RESEARCH ARTICLES Decision-Making Fairness and Consensus Building in Multisector Community Health Alliances A Mixed-Methods Analysis Larry R. Hearld, 1 Jeffrey A. Alexander, 2 Laura Bodenschatz, 3 Christopher J. Louis, 3 Jennifer O’Hora 3 1 University of Alabama at Birmingham, 2 University of Michigan, 3 Pennsylvania State University Given their inherently diverse composition and potentially com- peting interests, a foundational activity of community health alli- ances is establishing consensus on the vision and strategies for achieving its goals. Using an organizational justice framework, we examined whether member perceptions of fairness in alli- ances’ decision-making processes are associated with the per- ceived level of consensus among members regarding the alliance vision and strategies. We used a mixed-methods design to exam- ine the relationship between perceptions of fairness and consen- sus within fourteen multisector community health alliances. Quantitative analysis found the perceived level of consensus to be positively associated with decision-making transparency (proce- dural fairness), inclusiveness (procedural fairness), and benefits relative to costs (distributive fairness). Qualitative analysis indi- cated that the consensus-building process is facilitated by using formal decision-making frameworks and engaging alliance mem- Correspondence to: Larry R. Hearld, University of Alabama at Birmingham, School of Health Professions, Department of Health Services Administration, 1530 3rd Ave. S, Birmingham, AL 35294. E-mail: lhearld@uab.edu This research was supported by a grant from the Robert Wood Johnson Foundation. NONPROFIT MANAGEMENT & LEADERSHIP, vol. 24, no. 2, Winter 2013 © 2013 Wiley Periodicals, Inc 139 Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/nml.21086