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Overview

OVERVIEW AND EVIDENCE BASE

WHAT DO WE MEAN BY THIS PROCESS?

Defining Organizational Structure and Operating Mechanisms is a process of establishing and arranging clear ways to work together and get things done. When groups engage in Defining Organizational Structure and Operating Mechanisms, they take steps to (a) Organize the effort (i.e., form a structure, determine clear roles and responsibilities, levels of authority) and (b) Support the members (i.e., establish protocols for decision-making and conflict resolution, create a communication plan). The process of Defining Organizational Structure and Operating Mechanisms helps create a collaborative team that is both cohesive and task focused.

Defining Organizational Structure and Operating Mechanisms is a key process to help groups come together to plan and take effective action for change.

HOW IT WORKS

Defining a structure and operating procedures can help to create logistical conditions and social relationships to support collaborative action for change. Participation in this process can help groups develop an actual infrastructure for getting the work done, and also build a level of "relational capacity" that is necessary for working together, sharing power, minimizing differences, and valuing diversity (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001). Such clarity and formality help to create a stable structure and operating procedures for strategic action.

Although the exact mechanisms are not clear for how Defining Organizational Structure and Operating Mechanisms contribute to the success of an initiative, participation in this process may help groups to:

  • Enhance community participation and engagement. For example, frequent and productive communication enhances member satisfaction, participation, interaction, resource mobilization, and implementation (Kegler, Steckler, McLeroy, & Malek, 1998; Parker et al., 1998). In addition, other operating principles and procedures that guide a collaborative group can promote a feeling of ownership about decisions and outcomes (Mattessich & Monsey, 1992) and promote a level of inclusion that is critical for maintaining diversity and mutual respect (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001; Israel, Schulz, Parker, & Becker, 1998; Parker et al., 1998).
  • Clarify and connect people and opportunities for making a difference. Explicit arrangements (e.g., defining member roles) for talented, key people who are interested in the project's success to participate and work on collaborative projects multiply the power of change (Mattessich & Monsey, 1992; Ploeg et al., 1996).
  • Activate and enhance collaborative action. An organizing structure can help people come together, but in the absence of clear procedures for working together - especially decision-making, clear roles and responsibilities, and communication - groups may get lost in confusion or conflict and not get anything done (Florin, Mitchell, & Stevenson, 1993). By contrast, efforts to create a cohesive environment for working together can increase information sharing and problem discussion/resolution, member satisfaction and retention, implementation effectiveness, and the long term viability of a project (Foster-Fishman, Berkowtiz, Lounsbury, Jacobson, & Allen, 2001; Shortell et al., 2002).
  • Avoid or address barriers for moving forward. For example, confusion regarding roles and responsibilities among collaborating members can impede program performance by creating conflict and stalling action or momentum (Goodman, Wheeler, & Lee, 1995; Goodman, Liburd, & Green-Phillips, 2001). In particular, conflict management - especially through a shared and timely process - can help to create a positive organizational climate, ensure that benefits outweigh costs, and increase the likelihood that members stay engaged (Kegler & Wyatt, 2003; Kreuter, Lezin, & Young, 2000).
  • Promote task accomplishment, resource mobilization, program implementation (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001) and program survival (Kreuter, Lezin, & Young, 2000).

EMPIRICAL AND EXPERIENTIAL EVIDENCE

Issues related to the management of community health initiatives have been identified as critical for implementation. In a multiple case study of five neighborhood partnerships, investigators identified mechanisms for communication as a critical factor associated with community mobilization. For example, in addition to project updates at meetings, the HEART of OKC partnership kept members informed about task force activities through the Vietnamese newspaper (especially a full-page youth forum), letters to remind members about meetings and activities, and personal contacts through emails, phone calls, and informal conversations (Kegler & Wyatt, 2003). By contrast, similar but less effective groups relied predominantly on meetings and minutes to keep people involved. Other important organizational factors related to implementation included decision-making and conflict management procedures.

Problems associated with governance and management of community health initiatives have been cited as possible reasons for the inability of these efforts to demonstrate significant, measurable outcomes (Mitchell & Shortell, 2000). On one hand, evaluation of the Community Care Network (CCN) partnership project indicated that development of committee structures and operating procedures was associated with successful implementation of the plan for change. Partnerships that achieved greater progress on their action plans used a number of strategies to manage and channel conflict in more positive directions (e.g., clear and shared guidelines regarding attendance criteria prior to membership suspension) than those that were less successful (Shortell et al., 2002). In addition, projects that created a process of decision-making that was perceived as fair and open to all, and provided updated information to participants to keep everyone informed, reported higher levels of progress. By contrast, those partnerships least successful in addressing their priorities did not create mechanisms to actively manage community input or effectively focus member efforts toward collective action. In the absence of such mechanisms, groups lacked a level of "social capital," relationships through which resources flow, to set the stage for moving forward collectively.

IMPLICATIONS FOR RESEARCH AND PRACTICE

At present, much of the information available on Defining Organizational Structure and Operating Mechanisms does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in several empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.

Some key research questions include: (a) What framework can describe a systematic way of thinking about the contribution of governance and management to effectiveness? (b) How do governance and management issues affect an effort's ability to obtain needed resources, implement activities, and sustain efforts? And (c) What organizational structures and operating mechanisms lend themselves best for producing plans and implementing activities that successfully affect outcomes?

OVERALL RECOMMENDATION FOR PRACTICE

Based on research and experience, we highly recommend Defining Organizational Structure and Operating Mechanisms as a key process to advance community change and improvement.