Definition:

A Quorum is a group of people who are empowered to perform a specific task.

The Reflective Quorum is an example of how two of the core features of AMBIT (Core Features of AMBIT; Mentalization; Keyworker well-connected to wider team) underpin the practical application of an AMBIT team. There is related material at Rituals and Disciplines, including those under the heading of Thinking Together.

Mentalization and the Quorum

The notion of the quorum refers to the way in which the team, and its wider SupervisoryStructures adopts a distinct culture of interaction. The assumption is that talking to somebody with whom I have a working relationship helps me to regain/sustain my mentalizing capacity. (This is a contrast to many 'Duty systems' where junior practitioners may discuss cases with seniors who they have not actually worked with, or do not actually know.)

The team develops clear and explicit Rituals and Disciplines that are not rigidly defined by the model (although some are offered), but which should be considered and selected explicitly by local teams, and written in to their version of this manual.

The Reflective Quorum marks out very clearly the presence of a "mentalized focus" to discussions about case material (see also Thinking Together.)

An example of the kind of ritual that we are talking about might be something as simple as framing these specific conversations with the statement:
"Can we agree that we are quorate to discuss this here and now?"
or "I need help mentalizing this particular situation"...

For further description, and recordings of local team agreements, see Rituals and Disciplines

From a team culture point of view, the emphasis is that:

"This is how we work - we talk to each other all the time, because it helps us to think more clearly in situations where is is difficult to think straight."

Reflective Quorum and AUTHORITY

In practice a 'Quorum' is the number required for a group to have delegated authority to act in a certain circumstances.

For instance, Town Councils may debate whether or not they are "quorate" to make specific decisions about street lighting if the "street furniture expert" is on annual leave...

A different analogy is the case of questions of "capacity to consent":

This refers to whether or not a person is able to take legal responsibility for agreeing to a treatment that a doctor or therapist offers. Now, this is always and only in relation to a specific procedure/question (i.e. I may be seen as having capacity to consent to having a tooth removed, but at the same time (if I had, say, a psychosis with delusional beliefs about my leg being controlled by aliens) I would NOT be seen as having capacity to consent to a leg amputation that was offered me by an enthusiastic but misguided surgeon.)

Situation specific

The notion of whether keyworkers are "quorate" when they discuss a clinical problem is situation-specific - they may be quorate to decide on one question, but not on another.

• We acknowledge that multiple perspectives add to the likely accuracy of the picture/understanding.
• On the other hand reality frequently impinges and not all members of the team can be present for all discussions.

Thus two practitioners discussing an issue via mobile phones may be agreeable as quorate if both parties are confident that they have considered:

1. The potential risks associated with what they are discussing.
2. The limits to their own capabilities.

Not Quorate?

When practitioners decide they are NOT quorate:

If the nature of the problem, or practitioner-evaluations of their own capabilities, suggest that the involvement of a third person or even wider group, then decisions will have to be postponed until this can be arranged.

This is not so different from best practice in well-functioning teams, and in that sense is merely the making explicit what is often implicit.

Using technology

We advocate the use of technology to help form a Reflective Quorum - Technologies such as hands-free or speaker-phones (included on many/most mobile phones nowadays) can help to deliver "instant" quorate groups.

Teams may wish to consider the value of contracting formal "conference-call" facilities on their telephone network as another alternative: this is a reasonably cheap and very effective technology, that is probably easier to use than face-to-face video chat services such as Skype, Webex, etc, although some teams use these latter to good effect.