Our goal is that at Medicine Forward any person who feels strongly about an issue or a possibility has the power to do something about it. And, every decision is informed by collective intelligence. This decision-making policy empowers individuals while ensuring alignment with the organization’s purpose through clear processes and distributed authority. It emphasizes 1) autonomy, 2) decentralization, and 3) efficiency, prioritizing the Advice Process and consent-based decision-making while clarifying the role of individual decision-making.

1. Autonomy
   Empower individuals to make decisions independently within their roles and responsibilities.
   1. Accountability: Ensure individuals are responsible for their decisions and their outcomes.
   2. Invitation: Foster a culture of voluntary participation, encouraging people to step forward based on interest and expertise.
2. Decentralization
   Distribute authority to enable decision-making at all levels, minimizing reliance on hierarchical structures.
   • Inclusivity: Ensure decision-making includes input from those affected and individuals with relevant expertise to leverage collective intelligence.
   • Transparency: Make relevant information accessible to members to enhance trust and clarity.
3. Efficiency
   Streamline decision-making processes to avoid unnecessary delays and ensure timely action.
4. Purpose-Driven
   Align all decisions with the organization’s overarching purpose to ensure focus and coherence.

• When to Use: For decisions with minimal risk and short-term impact.
• Process:
  • Individuals make decisions independently within their domain of expertise.
  • They assume full responsibility for the decision and its outcomes.
• Examples: Selecting vendors for office supplies or scheduling team meetings.

• When to Use: For decisions affecting multiple people or requiring specialized knowledge.
• Process:
  • The decision-maker consults those affected and individuals with relevant expertise.
  • Advice is considered but not mandatory to follow.
  • The decision-maker assumes accountability for the final decision and its consequences.
• Examples: Initiating new projects, modifying work processes, or approving significant expenditures.
• Pitfalls to Avoid: Overlooking advice, failing to seek diverse perspectives, or bypassing consultations with key stakeholders.

• When to Use: For decisions requiring collective input and agreement, especially those with significant organizational implications.
• Process:
  • A facilitator is appointed to guide the process.
  • A proposal is presented, followed by clarifying questions.
  • Participants share reactions to the proposal without interruption.
  • Objections are raised if the proposal is seen as risky or regressive. Without valid objections, the proposal is approved.
  • If objections arise, the proposal is revised collaboratively.
  • Visual confirmation is used to approve a proposal.
• Accountability: The group collectively shares responsibility for the decision.
• Examples: Creating new policies, restructuring, or making strategic decisions.
• Pitfalls to Avoid: Prioritizing personal preferences over organizational goals, allowing dominant voices to overshadow others, or dismissing valid objections.

Needs to be developed.

“we’ll work together to find a decision that everyone is happy with.”

“Some decisions are ideally suited to consensus: what’s our purpose and principles? how do we make decisions? what’s are our priorities? You can use advice or consent for decisions with less impact, like what words are going on the website?”

“there’s increasing unity, buy-in, participation, and access to collective intelligence as you proceed from 1 to 4 (individual to consensus). Conversely, there’s more time spent in discussion and negotiation”

• General Principle: Anyone can initiate a decision using an appropriate method.
• No Hierarchical Overrides: Decisions made through the Advice Process or consent-based methods cannot be overridden by higher authority figures.
• Stewardship: Individuals serve as stewards of their roles, focusing on fulfilling the role’s purpose rather than asserting ownership.
• Autonomy: People have the freedom to make decisions within their roles without unnecessary consultations.
• Decentralization: Authority is distributed to empower decision-making at every level, fostering agility and inclusivity.

• Training: Provide education on decision-making processes, with emphasis on the Advice Process and consent-based methods.
• Transparency: Document all decisions and make them accessible to members.
• Conflict Resolution: Establish a process for addressing disagreements constructively.
• Regular Review: Periodically evaluate the policy to ensure effectiveness and relevance.
• Emphasis on Invitation: Shift towards inviting participation rather than mandating it.
• Metrics: Develop co-created metrics to evaluate decision-making effectiveness.
• Embrace Learning: Treat mistakes and decisions as opportunities for growth and improvement.
• Proposals: Foster an environment where everyone feels empowered to suggest improvements.
• Documentation: Maintain clear records of decisions, rationales, and action items.
• Communication: Ensure consistent and clear dissemination of decisions to all relevant parties.

• Relying Solely on Consensus: Avoid inefficiency by seeking consensus only when appropriate.
• Ignoring Diverse Perspectives: Actively include varied viewpoints to enhance decision quality.
• Confusing Personal Preferences with Organizational Needs: Focus decisions on what benefits the organization as a whole.
• Failing to Document Decisions: Ensure all decisions are clearly recorded with rationales and outcomes.
• Neglecting Ownership: Assign clear responsibility for each decision’s execution.
• Dominating Decision-Making: Encourage balanced participation and rotation of facilitation roles.
• Hierarchical Bias: Avoid defaulting to traditional top-down authority structures.
• Fear of Conflict: View conflict as a growth opportunity, and have mechanisms in place to address it.
• Avoiding Responsibility: Ensure individuals take ownership of their actions and decisions.

• Laloux, Frederic. Reinventing Organizations: A Guide to Creating Organizations Inspired by the Next Stage of Human Consciousness. Nelson Parker, 2014.
• Robertson, Brian J. Holacracy: The New Management System for a Rapidly Changing World. Henry Holt, 2015.
• Slade, Samantha. Going Horizontal: Creating a Non-Hierarchical Organization, One Practice at a Time. Berrett-Koehler Publishers, 2018.