Discussion

Table of Contents

Introduction
Method
Analysis
Results
Discussion
Directions for Future Research

What have coalitions learned about recruiting and retaining coalition members?

Coalitions are primarily recruiting members by word-of-mouth and through a variety of networking activities. It appears that these are effective means for recruiting members beyond the initial organizing core group. One networking activity that appears to be a successful starting point for many coalitions is the "asthma summit." This activity is not only successful in recruiting members, but also in developing a shared vision for the coalition and an action plan. Retaining coalition members is more difficult for those coalitions that do not have an action plan with specific activities that allow direct involvement by the membership. Older coalitions caution against making membership more labor intensive than it is worth, i.e., do not have the costs of membership outweigh the benefits. Two areas with low membership percentages in asthma coalitions were child-care providers and business/industry (outside of pharmaceutical companies/organizations). Interviews and presentation notes indicate that coalitions are beginning to approach housing authorities in urban areas and other environmental groups in order to combine resources.

Recommendations for recruiting and retaining members in established coalitions include:

• Have an action-oriented meeting; do not meet just for the sake of meeting.
• Distribute minutes to all members; include a copy of the action plan in the minutes.
• Get buy-in from members on the goals and objectives of the coalition.
• Identify key players in geographical areas.
• Get tied into local organizations and provide names of local contact people to coalition members to enable networking.
• Consider conducting asthma summits or conferences as a way of recruiting members and developing or reviewing action plans.
• Use the grant proposal development process as an opportunity to bring in other stakeholders.
• Look at other local coalitions or statewide organizations, see what they are doing and how they are organizing in your area.
• Make an effort at the beginning to keep asking, "Who’s not here at the table that should be?"
• Use a data component to assist in recruiting and retaining physicians.
• Identify some short-term projects in which members can see achievable results; this will keep the momentum going while working on projects that might be longer-term.
• Have systems in place for building consensus and prioritizing projects.

What have coalitions learned about communication?

Frequent and productive communication is associated with coalitions that have defined leadership roles and shared decision-making. Most coalitions communicate formally with their memberships through the distribution of meeting minutes. Informal and interpersonal communication takes place more frequently in those coalitions with active action groups or committees. Interview and presentation data showed that communication between coordinator/director and committee chairs was important to implementation of projects. When communication was frequent, there was more buy-in by the members and the projects were more likely to proceed according to the timeline. One particular form of communication instrumental in the start-up of many coalitions was the sharing of data. For example, once data were shared with schools regarding asthma-related absenteeism, school principals eagerly signed on for a pilot project to train school staff. This pilot program led to the coalition’s first grant and the organization of the coalition. Sharing information about the number of ER admissions at one local hospital led to the formation of an ad hoc steering committee to strategize what to do about the problem. This committee was the beginning of a formal asthma coalition.

Methods of communication varied across the coalitions, but it appears that coalitions are using electronic communication (e.g., e-mail and faxes) to communicate with their members almost as frequently as they use traditional forms, e.g., direct mailings, individual phone calls, and conference calls. Some coalitions have used newsletters as a means of communication, however, it appears that the Internet is becoming a more desirable mode for communicating with the public. A search of Internet Web sites indicates that approximately 25 asthma coalitions have established Web sites or have pages within other organization’s Web sites. The Web sites are used to communicate with the membership and general public. There is considerable variation among the sites in terms of the amount of information provided. Some coalitions are also communicating with the general public through aggressive marketing campaigns in their communities. These campaigns include radio announcements, poster ads, health fairs, and speaker bureaus.

Recommendations for communication include:

• Set up a database for communication with all contact information; divide database into members, nonmembers, key stakeholders, funders, etc. in order to make communication efforts more profitable.
• Identify the types of information that will be sent to particular groups.
• Do not overwhelm members with information that is not necessary.
• Get feedback from members as to the usability of the information they receive.
• Consider setting up a Web site as a way to disseminate information and communicate with members as well as nonmembers.
• Send out minutes to everybody who is a member and anybody who wants to be a member.
• Require reports from working groups or committees; incorporate a synopsis of these reports into the minutes.
• Hold special forums on particular issues of interest to the membership.
• Have a system in place for members to provide input into the decision making process and communicate this process to members.

What have coalitions learned about setting up a governance system?

Formal organizational structure does not appear to be essential in the planning phase of a coalition. However, as partnerships are developed and the membership grows and becomes more diverse, the complexity of the organizational structure appears to become more important in ensuring a positive organizational climate and maintaining linkages with other organizations. In addition, having defined leadership roles is an important component related to the implementation of coalition activities. Most of the coalitions do have either a coordinator or director with over one third of these being held as pro bono positions. The orientation of asthma coalitions appears to be primarily toward functioning committees and action groups. Indications are that this type of structure is satisfactory for implementing the types of activities associated with the majority of asthma coalitions, i.e., public awareness, public and professional education, data surveillance, speaker’s bureau, etc. Presentation and interview data support survey findings that a coalition’s success is related to having a shared vision, and specifying goals, objectives, and an action plan.

Recommendations for starting a coalition and setting up a governance system include:

• Begin with a set of informal meetings with different groups representing different viewpoints to come together and talk about the issues asking "tough questions."
• Structure organizationally so that the leadership is shared and that there is a plan for a transition of leadership over a period of time.
• Consider looking for local funding to stimulate the developing of an action plan.
• Understand that it could take a couple of years before a formal organization is established and ready to apply for tax-exempt status.
• Establish a steering committee or similar to guide the coalition and set up a strategic plan for recruitment, funding, operating procedures, etc.
• Use the steering committee to groom new leaders.
• Understand the purpose of the coalition - coalitions are a catalyst that would do things that individual groups or organizations by themselves are not doing or can’t do. Coalitions shouldn’t be in the business of running programs.
• Have realistic timeframes for the outcome. Start small and don’t try to conquer the world.
• Try to include everybody; people from all walks of life with different views and attitudes about asthma.
• Use a bottom-up coalition building model - start with local areas and build out. The participants should be the owners of the coalition and in order for them to be owners of the coalition they have to be actively involved with everything in that coalition.
• Organize action groups or committees around key goals.
• Identify co-conveners for each action group or subcommittee to share the work of the committee. The co-conveners are the linking pins to the other members of the action groups.
• Consider applying for funds to hire a coalition organizer.
• Organize so that a person who has asthma can have a stake in your coalition.
• Consider conducting an asthma summit to start the planning process and to garner input and support from various constituents. Use the summit to determine needs and strategies for addressing asthma in your area and then set up working groups to formalize the process.
• Develop a strategic plan through a steering committee, action plans through working groups, including development plans and marketing plans as appropriate.

What have coalitions learned about sustainability?

Results of the survey data, interviews, and presentation notes indicate that securing funding for coalition activities is a challenge for the majority of coalitions. As reported, annual budgets ranged from zero to $350,000 with the median budget being $9,000. It appears that the average development cycle for a coalition is 1 to 2 years of initial planning and organizing with the support and encouragement of a third party organization such as a hospital or the local Lung Association. The support is usually limited to providing office space and a phone line and it may include the provision of a part-time staff person. In the majority of cases, leadership is provided by an employee of the sponsoring organization in addition to or as part of ongoing job duties.

Coalitions that report success in launching an action plan have usually acquired small planning grants to cover the costs of an asthma summit or similar planning conferences. Data gathering costs are often covered by health departments and precede the development of projects based on the results of the data. It is apparent that letting the data serve as the basis for developing larger grants serves to focus the efforts of the coalition. A common mistake has been to go to a foundation for funding without any specific goals or projects in mind and without any data to support the need for the money.

Recommendations for acquiring funding and sustaining a coalition's work include:

• Look upon the grant writing process as an opportunity to further organize the coalition’s work, prioritizing goals and specifying funding needs.
• Look for opportunities to partner with other organizations for applying for funding of joint projects so that the coalition acts as a catalyst for the funding rather than a provider of services. Coalition programs should be demonstrations; they should have a lifetime; the coalition should not be scrambling after money forever to support them.
• Apply for operational grants to help offset costs of start-up and planning.
• Be aware of possible conflicts with competing member organizations in applying for money; if there is a conflict, see if there is an opportunity to collaborate.
• Divide a project into fundable pieces so the cost is not prohibitive to a single funder; for example duplication costs, hospitality costs, speaker costs, supplies/materials, etc.
• Be clear on the life of a program you are putting in a community. Will the program need to be taken on by another source after the initial funding period is over?
• Keep accurate data; if community benefit and significant cost savings can be demonstrated, additional funding for a program might be available.
• Work closely with potential funders, sharing plans, work done to date, and the specific program objectives; provide accurate and timely evaluation reports.
• Consider approaching alternative funding sources outside of specific health areas: for example, school-based grants, environmental grants, parent education, technology, housing, social services, etc.
• Research local funding sources such as community trusts for one time start-up or operational grants.
• Put together a development plan to identify funding goals and sources such as fund raising campaigns, educational events for bringing in funding and sponsorship.
• If a grant is not funded, ask for feedback on the proposal.
• Develop a strategic plan for institutionalizing programs or activities in member organizations.

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