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THE COLLABORATIVE COMMITTEE MODEL


Introduction

The idea of a non-decision-making committee came out of the "Understanding & Involvement" Project , which was a consumer evaluation of acute hospital practice. The committee's creation was organic, that is, it came out of the process of responding to a need identified by committee members.

The most interesting and educative part of this is that if the project team had not been so assertive in demanding Royal Park Hospital consent to a consumer perspective steering mechanism, this committee could easily have turned out just like any other committee.


The Steering Committee

As a consumer-run project, the team put in place mechanisms to try to make sure the consumer voice was loud. Most of these mechanisms worked well. They included:

  1. Divining for those with energy. An argument was made that efforts to artificially construct a committee mostly don't work. Hand picking one indigenous person, one person with schizophrenia, one person from a culturally and linguistically diverse background, etc. would flop. It would be an artificial construct and its very artificiality may be its downfall.
    This was crucial because there was (and is) a timidity about saying that we don't want one of each minority we can find. For this committee, and for many successful committees after, we knew we were not looking for multiple affiliations but rather for enough of a pulse to make a substantial difference. Sometimes this pulse is a flame put out by an over-preoccupation with diversity. Instead we used a metaphorical divining rod to feel where the energy was amongst consumers. Who was vitally interested in what we were trying to do?
  2. Hand picking supportive staff: This was a similar principle as divining. Consumers involved with the project argued that there was no point in using up precious energy arguing the case for the project with staff who were not committed. The project had been funded and it had the agreement of senior staff - the proving of its worth phase was over. Rather, the committee wanted to engage with the most supportive clinicians available and their role would be different. The team need allies.
  3. Critical Mass: The project team made sure that there was a 'critical mass' of consumers. This meant that there needed to be the same (or more) consumers on the committee than all the other members of the committee who weren't consumers. For consumers to be heard, critical mass is imperative.

It was good but not good enough:
Why the Steering Committee didn't Work

Although the Steering Committee was carefully constructed and led by consumer expertise, it was limited by its structure. These limitations were retarding the capacity of the committee to generate much-needed new thinking.

Committees need to be both a maker of decisions and a crucible for new ideas and thinking. Steering Committee structures, by their very nature, enhance the decision-making function but often at the expense of lateral thought and vision.

The problem with this dual responsibility is that the two tasks often pull the committee in different directions, particularly when consumers who have been starved of opportunities to speak their mind are involved.

Below are the specific problems we found with our steering committee, but they are typical:

  1. Just as the committee finds time for its secondary role as a think tank the chair would find the need to press on to conclude the meeting on time. This was unsatisfactory for everyone.
    • "We'd just get to the part where the most important subjects, the most important ideas, were starting to shyly come to the fore when the chair felt impelled to bring the committee to order and readdress the agenda. Everything was lost." paraphrased from Yoland Wadsworth U&I 1999

  2. Note taking took a person out of important discussions for little return. Minutes felt both insufficient and too much.
  3. Members said they didn't find this way of making decisions very useful. This went back to the concept of 'divining for energy'. Members unanimously believed that the energy was leaching and leaking. There were much more important things to do than sit on committees that made little sense to anyone. Everyone wanted to engage the crucible part and damn the decision-making!

The Collaborative Committee

Surprisingly the U&I Project team solved the problem of the Steering Committee by making it a major part of the evaluation. This was clever:

  1. It was called a non-decision-making committee, thus taking the emphasis off debating and decision-making and on to talking and listening;
  2. The time dedicated to the committee increased from one hour to two hours once a month;
  3. The role of the chair was rotated and shared equally by consumers and lay people;
  4. The discussion was taped and transcribed;
  5. Notes went back to all committee members who now had a vested interest in checking what they had said and making sure that what they uttered on the day truly reflected what they wanted to say;
  6. The transcripts then gave the consumer researchers a good idea of what committee members wanted for the future;
  7. What was created was a vital, inquiring, inter-subjective conversation where members were truly listening rather than switching off and just practicing what they personally wanted to say next, which is the way of most people in standard Steering Committees behave.

Deep Dialogue

As the project developed, the idea of the Collaborative Committee grew in strength and favour. People wanted more. The Deep Dialogue component grew out of the Collaborative Committee.

Deep Dialogue became a major initiative of the U&I project. This was a way of structuring talking and listening, not plotting and talking over people or jockeying for power. It was necessary to control the environment to allow consumers and clinicians to speak without fear. It also allowed and encouraged emotion, recognising that to try and remove emotion would shut people down and yet again silence them. It was about asking questions rather than knowing answers. It was about talking about things that interested one person and then listening with great care to another point of view. Deep Dialogue committees have grown out of the original project at Royal Park Hospital.

It is hard. Really listening is hard. Nonetheless it is one of the most interesting and progressive ideas to have developed around the challenge of bringing people with very different amounts of institutional power, very different agendas, very different ways of speaking their truth, and very different levels of tolerance of difference together to respectfully exchange ideas and new ways of being together. It also puts forward the idea that as much effort needs to go into the crucible role of any committee as is put into its decision-making agenda.


Some Questions

  1. Have you ever sat on a committee where you were frustrated by a lack of opportunity to really talk about the issue under discussion? What did you do?
  2. Have you ever felt sidelined on a committee or been offhandedly told the committee is not the right place to bring up the issue that is important to you? What feelings do you have associated with this?
  3. Sometimes consumers say that even though there are many people on a committee they feel alone. What is the dynamic behind this? Is it better to fight or to leave?
  4. Do you find yourself tuning out during a committee and just waiting for the item number where you have lined up something you want to say? What happens if everyone is doing this?
  5. Do you feel your expertise is truly respected? How do you know?
  6. Do you sometimes feel committees are shallow and decisions are being made on the run? How do you slow them down?
  7. Do you think you have ever experienced true 'deep dialogue' on a committee you have sat on as a consumer?
  8. What is the 'Tyranny of Agenda'? What can we do about it?
  9. Would you describe most/any committees you presently sit on truly collaborative?
  10. It is said ordinary committees suit some sort of consumers and collaborative committees suit another sort altogether. What do you reckon?

Conclusion

The following resources may be useful to help people understand the concepts behind collaborative committees: