Making Decisions Jointly with Community

• Often in traditional governance structures, meetings are run and decision making is led by people with a higher level of privilege than the community served. These structures reinforce existing power differentials and changing them to incorporate people with lived experience into the leadership structure is critical to sharing decision making power.

1. The L+M and LLHD leads started as co-chairs of the advisory board they established. As the advisory board expanded into HIC, the leaders recommended a self-selected coordinating team be established to support and guide HIC’s work between meetings. The coordinating team has eight members, including the L+M and LLHD members.

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• Inviting people with lived experience to the table and asking them to vote on issues such as health priorities or actions to address them does not guarantee that shared decision-making will occur. Even in a well-established collaborative or committee, individuals may disengage for any number of reasons. For example, topics may be irrelevant to community members, discussions may contain too much professional jargon, power dynamics may elicit fear of voicing an opposing opinion, or other committee members may commit microaggressions toward community members with minority identities. Deliberately seeking feedback on decision making processes can surface issues and concerns that may not be clear or top of mind to the people who are holding the power.

1. In the process of preparing for and holding a strategic planning retreat to kick off the coordinating team, a consultant interviewed coordinating team members and learned that some interviewees felt their participation was “tokenism” and that the L+M and LLHD leads held the power for the group.

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Make others’ lived experience and expertise the center of discussions about how to advance health equity. Taking this approach is key to embracing new decision-making processes in collaborations with CBOs and the communities they serve.  

• The HIC currently is expanding its qualitative data collection as the most recent CHNA is being finalized, to ensure sufficient information to characterize health inequities.  Moreover, HIC is working to expand its reach to individual community members for their input on health priorities. Both actions center the community’s voice and directly or indirectly enhance shared decision-making for determining CHIP activities.

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It is important to co-create a decision-making process that has the full support of those who will be using it. The process ideally centers lived experience and gives ample space for airing concerns.

• The coordinating team proposed a voting system in which members express their level of agreement with a 1 (low) to 5 (high) rating. Decisions pass if all votes are 3 or higher; anyone with a 1 rating explains their concerns to the group, and the group decides whether more discussion is needed or to advance the decision. The full HIC accepted this process, and members who had largely remained silent in the past began to contribute more freely. 
• The decision-making process is captured within a longer “Purpose and Procedures” (P&P) document, developed by a consultant and revised by the coordinating team. The P&P then underwent a highly iterative process with the full HIC to ensure sufficient time for all members to understand and contribute to the final product. It took about one year to complete, and is regarded by most, if not all, HIC members as an effort that was more important than any deadline related to the CHNA/CHIP work. 

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Deepening everyone’s understanding of and sensitivity to microaggressions provides a foundation for the open and honest conversations that are needed for a group to make well-informed decisions. Group members must be receptive to learning how what someone says and does can be dismissive and hurtful, and how to respond in a way that promotes trust and understanding. Moreover, having open and honest discussions may necessitate surfacing and addressing microaggressions in real time. For people holding power, this work can be uncomfortable. For people of color, this work can not only be uncomfortable but also can trigger a stress response based on past trauma. Indeed, it might feel unsafe due to fear of consequences resulting from the discomfort experienced by people holding power. For these reasons, it is important for group members to develop a shared commitment to addressing microaggressions in a “safe space,” i.e., an environment that is free from discrimination, criticism, harassment, defensiveness, or other negative repercussions. 

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