1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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 email then decides Steering Committee gets input from members via email then decides Staff decides with input from key leaders & organizations Staff decides with input from key leaders & organizations Action alert vote is sent via email to members Action alert vote is sent via email to members

8. Allies Decision-making Models

9. Decision-making Process

10. Level of Comfort with Decision-making Process

11. Power in Decision-making Category Category Level of Power None Some A Lot None Some A Lot 2002 2003 2002 2003 2002 2003 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%

12. Good Decision-making Process Significantly associated with: X 2 P Value Having voice in coalition 23.16 <0.0001 Having voice in coalition 23.16 <0.0001 Responsibility for activities 8.47 <0.0036 Responsibility for activities 8.47 <0.0036 Bringing benefits to community 8.01 <0.0047 Bringing benefits to community 8.01 <0.0047 Making progress in implementing 8.15 <0.0043 Making progress in implementing 8.15 <0.0043strategies Improving health outcomes20.28 <0.0001 Improving health outcomes20.28 <0.0001

13. Difficult or Controversial Decisions

14. 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

15. Level of Conflict Expected

16. Resolving Conflict

17. 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