary, by a third researcher. We extracted study characteristics, including publication year and data source, and potential performance indicators related to the roles and responsibilities of consensus leaders, and key attributes of the leaders. Qualitative data included statements or descriptions related to roles and/or responsibilities (before, after, or during meetings), criteria for assessing performance, behaviours of consensus leaders, accountability (e.g., the person and/or department the consensus leader reported to), tenure (e.g., time served), time commitment, compensation, conflict of interest, and any other relevant outcomes. Data analysis: thematic synthesis Reflexive thematic analysis, with an inductive approach that was informed by interpretivist and constructivist paradigms, was used to analyse and synthesise the qualitative data. 27 – 30 A reflexive approach to thematic synthesis was appropriate because we aimed to identify patterns and themes in the data regarding roles, expectations and behaviours of consensus decision committee leaders. The analysis phases were: reading and re-reading the extracted text (familiarising), generating initial codes, generating themes, reviewing potential themes, defining and naming themes, and report writing. 27 – 29 31 One researcher took a dynamic and recursive approach to generating codes and themes from the data. Reflecting a subjective approach, while constructing the codes and themes, the researcher collaborated with two other research team members in a reflexive manner for sense-checking of ideas, and to explore multiple interpretations of the data. The collaborative and reflexive approach aimed to reach a richer interpretation of the data, not to reach consensus on the meaning. 28 29 Extracts from the data items underlying each theme (data extracts) were constructed to describe and define the roles and responsibilities of consensus decision committee leaders. We present the data extracts descriptively. 16 28 – 30 Results The bibliographic database search retrieved 9547 records; from the grey literature, we identified 106 potentially relevant websites and added 20 highly-relevant citations from pilot searches. After removing duplicates, there were 6732 records included for title and abstract screening, and we excluded 6527 records that did not meet the eligibility criteria ( Figure 1 ). Download figure Open in new tab Figure 1. Flow chart of search records. We reviewed 205 records in full text, and included 24 records for review ( Figure 1 ). 14 32 – 54 We excluded 181 records for the following reasons: roles/responsibilities of meeting leaders not reported (n = 67), consensus decisions not studied (n = 39), published prior to 2002 (n = 33), ineligible study design (n = 31), government/legal/policy debates or meetings between adversary groups (n = 6), no full text available (n = 4), published in a language other than English (n = 1). The grey literature search identified 106 potential records, from which we included 16 records ( Figure 1 ). 55 – 70 Roles and responsibilities of consensus decision committee leaders We extracted 166 statements related to roles and responsibilities (68 statements describing roles, 60 statements describing responsibilities, and 38 statements describing general roles and responsibilities) from the 40 included records. We constructed 4 themes to reflect the roles and associated responsibilities of consensus decision committee leaders: 1) organiser, 2) facilitator, 3) adjudicator, and 4) administrator ( Table 1 ). View this table: View inline View popup Download powerpoint Table 1. Roles and responsibilities of consensus decision committee leaders Each role had specific responsibilities that occurred at every stage of the consensus decision committee meeting (i.e., before, during, and after). The data extracts presented below are intended to illustrate each role and associated responsibilities. The organiser The organiser co-ordinated the logistics and technical aspects of consensus decision meetings; 44 56 keeping the consensus meeting on track (planning for, managing and conducting the meeting) and managing the resources needed for a productive meeting. 38 41 46 55 56 59 63 Prior to a consensus decision meeting, the organiser prepared and distributed materials (including pre-reading), helped to select and recruit consensus decision committee members, identified appropriate content experts who would provide specific expertise not held within the consensus decision committee and directed consensus decision committee members to follow meeting guidelines. 38 50 56 The organiser played a key role in setting a professional environment when managing discussions, maintaining confidentiality, and addressing conflicts of interest. 33 55 Additional responsibilities were setting meeting dates and agendas, and managing time and flow of discussions between committee members. 33 41 43 46 55 56 59 62 – 64 The facilitator In managing the committee members’ interactions, 33 34 38 43 46 55 56 59 the role of facilitator was central to preparing consensus decision committee members for their consensus decision committee work. The facilitator set ground rules, provided necessary background information to set the context for discussion, and ensured consensus decision committee members had sufficient information to understand the task of the committee and to foster productive discussion. 33 46 48 To support a balanced discussion, the facilitator was responsible for delivering a psychologically safe and inclusive environment, where all committee members could participate and express their views. 34 38 55 The facilitator ensured the consensus meeting adhered to standard procedures, and fostered a collegial atmosphere in the meeting, recognising and addressing challenges that arose from interpersonal conflicts between committee members. 43 48 50 55 56 64 The adjudicator Ensuring balance and fairness in meeting discussions was the goal of the multifaceted adjudicator role. 46 48 52 56 59 The main focus of the adjudicator was on the process of reaching a consensus decision. 40 52 55 56 The adjudicator sometimes guided committee members through regulatory processes or evaluating information, ensuring that the scientific and technical merit of materials presented to the consensus decision committee were discussed fulsomely. 33 34 50 55 56 The adjudicator played a crucial role in consensus decision making—leading and moderating discussions based on objective and justifiable criteria, identifying where committee members agreed and disagreed, bringing confluent points together, recognising and limiting the influence of bias, and directing deliberations towards a decision (i.e., consensus) before bringing discussions among consensus decision committee members to a close, and declaring the consensus-based decision. 33 35 40 44 48 52 55 56 61 The adjudicator fostered an environment for respectful debate by impartially managing conflict, ensuring deliberations stayed on topic, and mediating discrepant opinions. 34 38 55 56 In grant peer review, the adjudicator may also monitor the quality of peer-review and support communication of recommendations and/required feedback.38 51 55 56 63 The administrator Governance and record-keeping in the meeting was the domain of the administrator. 55 56 61 To ensure reliability and accuracy in communication, the administrator was accountable for recording detailed meeting notes, summarising discussions, and flagging any potential issues related to ethics, budgets, etc. 55 56 The administrator also played a support role; they acted as a back-up to the primary consensus decision committee leader if the person was unavailable, and assisted with managerial tasks including documenting and helping to manage conflicts of interests. 55 56 Characteristics of consensus decision committee leaders We extracted 34 statements that reported attributes and characteristics of consensus decision committee leaders. Leaders had relevant experience and knowledge of the field (e.g., in research funding), plus evidence of an active career demonstrated through research or clinical impact. 37 41 49 50 64 To have success in the facilitator role, leaders needed to prioritise a respectful, inclusive, and collegial approach, and communicate well. 41 42 68 70 Managerial, organizational, and leadership skills helped leaders facilitate efficient and effective meetings. 33 41 To support effective decisions, leaders required impartiality and to act decisively. 33 37 41 We did not synthesise performance indicators reflecting accountability, tenure, time commitment, compensation, and conflict of interest, as the Canadian Institutes of Health Research was the only information source we identified for these elements. Discussion We identified 40 sources reporting the roles and responsibilities of leaders of consensus-based decision meetings. The roles and responsibilities described in our scoping review are a synthesis of research and governance literature from the fields of health sciences, biomedicine, education, psychology, management research, law, ethics, policy and economics. Our review highlights that the field of study of roles and responsibilities of leaders of consensus-based decision meetings is under-developed. Evaluating the process of consensus decision-making has often been limited because of its complexity - influenced by varying factors such as social, organizational, people, or system context 35 71 . However, given the prominence of consensus committees in peer review (for academic journals and grants) and health guideline development we argue for better defining the roles and responsibilities of committee leaders, train leaders to assume the responsibilities, and evaluating their performance. Our review uncovered substantial overlap between the roles and responsibilities of the leader (e.g., Chair), and co-leader (e.g., Scientific Officer) of consensus-based decision committees, with the exception of the role of administrator , which the co-leader most often assumed. In grant peer-review, as the Chair’s main roles focus on facilitating the peer review process, the Scientific Officer assumed an additional administrative role, capturing key elements of the scientific discussion as a record and to provide a written record of the consensus process and explanation of the consensus decision. The unique roles we extracted for leaders of consensus-based decision meetings encompassed 3 broad categories: (1) organizer and/or resource manager , (2) facilitator , and (3) adjudicator . An essential leadership quality that we observed across all roles was in facilitating discussion and decisions without dominating the group. The essential role of the leader or chair simultaneously requires balancing (i) dominating the group to counter ‘group think’ or vocal individuals, and (ii) relating to each member of the committee as an equal 33 . In this paradox, we argue that exemplary leaders likely leverage their highly-tuned emotional intelligence. Consensus committee leaders can influence meetings in negative and positive ways 52 . For example, the outcome of the meeting may be associated with the order in which panel members ask questions, a sequence that is set by the committee chair 34 . Gender differences in the ways that questions are asked may also play a role. 32 . There is no standard best practice guide for leading consensus committees. We believe a cogent next move is developing a guideline for executives leading consensus-based meetings. Possible objectives could be to: 1) develop a consensus-based list of roles and responsibilities for leaders, 2) develop educational training to aid development of the necessary skills and 3) create an evaluation framework for leaders’ performance. Committee leaders need advanced skills in facilitating, or at least have access to training to develop those skills 45 . In 2006, the World Health Organization reviewed the NICE guideline development programme, and proposed recommendations for developing standard training for chairs 70 . Unfortunately, it is unclear whether or how the recommendations were implemented. Researchers frequently find themselves serving in roles for which they lack formal training. 6 One example is journal peer review. Despite consensus among researchers regarding the necessity of training for peer reviewers, very few report receiving any training in peer review 72 . The leaders of consensus decision processes, including peer review, similarly report an absence of training. Consequently, there is a need to develop new tailored training and/or supplement existing training to nurture the leadership qualities required for effectively carrying out these roles. We are, sadly, not optimistic of rapid change, given that service as chair is typically voluntary. 58 Requiring leaders to find additional time for training may simply raise additional barriers. We suggest that organisations who are recruiting consensus committee leaders (and committee members) consider how they will support their people to function effectively in their roles and deliver quality consensus. Limitations We limited our search to works published since 2002 to capture contemporary approaches to the work of consensus committees. For feasibility reasons, we made the pragmatic choice to search databases and web sources for articles and grey literature in English. We included policy, mandates, and guidance documents published in English only, and only searched the websites of only the top 50 international biomedical research funders. Therefore, it is possible that we missed relevant guidance from some international organisations, and our findings likely mirror the cultural contexts of high-income, Western English-speaking countries. Conclusion We described and defined the roles and responsibilities of consensus decision committee leaders. Executives with leadership roles in consensus decision committees, assumed the roles of organiser, facilitator, adjudicator and administrator. Our findings provide a first step in defining how organisations that are responsible for consensus processes might approach training and evaluating the performance of consensus committee leaders. Data Availability The data produced are available online at the Open Science Framework (DOI 10.17605/OSF.IO/K4MC7) Footnotes Contributions: CLA and MG contributed to the concept and design of the review. DG constructed the search strategy and performed the bibliographic database search. AL provided methods guidance on the grey literature search; MG performed the grey literature search with supervision from AL, CLA and DG. JSG provided methods guidance on thematic synthesis. PB provided methods guidance on defining consensus-based committees. NM, SN, AM, DM and KMK advised on background and approaches to research grant peer-review, and research funders’ perspectives. MG, ACVA, JYN, HK, AL and CLA screened records. MG, ACVA and CLA extracted data. MG, JSG and CLA synthesised the data. MG, ACVA, AL and CLA drafted the manuscript. All authors provided intellectual input, read and reviewed the manuscript, provided feedback on drafts, and approved the final version of the manuscript. 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