Minutes of first Cochrane Members for Change open meeting in Krakow, April 3rd, 2019

Participants: 11 in person/ 10 online

View of Krakow from St.Mary’s church

To begin with, Jos Verbeek and other comrades from Cochrane Members for Change explained the origin of the movement. The main theme of the discussions following from this focused on the question “Is this group needed?”

  • We began by asking if there are other groups in Cochrane that already fulfill the function of Cochrane Members for Change. That is, is there a grassroots membership platform for bringing things to the attention of other groups (e.g. Council and Governing Board)?
  • Some Cochrane members attending the meeting expressed the feeling that it is not OK to openly express criticism against Cochrane. There is fear that some doors (in academia) will be closed for such members and this is problematic especially in low-and middle-income countries.
  • One goal of this forum could be to alleviate fear. People are removing Cochrane logos from teaching materials so as not to appear breaching the spokesperson policy.
  • Since the events in Edinburgh there have been some improvements in the Governing Board’s dealings towards members (tone, calls, involvement), e.g. center directors’ meetings.
  • But there were problematic events such as censoring of emails sent to mailing lists.
  • Also, not all members feel represented in existing structures – but is everyone aware of all structures and how to interact?
  • This group provides a no-threshold forum for everyone to raise voice/concerns.
Attendees at the Cochrane Governance Meetings in Krakow

How are we going to continue?

  • Goal: transparency should be improved (openness, reduction of fear to communicate, ways of communications, decisions)

Is the group officially recognized? Implicitly yes. How much can we expect to be listened to? Key question: how much weight will the board give to the effort of this group? As we have seen, the Governing Board has already started implementing suggestions the group has made, so we can assume it is listening.

Using petitions to emphasize the group’s initiatives is a possible mechanism but it is a rather cumbersome instrument. There used to be a mechanism in Cochrane to raise and rate initiatives according to perceived importance, but this was limited to software development only and even that was discontinued.

  • The group was surprised by the paucity of comments raised at the General Meeting of the Krakow mid-year meeting. This could be because people are experiencing fatigue, or they expect that their concerns would not be addressed anyway.
  • Process – lack of understanding in Cochrane – if issues are raised then they need to be discussed. Many discussions are not conducted openly and without real consequences. For example, with the Code of conduct it is not clear whether it is intended to defend people or to defend Cochrane as an organisation but the overall feeling was that its development process consisted of good discussions and a democratic process. Nonetheless, we should check if feedback will be incorporated.

In the General Meeting in Krakow when asking what the Governing Board had learned from the crisis and how they acted, the answer felt like it was intended to extinguish any further questions.

Cochrane leaders in Krakow

Where does fear come from? Perhaps from asymmetry in hierarchy in the organization and an unwillingness to admit mistakes. It would be good if the Governing Board would show a more collaborative approach and tone, or admit that some mistakes have happened.

For the success/usefulness of this group it depends how discussions of our group are incorporated in the final products, meaning policies, processes, and so on.

There was a common feeling that a lot of issues are not receiving enough attention by the leadership. Some people felt that the discussion on the code of conduct was unwieldy because it is highly inefficient to develop a document in a group consisting of hundreds of people.

There was some disagreement on whether we, as Cochrane, are too big to have direct democracy – others think this could easily be facilitated by voting on documents etc. Cochrane certainly has the means to organize the necessary mechanisms to achieve this.

What is the mechanism to provide feedback on activities and to whom? Although many felt that this was senseless – no one mentioned this afterwards – why? Where should we put criticism?

One participant raised the comment: Is Cochrane as a whole perceived to have a conflict of interest with drug companies such that the latter would have undue influence on reviews like the one on HPV vaccines. How can we react or move forwards here? Is this group a way to be aware of this problem? If you complain about the conduct of how a Cochrane Review is worded, produced or whatever, there is genuine fear of punishment by Cochrane leadership and consequently academia more broadly. There was agreement that Cochrane could still improve openness of discussion to erase concerns. Suspicions are raised in papers, from external people – but there is no evidence that Cochrane is favouring industry. It was felt that conflict of interest with regards to the drug industry is not an issue and Cochrane strives to set high standards here.

Attendees at the Cochrane Governance Meetings in Krakow

Is there an entity within Cochrane with a control mechanism to implement and enforce if editorial groups do not address their own CoI? – Yes CEU and EiC.

Conspiracy theories have been nurtured by the non-transparent process – and this has not been acknowledged by the Governing Board.  Lack of acknowledgement has created this atmosphere.

This group needs to focus on discrete actions. One suggestion: reach acknowledgement that there have been mistakes, Cochrane’s image has been seriously harmed. Main issue also for others that this was not acknowledged. What we could do? Bring it up again? Acknowledgement that communication should not take so much time. Suggestion: Ways to raise questions anonymously – maybe such a system could help.

Overarching themes of the discussion:

  • Need for a culture change to remove fear of speaking up and increase transparency.
  • More accessibility of Council and Governing Board needed.
  • More debate and feedback from community needed.

To do/wish list:

  • One page directing concerns: Increase ease and transparency of knowing who to go to when you have an issue.
  • Mechanism for raising concerns anonymously: Given people are fearful to speak up in a way that their name/face is attached to the comment/question there should be a way/mechanism to raise concerns anonymously and/or to escalate concerns if one feels ignored when they have used established channels.
  • Accessibility of leadership: More accessibility to Council and Governing Board since people are fearful of putting their hand up and asking questions at large meetings.
  • Frequency and mode of updates from leadership: There is a need to have more information updates on ongoing projects that are not hidden in PDF reports or are news items after all the work and decisions are made. This would allow people to provide feedback or raise concerns earlier in the process, rather than at the end of a project.
  • Improve governing communication: Culture change to one of openness and transparency and willingness to collaborate and work with the Cochrane community i.e. the Governing Board may not always know best. Requires a change in tone as communication has been through PDF agendas/minutes and lawyer vented statements (presenting one narrative, not facts), need to be more open, more frequent, more digestible. Also need to admit to mistakes or at least say what the lessons learnt were. Acknowledge that things aren’t 100% fantastic all the time, that there are struggles and there has been a tarnish on our reputation.
  • Pauses for feedback: There is a desire for more pauses to get feedback from community on major issues (hiring editor-in-chief, budget spending) and transparency to how that feedback will be used. Could be that more explaining of the thinking behind things and process is needed in the updates (e.g. when new editor-in-chief is hired, explain process of getting there).
  • More clarity on Spokesperson policy: There should be an update and training for spokesperson policy. There should be a page of tips, a video, clear contact person if you aren’t sure of the policy or what to check before posting or saying something.

The remaining questions for the CMFC group would be:

  • How does the group want to be officially recognized?
  • What direct supports can be offered centrally? (would we like an open Slack group which has built-in conference meeting capabilities?)
  • What are some practical recommendations for the colloquium? (e.g., anonymous questions for general meeting, discussion sessions with governing board and council, room for a CMFC meeting)

Final conclusion: There are enough reasons to continue with Cochrane Members for Change. We will communicate this to the Council and the Governing Board and put forward the concerns with the discussion in Cochrane as described above. We will meet again via video in May, 2019. Click this link (activated when the time is decided) to join the meeting at the allotted time.

Minutes by: Barbara Nussbaumer-Streit, Holger Schünemann, Muriah Umoquit and Jani Ruotsalainen

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