Principle 4. Shared decision making
Thoughtful design and application of mechanisms to distribute (rather than consolidate) decision-making power improve robustness, ownership and sustainability of actions taken.
- Shared decision making improves the robustness of decisions, ensures ownership across a network for actors, and strengthens sustainability of actions taken beyond project timeframes.
- Collaborative decision-making processes are not ‘power-free’ zones. Thoughtful design and application of participatory techniques are essential to distribute (rather than consolidate) decision-making power across all partners; centring local knowledge in those processes is critical (Principle 1).
- Existing forums or platforms for local decision-making may prove useful, but sensitivity to their strengths and weaknesses as spaces for shared decision-making is essential.
Many lay community participants (non-health professionals) in the planning process felt that Hospitals and Health Services held much of the power in decision-making when it came to health care and health services. However, it was also confirmed that Community Advisory Networks and Health Advisory Network Teams were in place to facilitate consumer feedback on services and current and future health needs. Such consumer-focused channels only acknowledge the value of the consumer as an individual, neglecting their value as a community member with power through community collective action. The project was described as ‘making waves’ and the plans that were developed through shared decision-making and aligning values and goals provided evidence to present through consumer advisory channels to influence and encourage further shared decision-making with health services.
There were also some strategies or actions identified that could be directly addressed by individuals and external agencies. Shared goals were addressed through development of collaborative partnerships.
For example, a Council bus was used to pick up community members to transport them to the clinic for their flu shots, thus overcoming a long-standing issue of access to preventive health activities.
Place-based health planning takes a holistic approach and in all project sites there were factors impacting on health, that were common goals that could be addressed by external agencies. Participants reported feeling empowered to advocate for improvements and changes.
