Consensus creates effective programs. "Quick response service" project reveals importance of stakeholders' input.

In the Hamilton-Wentworth area of Ontario, Canada, three acute care hospitals and a home care program joined together to try to reduce local senior citizens' admissions to hospitals and visits to emergency rooms. They hoped to achieve this by providing seniors with care in their homes. Realizing that the project would have to employ collaborative decision making, its cosponsors selected participants from both the hospitals (for example, administrators and physicians) and the community (for example, consumers and family physicians). The cosponsors chose cochairpersons from the hospital sector and the community sector. The project was complex because it involved so many stakeholders, but the cochairpersons gave it both its stability and its driving force. Decision making was done through consensus, a process that can be tedious and frustrating, especially when based on systemic evaluation, a process in which a group analyzes a full range of advantages and disadvantages to a course of action. Nevertheless, the cosponsors found the process vital to the project's success. By the end of the project, 342 hospital admissions and 70 emergency room visits had been averted. The cosponsors had discovered that because collaborative decision making can facilitate efficiency and "buy-in," it saves both money and time in the long run.