In 1999 the health care industry created the National Quality Forum—a network administrative organization—to address issues of health care quality in a new way by bringing together organizations from the public and private sectors and providing them with a forum to discuss and debate measures of quality, and ultimately, to effect change. Little, however, is known about the decision making processes of network administrative organizations despite the fact that their decisions may have far-reaching impacts on public policy. Using a grounded theory approach, this paper examines the creation and development of the NQF’s Consensus Development Process and identifies and discusses five key principles that underlie the process. This paper argues that in order to create a decision-making process for a network administrative organization that is balanced and inclusive of diverse interests a leader must consider and incorporate principles that are representative of the larger environment.