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Section Five
Running a Coalition

"The world is full of willing people, some willing to work, the rest willing to let them."
Robert Frost

Overview of Section

This section discusses several factors that are critical to the day-to day running of a coalition. It deals with the people of the coalition, the leaders, the members, the committees and its community allies, and the roles they need to play for a healthy coalition. The section also deals with communication and some of the obstacles to effective communication. Finally, it talks about conflict, inevitable when capable people come together to do something significant, and ways of handling that conflict.

D. Survey and Interview Results

Some Notes from A Descriptive Study of Asthma Coalitions, Spring 2000

When asked to give a rating to success with "Frequent and productive communication" as part of the survey questionnaire, members rated this item at a low level.
There were numerous comments citing the amount of time and effort it took to inform members along with comments on the difficulty of ensuring that you did indeed reach everyone.
The primary impression was that coalitions valued communication but many believed they did not have sufficient resources to do a good job.
Most coalitions believed that the use of e-mail and other electronic means of communication would enhance internal communications.

Some Comments From Coalitions on Leadership

We did divide out into some work groups last year. Typically people go off and work in groups—some of them have been more successful than others, some of them did more monitoring than actual work. The weakness is that we haven't had a real strong physician work group. But that has changed. We did a summit last fall which really sort of coalesced not only what we were doing but got a lot of other people interested in it and involved who maybe didn't want to come to regular meetings but wanted to be active and wanted to do things or maybe would be willing to work in groups.

Some Comments From Coalitions on Communication

Several coalition members discussed use of a Web site.

We just put the Web site up in September. So no we are not using it extensively now. But it has been discussed to be used for two things—communicating to our members and developing a bulletin for general public support.

One leader commented in response to an open-ended question about communication:

It is really tough sometimes to communicate with our members. When we are doing it right, we are sending out a newsletter quarterly. Well, last year, one newsletter got out. We have a tough time doing that. The other way we do it is with an annual celebration. Last year we had an asthma summit, we probably will do something similar this year. But communication is a problem for us. You know how hard it is—a newsletter. You have to run out and get people to give you articles, you have to put it in some kind of format, have to edit it so that it fits. It is always difficult.

Some Comments From Coalitions on Conflict

A number of coalitions commented on problems of turf issues and conflict.

This might be a turf issue that we are having a problem with and it might be different from other folks. We are a statewide coalition. We fought for the development of local coalitions. Where we have turf problems is between the local coalition and the state coalition. Who is going to do what? We are competing for a limited funding pot in a state where there are generous funders. But it is still a limited pot so when the state coalition decided that it wanted to submit a grant proposal to a foundation, one of our local coalitions thought that was a bad idea. Since they sit on the steering committee, we had some discussion about why they thought it was a bad idea. They think that everything should be a local response; others thought it should be the state's response; that some of these big corporations really ought to interact with the state coalition, not the local folks. That was a problem.

From day one we said that if we keep on going—this is going to a 501c3 freestanding organization. That's an idea we got from another coalition for exactly the same reason that they got it. Then the money flows to an organization not a particular institution so that competing institutions don't feel that the other one got the money and we didn't. Occasionally, there were a few institutions that compete for a grant award and they wanted the coalition to write support letters. One felt the other got a stronger letter and it was the other that got the grant. They actually pulled out for awhile. Not in name but in fact. They are back in again and we have had to go down and talk to them and see what their priorities are so that they will feel good about being on and participating as members.

There are personality issues. I think that is one of the biggest issues that all coalitions have to face and we have faced it. Another problem is not as much institutional as a conflict of philosophy between clinical and academic people. There is a belief that if you are going to do anything, you have to evaluate it NIH style. This means a million dollar random case control trial, and if you don't do it that way, you are not responsibly evaluating. They see that as only right way to do it. And then you have the community saying, "Well, wait a second. If it is going to cost a million dollars and it's going to take us 3 years to find out if one little thing makes a difference and there are 50 little things that we have to do to make a difference, this is crazy." So, you have to take the philosophical divide between these people—both of who feel very strongly about it.

One national association here is pretty much a member of our coalition because we have been successful and because they want to keep an eye on us. It wouldn't have been here if we hadn't achieved this kind of success in this short time. The director said to me, "Frankly, we see you as competition and we don't think that you should exist."

We have some turf issues and I don't know if we have done such a good job of handling them. The biggest turf issue would be between the primary care physicians and the specialists, to be quite honest. We continually drive home the national guidelines for referrals to an allergy specialist and we are going to start documenting that as part of our initiative. They get the children that we are seeing if they fall within the guidelines for referral to an asthma specialist. That's our biggest turf issue.

The tobacco settlement is an opportunity for some interesting turf issues. There are going to be politics in every region. We are part of the tobacco settlement. One of the tobacco settlement states, actually an insurance company sued the tobacco industry. So there is a great deal of money coming through a foundation that was formed for the distribution of those funds. Unbeknownst to us, there is a lot of political overtures going on in some of the regions for that money and how they are applying for that money. It primarily is through the public health sector and also the private hospitals, etc.

Yes, I think there are some turf issues and we are also noticing politics of the physician community. We go in with our agenda in mind and it is pretty hard to get beyond it because it is a good agenda and it makes sense. So, anybody going in and jockeying for the control will have a difficult time.

Survey Comment Snapshots

"There are turf issues and too much competition among the member hospitals. These are all money based."

"There is a need to bring the institutions in our coalition together. They still think independently."

"We have brought together many diverse members willing to work cooperatively toward a common target."

"We need to provide leadership training for the members of the coalition who chair committees. Sometimes they tend to get forgotten."

"We have an excellent leader who is adept at a lot of different aspects and I worry that this may become more and more a one person show. What happens when she leaves."

"Our steering committee can take credit for so many diverse members who are willing to work together toward a common object."

The Essential Points

Successful coalition leaders are those who have the ability to actively guide the coalition in its earliest stages and are able to share that responsibility with others as it matures.
Research indicates that the two most important factors in the success of coalition leaders are the community organization skills the leaders possess and the time available to them to work on the coalition.
Coalitions need to give prospective and new members sufficient information about the coalition and their role in it so that their expectations as new members conform to the reality of the coalition.
Coalitions exist with a variety of structural models for management and decision making. Successful coalitions will ensure that whatever forms these take are conveyed to all members and that the coalition retains the flexibility of changing them as it grows.
As with all organizations, communication with members and with the larger community remains the greatest opportunity and the greatest problem.
Coalitions should not be surprised that those who they have counted on for support sometimes greet them with indifference or suspicion.
A successful coalition is not one that has learned how to avoid conflicts, but one that has learned how to deal openly with them.