Good care in ongoing dialogue. Improving the quality of care through moral deliberation and responsive evaluation.

"Furthermore, we should be clear that moral deliberation and responsive evaluation are not always ideal, linear processes. Sometimes, dialogue is not (yet) feasible. Conflicts of interest, asymmetrical relationships, scepticism among established or disempowered groups and sensitive topics may hinder genuine conversations among stakeholders. When a dialogical process is possible, it will not always result in mutual agreement and consensus. If, nonetheless, agreement is reached, it may prove difficult to put the conclusions into action. Moreover, those who want to practice moral deliberation and responsive evaluation processes should not expect that consensus is everlasting. On the contrary, consensus is always fragile. A responsive and open attitude fosters the handling of inevitable misunderstandings and failures. Misunderstandings and failures do not have to make us passive. If we recognise that agreement is always partial and finite, then the same applies for misunderstandings and failures. We can be open for cases of disagreement, and prepared to learn from them. Dialogue does not prevent misunderstanding, but offers a possible way to understand and deal with misunderstanding when it occurs and to learn from mutual disagreement. This idea is shared by moral deliberation and responsive evaluation, and provides a basis for their cooperation in improving healthcare practice."