PNP 6013 Module 4 Collective Action and Shared Accountability Paper Example

Everyone Owns It, So No One Does? Collective Action and Shared Accountability in a County Overdose Prevention Coalition

Student Name

American College of Education

PNP6013: Stakeholders and Roles in Public and Nonprofit Organizations

Module 4 Assignment

Instructor Name

November 2, 2026

Introduction

ACE's course description asks how stakeholders contribute to collective action and organizational effectiveness. The overdose prevention coalition in central New Mexico shows both the promise and the difficulty. Seventeen organizations and groups share a goal no single member can reach, fewer overdose deaths in the county, yet the coalition has met for three years without a shared way to judge whether its work is making a difference or who is responsible for what. This paper diagnoses that accountability gap, proposes shared measures and member commitments and designs a way for members to hold one another accountable when none has authority over the others.

Why Collective Action Stalls

Olson (1965) argued that when a benefit is shared by everyone in a group, each member has a reason to let others bear the cost of producing it, and large groups in particular struggle to act without incentives or rules that reward contribution. The coalition fits the pattern. Every member benefits if deaths fall, but the work of collecting data, staffing outreach or changing internal policy falls on whoever volunteers. In practice the county health department and the harm reduction organization carry most of the load, attendance by other members has drifted and meetings have become updates rather than decisions. The coalition does not lack goodwill; it lacks a structure that makes contributions visible and expected.

A Shared Measurement Set

Shared accountability begins with agreement on what counts. The proposal distinguishes three levels. Population outcomes, which the coalition influences but does not control: overdose deaths in the county and emergency department visits for nonfatal overdose, reported annually from state surveillance data. Coalition-level results, which members together can move: the share of people leaving jail who receive naloxone, the number of pharmacies stocking naloxone without a prescription and the share of emergency patients treated for overdose who start treatment within seven days. Member contributions, which each organization controls: specific activities reported quarterly. Separating these levels matters. If fentanyl supply changes cause deaths to rise, members should not abandon work that is meeting its own targets, and if deaths fall, the coalition should not claim credit it cannot show.

Member Commitments

Each member would make one or two commitments tied to its structural strengths, reported quarterly. The health department would publish a quarterly overdose data brief and maintain the naloxone standing order. The harm reduction organization would report naloxone kits distributed and overdose reversals reported by participants. Each hospital system would report the share of overdose patients offered same-day addiction consultation and the number linked to treatment. The detention center would report kits distributed at release. Treatment providers would report wait times for new intakes. The recovery ministry would report participants in recovery and grief groups, and the family support group would co-lead public messaging. Commitments would be written in a one-page agreement each member's leader signs, which turns informal goodwill into a visible promise.

Accountability Without Hierarchy

No member can order another to act, so accountability must come from other sources. Page et al. (2015) proposed that the public value of cross-sector collaborations be judged on three dimensions: democratic accountability, meaning whether those affected have a voice and the collaboration answers to the public; procedural legitimacy, meaning whether its processes are fair and transparent; and substantive outcomes. The coalition's design addresses each. For democratic accountability, a community panel drawn from current drug users, people now in recovery and bereaved relatives would review the quarterly data and could ask any member to explain its results. For procedural legitimacy, decisions would follow written rules, with minutes and data published online. For substantive outcomes, the measurement set provides the evidence. Peer review at quarterly meetings, in which each member presents its contribution, would add the reputational pressure that Olson's analysis suggests is needed.

Data Sharing

Shared measures require shared data, which raises legal and trust issues. Hospitals must protect patient privacy, the harm reduction organization has promised participants anonymity and law enforcement data could deter participation if misused. The proposal limits sharing to aggregate counts by quarter, prohibits any member from requesting individual-level information through the coalition and makes the health department, which already handles protected surveillance data, the sole recipient of hospital data. A written data-sharing agreement would set these rules before any data move.

Shared Motivation

Structures alone will not sustain the effort. Emerson et al. (2012) identified shared motivation, built from trust, mutual understanding and commitment, as one of the dynamics that keep collaborations working. The coalition can strengthen it in practical ways: opening each quarterly meeting with a brief account of a life saved or lost, celebrating members that meet commitments and reviewing shortfalls as problems to solve together rather than failures to criticize. Members that miss commitments repeatedly would be asked privately by the co-chairs whether their commitment should change, not publicly shamed.

Risks of Shared Measurement

Measures can distort the work they are meant to support. If kits distributed becomes the harm reduction organization's main number, staff may hand out kits to people unlikely to use them simply to raise the count. If hospitals are judged on treatment starts within seven days, they may refer patients to programs with no real capacity, producing referrals that never become care. And if quarterly peer review turns into public comparison, members with harder roles, such as the detention center, may disengage. Each risk has a safeguard: pairing every count with a quality check, such as reported reversals alongside kits distributed; defining a treatment start as a first attended visit, not a referral; and framing reviews as shared problem solving. The community panel adds a further check, since its members can say when a number looks good but does not match what they see.

Governance Support

Shared accountability needs someone to run it. Provan and Kenis (2008) noted that networks with many members and moderate trust often need a dedicated administrative function. Until a separate administrative entity can be funded, the coalition coordinator role, currently a quarter of my position, would expand to half time to manage data collection, prepare the quarterly dashboard and support the community panel, with the cost shared by the health department and the two hospital systems.

What Year One Should Achieve

The first year is about building the system, not proving impact. Success in year one would mean that every member has signed a commitment, that four quarterly dashboards have been published on schedule, that the community panel has met each quarter with at least two current drug users among its members and that the data-sharing agreement is in force. Population outcomes will appear in reports, but the coalition will not be graded on them until at least two years of consistent data exist. Setting these modest, checkable aims protects the effort from being declared a failure before it has had a chance to work.

Conclusion

The coalition's stall reflects a familiar collective action problem: a shared goal with diffuse responsibility. The remedy proposed here separates population outcomes, coalition results and member contributions, asks each member for signed, reportable commitments, builds accountability through a community panel, transparent procedures and peer review, protects privacy in data sharing and supports the system with a dedicated coordinator. Module 5 turns these structures into a stakeholder engagement plan.

References

Emerson, K., Nabatchi, T., & Balogh, S. (2012). An integrative framework for collaborative governance. Journal of Public Administration Research and Theory, 22(1), 1-29. https://doi.org/10.1093/jopart/mur011

Olson, M. (1965). The logic of collective action: Public goods and the theory of groups. Harvard University Press.

Page, S. B., Stone, M. M., Bryson, J. M., & Crosby, B. C. (2015). Public value creation by cross-sector collaborations: A framework and challenges of assessment. Public Administration, 93(3), 715-732. https://doi.org/10.1111/padm.12161

Provan, K. G., & Kenis, P. (2008). Modes of network governance: Structure, management, and effectiveness. Journal of Public Administration Research and Theory, 18(2), 229-252. https://doi.org/10.1093/jopart/mum015