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RESOURCES - Leadership Guide

Section 10 - Building Coalitions to Effect Change

As stated earlier, one of the primary goals of the national outreach campaign is to support the creation of Remaking American Medicine (RAM) coalitions that focus on improving quality health care in America - community by community.

The primary rationale for the development of a coalition is to accomplish a goal that may reach beyond the capacity of any individual member or organization. This may range from information sharing to coordination of services, from community education to advocacy. Although coalition building has become a popular grassroots approach, the concept is not new. In 1840, Alexis de Tocqueville, the first noted international researcher on American society, remarked that "Americans are a peculiar people…If, in a local community, a citizen becomes aware of a human need that is not met; he thereupon discusses the situation with his neighbors. Suddenly a committee comes into existence…and begins to operate on behalf of the need. A new community function is established. It is like watching a miracle."1

We do not expect miracles, but we do expect results. RAM coalitions, which are forming across the country, will set goals, establish alliances, pool resources and take action. They will include representatives/members of the National Partners, PBS stations, and numerous other local organizations concerned about the quality of medical care in their community.

RAM coalitions are expected to:

  • Represent diverse interests and involve all of the major stakeholders.
  • Leverage the knowledge base and expertise of coalition members.
  • Select a quality-related issue that is of concern to their respective communities.
  • Underscore the importance of this issue with key target audiences.
  • Recommend and institute positive change.
  • Feature local Champions of Change.
  • Build upon "lessons learned".
    Empower all segments of the community.
  • Capitalize on the national promotional campaign surrounding the national broadcast of Remaking American Medicine.

Connect with Others

To become involved in a local RAM coalition, log on to and select Connect with Others. You can quickly locate coalitions by community or state as well as organizations that focus on quality issues related to home health care, technology-driven quality improvement, patient safety, chronic care, acute care and other topics. You can also search for health-quality organizations designed for specific audiences or review best practice examples of quality improvement from around the country.
As mentioned earlier, National Partners are actively encouraging their members, affiliates and constituents to become involved at the local level. We encourage you to log on to Partner Web sites to learn more about each organization and to help you identify potential coalition partners in your community, state or region.

Examples of some of the National Partners with community-based affiliates and individual members include:

The AARP, with more than 35 million members, has offices in all 50 states as does the American Heart Association, the American Stroke Association and the American Cancer Society. These organizations encourage individuals to connect with one another, geographically as well as through online "communities".

The Association for Community Health Improvement (ACHI), supported by the American Hospital Association's Health Research & Educational Trust, provides a unique peer networking and educational resource for those working in hospitals and health centers, public health and community organizations. The ACHI works with more than 28 state and regional community health organizations.

The American Nurses Association has more than 150,000 members and is at the forefront of policy initiatives pertaining to health care reform. The National Hispanic Medical Association represents 36,000 licensed Hispanic physicians and the National Medical Association is the largest and oldest national organization representing African-American physicians and their patients in the United States.


The mission of the American Hospital Association (AHA), which represents and serves all types of hospitals and health care networks, is to advance the health of individuals and communities nationwide. The AHA has more than 4,600
members. The National Association of Children's Hospitals and Related Institutions represents 181 children's hospitals, large pediatric units of
medical centers and related health systems throughout the United States. The National Association of Public Hospitals and Health Systems represents more than 100 hospitals and health systems in many of America's largest metropolitan areas.

Several National Partners focus on the business community. The National Business Group on Health (NBGH) is the only national nonprofit organization exclusively devoted to representing the perspective of large employers and providing practical solutions to its members' most important health care problems. NBGH's members provide health coverage for more than 45 million U.S. workers and retirees, and their families.

The Buyers Health Care Action Group is a coalition of public and private employers working to recreate the health care system so consumers will get the care they need in the right place, at the right time and at the right price. The National Business Coalition on Health is a national, nonprofit membership organization of employer-based health coalitions.

Coalition Organizational Tools

The Community Tool Box

As a companion to this Guide, we suggest you take advantage of The Community Tool Box, a comprehensive, free Internet-based service designed to assist in developing community actions that address a range of health issues. On this site, which can be accessed at, you will find scores of resources including guidelines, checklists, examples, and training materials. The Community Tool Box has more than 6,000 pages of detailed information related to coalition development and support.

Chapters that may be of particular interest include:

  • Create and maintain coalitions and partnerships
  • Assess community needs and resources
  • Analyze problems and goals
  • Develop strategic action plans
    Build leadership
  • Advocate for change
  • Evaluate the initiative

In addition, The Community Tool Box offers several ways to connect with others including links to online resources by category and core competency, a forum or chat room to create a "learning community" and expert advisors.

Developing Effective Coalitions: An Eight Step Guide

Developing Effective Coalitions: An Eight Step Guide is another excellent resource that provides clear direction on how to build an effective coalition. In addition to a clear definition of terms, the guide
provides useful principles for initiating and maintaining effective coalitions. It features eight very specific steps. It is anticipated that the particular details of how local coalitions are formed and maintained will be unique to each community.

The guide was originally developed at the Contra Costa County (California) Health Services Department Prevention Program to assist public health programs in developing effective community coalitions for injury prevention. The ideas presented in the guide are an outgrowth of a Special Project of Regional and National Significance (SPRANS) grant awarded to the Contra Costa 26 County Health Services Department by the U.S. Department of Health and Human Services Maternal and Child Health Division. It was edited and printed by the Children's Safety Network at the National Center
for Education in Maternal and Child Health. Developing Effective Coalitions can be accessed at under Publications.

The Collaboration Primer, produced by the Health Research & Educational Trust, in partnership with the American Hospital Association, provides a series of proven strategies and tools to implement effective collaborative efforts. It can be accessed on AHA's Web site or Just click on to HRET, Publications.

Community Care Notebook: A Practical Guide to Health Partnerships, also produced by the Health Research & Educational Trust, is a comprehensive how-to guide. It provides real-life examples and practices drawn from the National Community Care Network Program as well as useful tools, templates and other resources.

Tip: Every National Partner is committed to improving the quality of health care. For additional information, including contacts, please refer to Appendix A.

"It is critical that leadership from the private sector, both professional

and other health care leaders and consumer representatives, be involved

in all aspects of this effort."

-- Crossing the Quality Chasm:

A New Health System for the 21st Century
Institute of Medicine



































































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