1st Annual Crossing the Quality Chasm Summit: A Focus on Communities http://books.nap.edu/catalog/11085.html
1ST ANNUAL CROSSING THE QUALITY CHASM SUMMIT
Box ES-8. Community Coalition Building: Key Strategies
Determining who is going to be involved in the coalition
Getting people to agree on a common objective and determining how to measure whether this objective has been achieved
Community Coalition Building
Coalitions are organizational structures that integrate and support the work of multiple diverse stakeholders on a focused, shared goal. Input from participants prior to the summit revealed the desire for additional knowledge and skills in developing community engagement. In response, a session in this area was added to identify strategies that communities might use to establish and sustain a coalition, with particular attention to public– private partnerships and ways to gather the necessary human and financial resources. For the purposes of the summit, the aim of coalition building was identified as improving the quality and efficiency of care at the community level.
The first step in the process of activating a coalition is to ensure a proper balance among stakeholder groups—at both the community and organizational levels. Often this entails bringing together groups with competing interests. To minimize conflicts and avoid potential gridlock once the coalition has been assembled, it is critical to identify a common objective that supercedes differences in perspectives. Transparency regarding biases and conflicts of interest is paramount. Early on in the process, it is prudent to determine what issues are most important to each participant and then negotiate a workable solution that is sensitive to those concerns (Sofaer, 2003).
Once consensus has been reached around an actionable and manageable goal, the coalition must establish objectives and agree on how its impact on the community will be measured, both quantitatively and qualitatively. Care must be taken in selecting metrics that are meaningful to diverse members of the community and relevant to multiple stakeholder groups. Measurement has the dual purpose of documenting progress while also supporting a shared accountability that solidifies community cohesion and directs the rational use of coalition resources to areas of need. Documenting positive outcomes—and reasons for negative ones—helps coalitions acquire additional support and resources.
CONDITION-SPECIFIC ACTION PLANS
The cross-cutting sessions helped prepare summit participants for the condition-specific work that followed. The composition of the condition-specific working groups balanced local- and national-level stakeholder groups, individuals with proficiency in the cross-cutting areas, and nationally recognized experts in the chronic conditions represented. Before the summit, the participating communities completed substantial preparatory work to identify gaps in their current care programs as compared with “ideal” evidence-based care. As a result, it was possible to minimize the time spent reviewing past accomplishments and obstacles during the summit and to focus on shared learning and collaborative problem solving.
In identifying strategies most relevant to each priority condition, participants acknowledged that for these five conditions, health care disparities persist for minority/underserved populations within communities and that addressing this issue should be a high priority (IOM, 2002b). Several overlapping strategies were proposed across the condition-specific working groups, echoing the themes that emerged during the cross-cutting sessions.
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