Working Collaboratively Toward Effective Decision-making Frances D. Butterfoss, PhD, MSEd Center for Pediatric Research James M. Krieger, MD, MPH University of Washington Michael P. Rosenthal, MD Thomas Jefferson University

Democracy “It’s not perfect, but it’s the best way for 280 million people to make a decision.”

Process of Building Governance Develop mission & goals Develop mission & goals Integrate ideas from many stakeholders Integrate ideas from many stakeholders Transition from networking to engaging, involving & empowering partners Transition from networking to engaging, involving & empowering partners Qualitative analyses may provide insight into process Qualitative analyses may provide insight into process

Continuum of Decision-making Power ADVICE ➨ CONTROL ADVICE ➨ CONTROL Coalition develops ➨ Coalition itself recommendations, buthas final decision- other organization(s)making power Have final say Wandersman, 1981 Wandersman, 1981

Shared & Formalized Decision-making in Coalitions Creates positive coalition environment Creates positive coalition environment Ensures that member benefits outweigh costs Ensures that member benefits outweigh costs Encourages pooling of resources Encourages pooling of resources Increases member engagement (commitment Increases member engagement (commitment to mission & goals, participation in activities, satisfaction with coalition work) Makes effective assessment & planning Makes effective assessment & planning more likely Butterfoss & Kegler, 2002

Models of Decision-making in Coalitions Steering Committee, coalition chair or lead agency decides Steering Committee, coalition chair or lead agency decides Voting or majority rule (2/3 rule) Voting or majority rule (2/3 rule) Consensus Consensus Combination of models, depending on issue Combination of models, depending on issue

Rapid Decision-making Models Steering Committee (coalition & committee chairs & key at-large organization members) decides Steering Committee (coalition & committee chairs & key at-large organization members) decides Steering Committee gets input from members via then decides Steering Committee gets input from members via then decides Staff decides with input from key leaders & organizations Staff decides with input from key leaders & organizations Action alert vote is sent via to members Action alert vote is sent via to members

Allies Decision-making Models

Decision-making Process

Level of Comfort with Decision-making Process

Power in Decision-making Category Category Level of Power None Some A Lot None Some A Lot Lead Staff 2% 2% 34% 33% 64% 65% Chairs/Steering Committee 1% 2% 25% 21% 74% 78% Members 4% 4% 55% 61% 41% 35% Individual 18% 21% 61% 62% 21% 17%

Good Decision-making Process Significantly associated with: X 2 P Value Having voice in coalition < Having voice in coalition < Responsibility for activities 8.47 < Responsibility for activities 8.47 < Bringing benefits to community 8.01 < Bringing benefits to community 8.01 < Making progress in implementing 8.15 < Making progress in implementing 8.15 <0.0043strategies Improving health outcomes20.28 < Improving health outcomes20.28 <0.0001

Difficult or Controversial Decisions

Examples of Difficult or Controversial Decisions Decisions about mission, goals & objectives Decisions about mission, goals & objectives Transition from asthma campaign to asthma management & evaluation focus Transition from asthma campaign to asthma management & evaluation focus Decisions who gets resources & recognition Decisions who gets resources & recognition Referring & coordinating requests for patient education & home assessments fairly among partners Referring & coordinating requests for patient education & home assessments fairly among partners Decisions about power, prestige & influence Decisions about power, prestige & influence Competition for election to coalition office Competition for election to coalition office Decisions about funding opportunities/grants Decisions about funding opportunities/grants Competition for who leads, who shares Competition for who leads, who shares

Level of Conflict Expected

Resolving Conflict

Summary Decision-making in coalitions can be potential source of conflict Decision-making in coalitions can be potential source of conflict Decision-making must be managed in standard, fair & timely manner Decision-making must be managed in standard, fair & timely manner Comfort with decision-making leads to member satisfaction, commitment & participation Comfort with decision-making leads to member satisfaction, commitment & participation Coalitions that practice good decision-making are more likely to have members that are committed to the mission and goals Coalitions that practice good decision-making are more likely to have members that are committed to the mission and goals