The following definition of community coalition building was adopted by the working group and helped guide the ensuing discussions (IOM, 2002; Sofaer, 2003):
Coalition building aims to build an organizational structure that integrates and supports the work of multiple, diverse stakeholders—often at both the local and national levels—on a focused and shared goal, in this case improving care quality and efficiency at the community level. Such coalitions, sometimes referred to as partnerships or collaborations, may foster visibility and information exchange; serve as planners, coordinators, or implementers of joint activities; mobilize broader support for an initiative; or promote policy changes. Coalitions that span the public and private sectors have been encouraged.
Participants in the session on coalition building focused on three key strategies for developing and sustaining effective coalitions: (1) identify those who should to be involved in the coalition, (2) obtain agreement on a common objective, (3) determine how the achievement of this objective can be measured. At the summit, four community coalitions shared their strategies and lessons learned in engaging many diverse groups around a mutual goal: the Greater Flint Health Coalition (GFHC), the Mid-America Coalition on Health Care Community Initiative on Depression (MACHC), the Pediatric/Adult Asthma Coalition of New Jersey (PACNJ), and the Rochester Health Commission (RHC). The MACHC initiative is described in Box 4-1 in Chapter 4; the other three initiatives are described in this chapter.
The participants concurred that one of the most important steps in the process of activating a coalition is getting the right people to the table. In the recruitment phase of coalition building, care needs to be taken to ensure a proper balance among stakeholders—at both the community and organizational levels. Although there is no set number of people that should participate, emphasis should be placed on casting a wide net to ensure that multiple perspectives are represented and to harness a range of skills and resources (Sofaer, 2003). Often, this involves bringing together groups that have competing interests, which can prove challenging. RHC (see Box 7-1) illustrates the evolution of a coalition influenced by stakeholder relations.
Participants also discussed leadership within a community coalition and desirable characteristics for individuals assuming this role. They cautioned against either appointing a strong expert as a leader, who might limit dialogue, or relying solely on the energies of a charismatic leader, whose departure could result in the coalition’s demise. Rather, the notion of “servant leadership” was embraced—a facilitator who is capable of bringing together a group of people with varied agendas, slowly developing trust, and then building consensus on what must be done to achieve a mutually desired outcome (Greenleaf, 1983). It was also pointed out that this leader must be culturally competent, not only with regard to race and ethnicity, but also in balancing the strategies necessary for community organization at the grassroots level with those required to build interagency groups or business coalitions.