Working Collaboratively Working Collaboratively Toward Effective Decision-Toward Effective Decision-

making making

Frances D. Butterfoss, PhD, MSEdFrances D. Butterfoss, PhD, MSEd

James M. Krieger, MD, MPHJames M. Krieger, MD, MPH

Michael P. Rosenthal, MDMichael P. Rosenthal, MD

DemocracyDemocracy

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

decision.”decision.”

Process of Building Process of Building GovernanceGovernance

Develop mission & goalsDevelop mission & goals

Integrate ideas from many stakeholdersIntegrate ideas from many stakeholders

Transition from networking to engaging, Transition from networking to engaging, involving & empowering partnersinvolving & empowering partners

Qualitative analyses may provide insight into Qualitative analyses may provide insight into processprocess

Continuum of Continuum of Decision-making PowerDecision-making Power

ADVICEADVICE ➨➨ CONTROLCONTROL

Coalition develops Coalition develops ➨➨ Coalition itselfCoalition itselfrecommendations, butrecommendations, but has final has final

decision-decision-other organization(s)other organization(s) making making

power power has final sayhas final say

Wandersman, 1981Wandersman, 1981

Shared & Formalized Shared & Formalized Decision-making in CoalitionsDecision-making in Coalitions

Creates positive coalition environmentCreates positive coalition environment Ensures that member benefits outweigh Ensures that member benefits outweigh

costscosts Encourages pooling of resources Encourages pooling of resources Increases Increases member engagementmember engagement

(commitment (commitment to mission & goals, participation in to mission & goals, participation in activities, satisfaction with coalition work)activities, satisfaction with coalition work)

Makes effective assessment & planning Makes effective assessment & planning more likelymore likely

Butterfoss & Kegler, 2002Butterfoss & Kegler, 2002

Models of Decision-making Models of Decision-making in Coalitionsin Coalitions

Steering Committee, coalition Steering Committee, coalition chair or lead agency decideschair or lead agency decides

Voting or majority rule (2/3 rule)Voting or majority rule (2/3 rule)

ConsensusConsensus

Combination of models Combination of models depending on issuedepending on issue

Rapid Decision-making ModelsRapid Decision-making Models

Steering Committee (coalition & Steering Committee (coalition & committee chairs & key at-large committee chairs & key at-large organization members)organization members)

decides decides Steering Committee gets input from Steering Committee gets input from

members via email then decidesmembers via email then decides Staff decides with input from key leaders Staff decides with input from key leaders

& organizations& organizations Action alertAction alert vote is sent via email to vote is sent via email to

membersmembers

Allies Against Asthma Allies Against Asthma Decision- making ModelsDecision- making Models

Decision-making ModelDecision-making Model AAA AAA CoalitionsCoalitions

Consensus by members Consensus by members 65%65%

Steering Cmte. makes final Steering Cmte. makes final decisiondecision

28 %28 %

Voting or majority rule by Voting or majority rule by membersmembers

16%16%

Lead agency makes final Lead agency makes final decisiondecision

8%8%

Coalition chair makes final Coalition chair makes final decisiondecision

6%6%CCSAS

N=294

Decision-making ProcessDecision-making Process

0102030405060708090

Clear Fair Timely GoodResults

Disagree

Agree

CSAS

N=294

Level of Comfort with Level of Comfort with Decision-making ProcessDecision-making Process

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 All

Not at allSomewhatVery

CSAS

N=294

Power in Decision-makingPower in Decision-making

CategoryCategory

Level of PowerLevel of Power

None Some None Some A LotA Lot

Lead Lead StaffStaff

2%2% 34%34% 64%64%

Chairs/SChairs/SCC

2%2% 25%25% 74%74%

MembersMembers

3%3% 55%55% 41%41%

IndividuaIndividuall

18%18% 61%61% 21%21%CSAS

N=294

Power in Decision-making Power in Decision-making

** Significantly associated with: Significantly associated with:

Positive opinion about leadershipPositive opinion about leadership Agreement with coalition visionAgreement with coalition vision Reporting more benefits of Reporting more benefits of

participationparticipation Higher degrees of support and trustHigher degrees of support and trust

* * p=< .01p=< .01

Difficult or Controversial DecisionsDifficult or Controversial Decisions

Coalition mission & goalsCoalition mission & goals 50%50%

Specific objectives usedSpecific objectives used 71%71%

Strategies used to achieve Strategies used to achieve objectivesobjectives

79%79%

Fighting for power, prestige, Fighting for power, prestige, influence, resourcesinfluence, resources

77%77%

Procedures used to complete Procedures used to complete workwork

53%53%

Personality clashesPersonality clashes 48%48%CSAS

N=294

Examples of Difficult or Examples of Difficult or Controversial DecisionsControversial Decisions

Decisions about mission, goals & objectivesDecisions about mission, goals & objectives Transition from asthma campaign to asthma Transition from asthma campaign to asthma

management & research focusmanagement & research focus Decisions who gets resources & recognitionDecisions who gets resources & recognition

Referring & coordinating requests for patient Referring & coordinating requests for patient education & home assessments fairly among education & home assessments fairly among partnerspartners

Decisions about power, prestige & influenceDecisions about power, prestige & influence Competition for election to coalition officeCompetition for election to coalition office

Decisions about funding opportunities/grantsDecisions about funding opportunities/grants Competition for who leads, who sharesCompetition for who leads, who shares

Level of Conflict ExpectedLevel of Conflict Expected

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 All

Less As expectedMore

CSAS

N=294

Resolving ConflictResolving Conflict

0

10

20

30

40

50

60

OpenDebate

PostponeAvoid

3rd PartyMediate

Negotiate One sidegives in

Don'tKnow

CSAS

N=294

SummarySummary

Decision-making in coalitions can be Decision-making in coalitions can be potential source of conflictpotential source of conflict

Decision-making must be managed in Decision-making must be managed in standard, fair & timely mannerstandard, fair & timely manner

Comfort with decision-making leads to Comfort with decision-making leads to member satisfaction, commitment & member satisfaction, commitment & participationparticipation

Coalitions that practice good decision-Coalitions that practice good decision-making are more likely to be effective & making are more likely to be effective & sustainedsustained