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Section Two
Examining Coalitions

"Louie, this looks like the beginning of a beautiful friendship."
Humphrey Bogart in Casablanca

Overview of Section

This section provides an overview of coalitions and seeks to distinguish them from other types of operating partnerships. It provides a list of traits from successful coalitions and provides an opportunity for some coalition developers to describe their experiences.

C. Survey and Interview Result

What Does the Coalition Look Like?

The following observations are based on the Asthma Coalition Study conducted during early 2000 by The Chest Foundation.

Asthma coalitions are young and in a formative state. Approximately 3 out of every 4 have been started since January 1, 1997.
Coalitions range in size from 4 members to 325 members.
One coalition had only 1organizational partner; another coalition had as many as 180 organizational partners.
55% of the membership of these coalitions comes from the health sector.

How Did You Get Started?

Interviews were held with a number of individuals involved in the development of coalitions. Several responses demonstrate the variety found in coalitions as they begin.

This whole asthma initiative started in the hallway of our children’s hospital when we got about 3 or 4 admissions one afternoon. It was a brief conversation out of frustration saying that "Gosh, it seems like this is all we ever get anymore". Kids with asthma. So we decided to take that hunch a step further and what we did was we worked people in our information system here and we found out that in fact our hunch was proven in data. Pediatric asthma was the number one reason for emergency dept. utilization, and it was the number two reason for admission to the Hospital. From that, we knew we needed to carry that information to someone else. So we got a couple of Vice Presidents involved and from that we decided that this could not just be a hospital-driven initiative but it had to come from out in the community. We got our first group together. We actually call it our steering committee, and that still is what it is called. We got our first steering committee together and it included the American Lung Association, parents of an asthmatic, it included the school system and that included the Director of Student Health Services and a principal of a local elementary school. It included physicians from private practice and a School of Medicine. As a teaching hospital we included specialists—allergists. There were representatives from the hospital, including the Emergency Department, pharmacy, and respiratory nursing. We started by sharing information.

Another coalition had a slightly different beginning.

Originally, we started as a work group. We were interested in looking for funding for a program called "Open Airways" for schools. We wanted to do a statewide grant. We didn’t want to be limited to a regional grant so we said that we would like to get a core group of folks together and doing a grant that we could then take to some potential funders and it would be statewide. So, we worked with the State Department of Health because they had already identified this as a priority so something they wanted to work on. And then we pulled a few other folks who had been very active implementing the Open Airways for school programs so they could critique it and say, " O.K., what do we need to do to make this universal so we can take it statewide. But what happened, we got these folks together over a few months and it became apparent pretty quickly that people wanted to do more than that. Then there was a bit of a hesitation on the part of the sponsoring agency because it no longer was their project. It was now going to have a life of its own. They were concerned that they may not be able to control what this group did, that the group might go off and do things the sponsoring agency would not support. But we felt that the sponsoring agency could not work as diligently or as with as much effort as we would on our own priorities. But with the blessing of the Executive Director, we said well that’s where we are going. So that’s what we did and in that sense, the group is still rather loosely formed. We haven’t got into a bunch of bylaws. Frankly, it has worked well for this particular group.

Survey Comment Snapshots

A few briefer comments from survey participants touch on some other issues affecting coalitions as they start.

"We found that the toughest question for us to answer originally was who are the hardest people to reach in the community."

"We encounter a lot of apathy from physicians about the coalition. Since they already know all the answers it’s hard for them to get into the solution."

"We think we have a successful model for our coalition. It’s so exciting to take it to neighboring communities and see them get excited about it."

"We did not let the fact that we had no money keep us from getting started. Maybe it should have. We have been very slow getting anything done."

The Essential Points

Coalitions emerge from a societal need to promote strategic relationships that achieve specified goals effectively and efficiently.
The formation of a coalition represents the creation of a new entity with its own mission and goals.
Coalitions operate with a very different dynamic than an organization that is not a partnership. While maintaining the partnership is a continuous challenge, coalitions derive their energy from the creative union of organizations and individuals previously disparate.
Asthma coalitions are of very recent origin with most going through the identical formative phases at the same time.