Coalition Building and Community Activation: Key Elements of Quality Improvement

1
Coalition Building and Community Activation Key
Elements of Quality Improvement

• Shoshanna Sofaer, Dr.P.H.
• School of Public Affairs
• Baruch College

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Overview

• Whats a coalition?
• Whats community activation?
• Why a coalition?
• Why community activation?
• Key factors in building coalition effectiveness
  and community activation

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Definitions of Coalitions

• Definition 1 An unnatural act among
  nonconsenting adults
• Definition 2 A vehicle for structured,
  purposeful interaction among a set of
  organizations, groups and individuals

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Definitions of Community Activation

• Engaging those in the community with the most to
  gain from improvements in quality
• But what does community mean?
• Is the community defined by who participates in
  the coalition (i.e. the coalition becomes a
  community)
• Or do build your coalition on a sense of the
  community whose health and health care quality
  you want to improve?

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Why a coalition?

• To get things done that no one entity can do on
  their own
• Because the hard problems are complex the
  solutions are not self-evident and the wisdom of
  many is needed to find them
• Because it is a long journey and we will need
  support to stay the course

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Why a coalition?

• To mobilize and maximize power and influence
• To share responsibility/accountability
• To coordinate planning, strategy, action
• To pool resources and expertise and
• To minimize duplication of effort

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Why community activation?

• Because so many people and institutions are not
  aware of
• How much improvement can be achieved
• The benefits of improvement to themselves and
  others
• The critical role they must play for improvements
  to be achieved

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Why community activation?

• A key benefit of both coalitions and community
  activation is this
• If you build it with a coalition and with a
  community,
• They are a lot more likely to come!

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Key factors in coalition building and community
activation

• Membership getting the right people to the
  table, at the right time
• Engagement maximizing contributions and
  commitment
• Balancing dialogue and action

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Membership

• Coalition effectiveness and community activation
  both depend on having the right people at the
  table
• For QI this means involving not only medical
  experts but
• Decision-makers in key institutions
• Gatekeepers and Influentials in the
  populations you want to reach
• People who are both creative and flexible about
  interventions
• Trusted fair brokers to help keep the process
  open, honest and legitimate

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Getting the right people to the table

• Decision makers in key institutions
• Think through, strategically, which are the key
  institutions
• Some of these may be competitors you need them
  to participate in bounded collaboration
• Look for
• People who have the will and the capacity to make
  changes
• People who will always listen, if not agree

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Getting the right people to the table

• Gatekeepers and influentials -- this means
• Knowing your target groups/community who do
  they trust and who do they not always trust
• Who do different groups talk to about their
  concerns think out of the box and beyond the
  usual suspects Avoiding the people who are
  professional representatives of patients or
  the public
• Remember that the goal here is also to increase
  community capacity to understand and deal with
  health care quality in all its complexity

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Getting the right people to the table

• Creative and flexible programmers
• Good communicators
• Good motivators
• People who can work across disciplines
• People who can work with (not just on) the public

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Getting the right people to the table

• Fair brokers
• People who dont have apparent self-interest
• People who want to pursue win-win strategies
• People who are respected by all sides
• People who can voice how and why your goals are
  relevant to EVERYONE in the coalition

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Maximizing Contributions

• Giving people tasks they see as suitable to their
  position and expertise
• Giving everyone ample air time
• Making sure meetings belong to the coalition
  members, not to staff or the lead agency
• Recognizing contributions frequently

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Maximizing Contributions

• Using peoples time efficiently (read not wasting
  time)
• Having different levels of participation
  available
• Providing leadership opportunities to many
• Through task forces and committees
• Through public speaking engagements
• By rotating roles

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Maintaining Commitment

• Specifying and maintaining a clear and
  overarching vision
• Specifying short and mid term milestones that can
  be achieved and to which many if not all can
  contribute
• Permitting dissenting voices to be heard
• Celebrating the victories, small and large

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Maintaining Commitment

• Being prepared for the times when a person has to
  step back for a while
• Staying in touch, one on one, as often as
  possible (this does NOT have to be just one
  persons job!)
• Creating a group identity
• Using the identity regularly in all your
  communications

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Maintaining Commitment

• The bottom line making sure the benefits of
  participation exceed the costs
• This requires
• Testing the waters periodically, through formal
  or informal means
• GETTING THINGS DONE!

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Balancing Dialogue and Action

• Coalitions can take on a life of their own but
  they are a means to an end, not an end in
  themselves
• Dialogue among highly diverse actors is the
  raison detre of most coalitions
• Dialogue has to be supported, BUT

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Balancing Dialogue and Action

• If the group never finishes a discussion, makes a
  decision, takes an action, gets anything done
• All the dialogue in the world wont keep people
  from heading for the door!

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Balancing Dialogue and Action

• Leaders and members both have to
• Be vigilant to maintain the balance
• Stay focused on the essentials
• Communicate clearly and efficiently
• Find areas of consensus and move rapidly on those
  areas
• Keep working to build even greater consensus

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Balancing Dialogue and Action

• Key ingredients in balancing dialogue and action
• Clear, fair and understood procedures to set
  agendas and make decisions
• Continuous openness to new evidence and new kinds
  of evidence
• Recognition that the currency of any
  collaborative is in fact trust

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Balancing Dialogue and Action

• Other key ingredients
• Leadership that facilitates rather than controls
• Staff that work hard but not too hard
• Recognition that everyone in a coalition will
  make cost-benefit calculations that determine
  whether they will stay engaged
• A sense of humor!