building a coalition case study

Creating High-Impact Coalitions

CEOs can lead the charge on society’s biggest problems. by Rosabeth Moss Kanter and Tuna Cem Hayirli

Summary .   

Traditionally, responses to crises and societal problems—the Covid-19 pandemic, natural disasters, racial inequities—are considered the responsibility of the public sector and NGOs. But addressing the world’s most critical problems requires leadership, resources, and skills beyond those of any single organization, industry, sector, or government. What’s needed, the authors argue, is high-impact coalitions—an emerging organizational form that reaches across boundaries of business, governments, and NGOs.

Although public-private partnerships have existed for some time in various forms, large cross-sector, multistakeholder initiatives are newly resurgent and not yet widely understood. They are more voluntary and relationship-based than formal organizations but more task-directed than networks. They connect otherwise disparate spheres of activity that bear on big problems by aligning powerful actors behind a purpose-driven mission. Once underway, they can harness and utilize capabilities quickly and flexibly.

This article describes the features of high-impact coalitions and sets out five principles that make the difference between success and failure.

If you ask CEOs what keeps them up at night, you find that their worries go well beyond staying ahead of the competition. Increasingly they worry about big systemic challenges and what they can do to help fix them. That’s because they’re keenly aware of people’s expectations: A high proportion of stakeholders—86% on the 2021 Edelman Trust Barometer—believe that business executives must play a lead role in tackling societal issues.

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• Section 5. Coalition Building I: Starting a Coalition

Chapter 5 Sections

• Section 1. Strategies for Community Change and Improvement: An Overview
• Section 2. Community (Locality) Development
• Section 3. Social Planning and Policy Change
• Section 4. Social Action
• Section 6. Coalition Building II: Maintaining a Coalition

• Main Section

Often, community problems or issues are too large and complex for any one agency or organization to tackle. In these cirumstances, putting together a coalition of groups and individuals can be an effective strategy for changing the programs and policies - in schools, business, government, and other relevant sectors - that are needed to solve the problem or achieve the goal. This section discusses what a community coalition or partnership is, why and when it can be a good strategy, who should be included, and how to implement it.

What is a coalition?

In simplest terms, a coalition is a group of individuals and/or organizations with a common interest who agree to work together toward a common goal. That goal could be as narrow as obtaining funding for a specific intervention, or as broad as trying to improve permanently the overall quality of life for most people in the community. By the same token, the individuals and organizations involved might be drawn from a narrow area of interest, or might include representatives of nearly every segment of the community, depending upon the breadth of the issue.

Coalitions may be loose associations in which members work for a short time to achieve a specific goal, and then disband. They may also become organizations in themselves, with governing bodies, particular community responsibilities, funding, and permanence. They may draw from a community, a region, a state, or even the nation as a whole (the National Coalition to Ban Handguns, for instance). Regardless of their size and structure, they exist to create and/or support efforts to reach a particular set of goals.

Coalition goals are as varied as coalitions themselves, but often contain elements of one or more of the following:

• Influencing or developing public policy, usually around a specific issue.
• Changing people's behavior (reducing smoking or drug use, for instance).
• Building a healthy community. This term generally refers both to the community 's physical health (which may include not only medical and preventive or wellness services, but the environment, community planning, housing, hunger, substance use, and other factors) and its social and psychological health (encompassing diversity, education, culture and the arts, violence prevention, youth development, employment, economic development, mental health and other human services, etc.).

In November of 1986, at an international conference on health promotion co-sponsored by the Canadian Public Health Association, Health and Welfare Canada, and the World Health Organization, participants drafted what has become known as the Ottawa Charter. This document set out guidelines for attaining healthy communities and a healthy society, and laid the groundwork for the Healthy Communities movement. Perhaps its most important statement is encapsulated in these two sentences: "The fundamental conditions and resources for health are: peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity. Improvement in health requires a secure foundation in these basic prerequisites."

Why start a coalition (and why might it be difficult)?

There are a number of reasons why developing a coalition might be a good idea. In general terms, it can concentrate the community's focus on a particular problem, create alliances among those who might not normally work together, and keep the community's approach to issues consistent.

Consistency can be particularly important in addressing a community issue, especially if there are already a number of organizations or individuals working on it. If their approaches all differ significantly, and they're not cooperating or collaborating, it can lead to a chaotic situation where very little is accomplished. If, on the other hand, they can work together and agree on a common way to deal with the issue and on common goals, they're much more likely to make headway.

Some more specific reasons for forming a coalition might include:

• To address an urgent situation. The youth violence example that introduces this section is a good illustration of this reason.
• To empower elements of the community - or the community as a whole - to take control of its future. This may mean addressing the place of youth in the community, for instance, or looking at economic development in light of globalization and community resources.
• To actually obtain or provide services. It may take a coalition - either initially or over the long term - to design, obtain funding for, and/or run a needed intervention in the community.
• To bring about more effective and efficient delivery of programs and eliminate any unnecessary duplication of effort. Gathering all the players involved in a particular issue can result in a more cohesive and comprehensive intervention. Rather than duplicating their efforts, organizations can split up or coordinate responsibilities in ways that afford more participants access to programs and allow for a greater variety of services.

When discussing duplication of effort, "unnecessary" is a key word. In most instances, a number of organizations providing similar services, or services to the same population, are addressing a need greater than even all of them together can meet. The important thing here is to explore whether a unified approach can in some way increase or improve the services currently available.

• To pool resources. A number of organizations and individuals together may have the resources to accomplish a task that none of them could have done singly. In general, people and organizations join coalitions to do just that - accomplish together what they cannot alone.
• To increase communication among groups and break down stereotypes. Bringing together groups and individuals from many sectors of the community can create alliances where there was little contact before. Working together toward common goals can help people break down barriers and preconceptions, and learn to trust one another.
• To revitalize the sagging energies of members of groups who are trying to do too much alone. A coalition can help to bolster efforts around an issue. For people who've worked too long in a vacuum, the addition of other hands to the task can be a tremendous source of new energy and hope.
• To plan and launch community-wide initiatives on a variety of issues. In addition to addressing immediately pressing issues or promoting or providing services, coalitions can serve to unify efforts around long-term campaigns in such areas as smoking cessation, community economic development, or environmental preservation.
• To develop and use political clout to gain services or other benefits for the community. A unified community coalition can advocate for the area more effectively than a number of disparate groups and individuals working alone. In addition, a wide -ranging coalition can bring to bear political pressure from all sectors of the community, and wield a large amount of political power.
• To create long-term, permanent social change. Real change usually takes place over a period of time through people gaining trust, sharing ideas, and getting beyond their preconceptions to the real issues underlying community needs. A coalition, with its structure of cooperation among diverse groups and individuals and its problem-solving focus, can ease and sometimes accelerate the process of change in a community.

Barriers to starting a coalition

There are often barriers to starting a coalition, and it's important to be aware of and anticipate them, because they may dictate the process the coalition will have to follow in order to begin successfully. Among the most likely:

• Turf issues. Organizations are often very sensitive about sharing their work, their target populations, and especially their funding. Part of the work of starting a coalition may be to convince a number of organizations that working together will in fact both benefit all of them and better address their common issues.
• Bad history. Organizations, individuals, or the community as a whole may have had experiences in the past that have convinced them that working with certain others - or working together at all - is simply not possible. A new coalition may have to contend with this history before it can actually start the work it needs to do.
• Domination by "professionals" or some other elite. All too often, agency people with advanced degrees, local politicians, business leaders, and others, in their rush to solve problems or to "help the disadvantaged," neglect to involve the people most affected by the issue at hand and other community members. Creating a participatory atmosphere and reining in those who believe they have all the answers is almost always part of starting a coalition.

Part of a solution here may often be providing support for those who aren't used to the "professional" way of holding meetings and reaching conclusions, while at the same time training professionals and others to include those whose opinions are likely to be far more accurate and important to the solving of the problem than their own. This might mean bringing in an outside facilitator, or simply paying careful attention to guiding the process from within the group.

• Poor links to the community. A first step may have to be the development of hitherto nonexistent relationships among agencies and the community at large.
• Minimal organizational capacity. It might be necessary to find a coordinator, or for one or more individuals or organizations to find a way to share the burden of organization for the new group if it is to develop beyond - or as far as - a first meeting.
• Funding. The difficulty of finding funding is an obvious obstacle. Less obvious are the dangers of available funding that pushes the coalition in the wrong direction or requires it to act too quickly to address the issue effectively. New coalitions have to be alert to funding possibilities from all quarters, and also have to be vigilant about the kind of funding they apply for and accept.
• Failure to provide and create leadership within the coalition. Coalitions demand a very special kind of collaborative leadership. If that leadership isn't available and can't be developed from within the coalition, its existence is probably at risk. It may be necessary to bring in an outside facilitator and/or training in collaborative leadership to salvage the situation.
• The perceived - or actual - costs of working together outweigh the benefits for many coalition members. The task here may be to find ways to increase benefits and decrease costs for the individuals and organizations for whom this is the case if the coalition is to survive.

If you understand the potential barriers to forming a coalition in your community, you can plan for them, and increase your chances of success.

When should you develop a coalition?

A coalition needs to have a purpose if it is to be successful. As discussed above, the purpose may be broad or narrow, but it's unlikely that a diverse group will come together unless there's a reason to do so. At particular times, circumstances help to move the formation of coalitions.

When dramatic or disturbing events occur in a community.  In a town of 6,000 in western Massachusetts, four women were murdered by their domestic partners in a space of less than a year. These murders spurred the formation of a coalition to address not only domestic violence, but the whole issue of violence against women, and such related problems in the community as drug dealing and the lack of responsiveness of the courts.

The events leading to the formation of a coalition don't necessarily have to be local. In the wake of the destruction of the World Trade Center on September 11, 2001, many communities formed local coalitions to contend with such issues as intolerance toward Muslims and the psychological effects of the disaster on children and families.

When new information becomes available . The latest unemployment figures may show that the community's jobless rate is rising rapidly, motivating the formation of a coalition to deal with economic development. A new study may alert a community to the fact that Black males - a significant part of its population - are at very high risk for heart disease, and community health providers may respond to that risk with the formation of a coalition to provide information, testing, and treatment to that population.

When circumstances or the rules change.  After the state passed welfare reform legislation, an already economically depressed rural county found itself faced with the prospect of finding permanent jobs for a large number of welfare recipients within the next two years. As a result, the local welfare office, the local branch of the state employment agency, and several other agencies that worked with welfare recipients and their families formed a coalition to try to deal with the situation.

When new funding becomes available.  A new Request For Proposals (RFP) from a state agency or other source of funding may either require a coalition to obtain funding for a particular service, or a coalition may form in order to create a comprehensive proposal that would spread the funding as widely as possible throughout the community.

An anti-poverty agency in Hampshire County, Massachusetts, took the lead in establishing a coalition of educators, health professionals, child care and human service providers, and parents to act as the required community oversight committee for a Department of Education grant that offered services to the families of children aged three and under. The group planned the grant proposal, and then continued to act as the advisory group for the administration of the funds after the proposal was successful. The members of the coalition also used it to refine and improve their cooperation and collaboration with one another in all their work, resulting, over the long term, in better services across the board in the county.

When there's an outside threat to the community. Communities have formed coalitions, for instance, to prevent their local hospitals from being purchased by national, for-profit health providers; to keep out unwanted, pollution-causing industry; and to preserve open space from development.

When a group wishes to create broad, significant community change. Sometimes a problem or issue is so complex and deeply-rooted that only major changes in the way the community views things, or even in its social fabric, can have any effect. In that situation - again, the Pryorville youth violence problem is an example - a broad coalition is necessary to draw in all affected elements of the community, and to approach the problem on a number of different levels.

A coalition for social change can be a different proposition from one dedicated to much narrower or shorter-term goals. For one thing, social change takes time - years, or even decades, not months. Coalition members have to make a commitment for the long run, and they -or their organizations, as individuals come and go - have to honor that commitment. A second point is that a social change coalition has to be held together by a coherent, shared vision. Such a vision is usually not possible without a group process that can articulate the vision and help others see it as a reachable goal. Third, social change coalitions often have to settle for small gains that add up only over time. Members must be able to be satisfied with small victories and to weather the inevitable setbacks that sometimes cancel those victories out. Taking the long view is as important to successful social change as making a long-term commitment.

When you have not only a good reason for starting a coalition, but also the possibility that one can be started successfully in the community. This is an extremely important issue, one that is dependent upon a number of factors:

• Is the issue or problem clear enough that everyone can agree on what it is? If there's no agreement that it is an issue, it's unlikely that you'll be able to form a coalition around it. It needs to be clearly defined, even if the solution is not.
• Is there at least some level of trust among the individuals and organizations who'd make up the coalition? Community history, or the history of particular organizations, may present what seem to be insurmountable barriers to the formation of a coalition. Community divisions along racial, ethnic, class, religious, or political lines; old feuds; turf battles among agencies; or past failed coalition efforts may mean that a great deal of groundwork has to be done before the community is willing to consider the possibility of a coalition. It may take a long time to build up trust to that point.

Even if there is enough trust to start a coalition, be aware that it is not only possible, but just about inevitable that there will be bad feeling among some groups or individuals. That's a reality in any community, and the coalition will probably have to face it. In many cases, working together toward a common purpose can do a lot to change attitudes and to smooth over the past...but in other cases, it won't make any difference at all, and old enmities will surface.

• Can the issue be better addressed if all concerned parties are working together, and will a coalition help to accomplish that purpose?
• Will a coalition increase the likelihood that all the factors impinging on the issue are identified and attended to?
• Will a coalition increase the coherence, strength, and effectiveness of the community's response to the issue?
• If the community already has a number of coalitions, is yet another the best response to this issue?

A coalition will only be formed when it can be.

Who should be part of a coalition?

In general, the broader the membership of any coalition, the better, but there are certain people and groups whose representation on a coalition is absolutely essential.

Stakeholders.

These are the people who have a stake in the success of the coalition's efforts. They can include:

• Those most affected by the issue. These may comprise current or potential participants in programs, people who lack such basic amenities as health insurance or decent housing, sufferers from particular diseases, or - in the case, for instance, of many environmental and public health issues - the community as a whole. It makes no sense, and is patently unfair, to make decisions that affect people's lives without including them in the process.
• Formal and informal helpers, those charged with carrying out community functions related to the issue, and others affected by what the coalition might do. The staffs of health and human service providers or other organizations and community agencies, police, school personnel, the probation and court system, local employers, landowners - some or all of these and/or many others may be directly or indirectly involved in the results of coalition initiatives.

Community opinion leaders.

It's extremely useful to save seats at the table for those who can influence large numbers of others. Clergy, business or civic leaders, or people who are simply highly credible in the community may fall into this group.

Involving emerging leaders is equally important. These are people, often without a particular position, whom others look to for guidance. They may be leaders of volunteer efforts, youth highly respected by their peers, active parents, or just those with clear leadership potential. They are important to have on board, both for their ideas and energy, and for the influence they wield and will wield as they become more widely known and respected in the community.

Policy makers.

The participation of local political leaders, state representatives, and others in policy-making positions will both add credibility to your enterprise and increase the chances that you can actually influence policy in your area of interest.

In addition to these specific groups, virtually any coalition can benefit from the membership of at least some concerned citizens who may have no direct connection to the issue at hand. Such people can both act as barometers of the attitudes of the community at large, and can bring information back to the community that helps to explain the work of the coalition and give it a higher profile. Another group that you might want to involve, but in a slightly different way, is the media. Rather than trying to get media members to join, you might want to contact them to publicize and cover your coalition and its efforts. If they join, there may be ethical limitations on the amount of coverage they can give you.

How do you start a community coalition?

So...you've decided a coalition is indeed the way to go in your community. How do you actually go about starting one?

Put together a core group.

You're probably already not alone in your concerns about the issue at hand, and you may already have a core group - a few individuals or organizations - ready to work at forming a coalition. If not, your first step is to find and make contact with those few individuals and organizations most involved with the issue.

Some reasons why a core group, rather than an individual, should lead the effort:

• A core group will have more contacts and more knowledge of the community than a single individual.
• It will give the idea of a coalition more standing among potential members.
• It will make finding and reaching potential members a much faster process.
• A core group will make the task easier on all the individuals involved, and therefore more likely to get done.
• It shows that the effort has wide support.

There are a few ways to approach assembling a core group :

• Start with people you know. If you're a longtime activist on this issue, or if you've been living or working in your community for a while, you have lots of contacts, particularly among others concerned with the same things you are. Use those contacts now, either to pull them into the circle, or to get the names of others who might be part of a core group. Someone who knows you - assuming you have a positive relationship - is usually more easily persuaded than someone who doesn't.
• Contact people in agencies and institutions most affected by the issue. Pryorville Youth Services, in its drive to start a coalition on youth violence, went to both the Chief of Police and the Superintendent of Schools for support. As a result, a Community Affairs officer and an Assistant Superintendent both became part of the core group that set out to put the coalition together.
• Talk to influential people, or people with lots of contacts. These may be business or civic leaders, ordinary citizens with high credibility, or people like the United Way director, whose job it is to know nearly everyone.

Try to recruit to the core group some members of the group most affected by and concerned with the problem. A youth violence coalition should look for teens - perhaps gang members - to be core group members; a homeless and housing coalition should try to recruit current or former homeless people. Incorporating such people into the core group will give you a built-in reality check, provide a link to the group they represent, add credibility to your effort, and make clear your commitment to a participatory process.

Identify the most important potential coalition members.

Especially if your coalition has a narrow and time-limited purpose, there are probably people or organizations you can't do without. It's important to identify them, and to target them specifically for membership. This may mean courting them - an initial meeting over lunch where you pick up the tab, for instance, or a promise of a place on the steering committee.

Most of these individuals and organizations are referred to in "Who should be part of a coalition?" above, but each community is different. In yours, there may be a specific person among the target population, or a particular town official, without whom nothing can get done. The chances are you - and if not you, then other members of the core group - know this person, or at least know who she is, and have some connection to her.

As mentioned earlier, none of this is to say that you shouldn't recruit many other people and organizations to your coalition as well. It simply means that you need to make a special effort to enlist these crucial members.

Recruit members to the coalition.

Now that your core group is in place, and you've decided on the potential members who are necessary to the success of the coalition, you can start recruiting members. Although it's important to start with the individuals and groups mentioned above, you'll probably want to be as inclusive as possible. It's unusual to hear about a coalition suffering because it has too many members.

Use the networking capacity of your core group to the fullest. The core group can brainstorm a list of possible members, in addition to those deemed essential. Then each member can identify individuals on the list whom he knows personally, or organizations where he has a personal contact. If there are names left on the list without a contact, they can be divided among the members of the core group.

There are, obviously, a number of ways to contact people and organizations, including:

• Face-to-face meetings
• Phone calls
• Personal letters
• Mass mailings
• Public Service Announcements or ads in the media
• Flyers and posters

These are listed here in their approximate order of effectiveness, with direct personal contact being the best. It also takes longest, however, and probably should be reserved for those "must-haves" we discussed earlier. Most people are likely to be recruited by phone.

Be sure to ask those you talk to for suggestions about other potential members, and try to have them make the contact. That will spread out the work, and also give the invitation more credibility, since it comes from someone the contacted person knows. If you are successful, you could end up contacting and recruiting several times the number of people and organizations on your original list.

When you contact people to recruit them to the coalition, make sure you have something substantive to offer or to ask them to do. An invitation to a first meeting - at a specific time and place far enough in the future that schedules can be arranged to fit it in - is perhaps the most common offer, but you could also, for instance, ask people to contact their state representative or to work with a small group. An appeal to join without something specific attached to it will often fall on deaf ears. People's time is valuable, and they want to know that it won't be wasted.

Plan and hold a first meeting.

The first meeting of a coalition is important. If it's a high-energy, optimistic gathering that gets people excited, you're off to a good start. If it's depressed and negative, or just boring, it's a good bet that a lot of people won't come back. It's up to the core group - in what may be the last official task they undertake - to plan a meeting that will start the coalition off on the right foot.

There are really two concerns here: the logistics of the meeting (where, when, how long, etc.) and the content of it.

There are a number of possibilities for the content of the first meeting. The agenda should depend on your particular issue and purposes, and on the needs of your community, but you'll probably want to include some of the following:

• Introductions all around. Everyone present should give a brief statement of who they are, the organization, if any, they're connected with, and the nature of their interest in the issue.
• Start defining the issue or problem around which the coalition has come together. This might mean the group coming up with an actual statement, or it might entail an initial discussion, followed by a small group being asked to draft a possible definition for the next meeting.
• Discuss the structure of the coalition. What kind of group will it be, how (if at all) will it be run, what kinds of things will it actually do? Is hiring staff a reasonable goal, either currently or eventually?
• At least start the process of creating a common vision and agreeing on shared values about the direction of the coalition. This is the first step toward developing the vision and mission statements that will define the coalition and guide its work.
• Discuss a procedure for forming an action plan. Again, this may result in an actual, or at least a preliminary, plan, or it may lead either to the appointment of a smaller group to draft a plan, or to the establishment of a procedure by which the larger group will generate a plan over a set period of time.
• Review the things to be done before the next meeting, and who has agreed to do them. As mentioned above, it's important that people leave the first meeting feeling that something has been accomplished. If there are tasks being worked on, and specific results expected at the next meeting - even if those results are simply statements or preliminary plans to react to - coalition members will have that feeling.
• Schedule at least the next meeting. It may be possible to develop a regular meeting schedule at this first meeting, or it may make more sense to schedule only the next meeting and wait until the membership stabilizes and some other people join before creating a long-term schedule.

Follow up on the first meeting.

You've held a successful first meeting - terrific! The job of building a coalition has only begun, however. First, you have to follow up to make sure that there will be a well-attended second meeting at which work can continue.

The list that follows is one for whoever is actually putting the coalition together. That may be an individual, a core group, a staffer, or even a new coalition governing body of some sort. Whoever it is, someone has to be responsible for keeping an eye on the larger picture and making sure that the jobs get done. Without some level of coordination from somewhere, it's very unlikely that a coalition will survive and succeed.

• Distribute the minutes of the first meeting and reminders about the next meeting to those who attended, and send them out with invitations to potential new members as well. Try to widen your net as much as possible. Get to the folks you missed the first time, or to those whose names you've gotten from people who attended the first meeting.
• Follow up on the groups or individuals who are working on tasks assigned at the first meeting. Offer help, attend meetings, try to involve other people with relevant skills or knowledge - do everything you can to make sure those tasks get accomplished.
• If there are committees or task forces forming, try to recruit new members for them. The real work of the coalition will probably be done in these small groups, so it's important that they have the right members. If you know people with expertise that could be used in particular ways, grab them. Most people will respond if they're asked, especially if they're asked because you value what they bring to the task.
• Keep looking for new coalition members.
• Keep track of the fundamental building blocks of the coalition that aren't in place yet.  If the group hasn't yet decided on a structure or a coordinating body, you need to make sure that the decision doesn't get pushed aside, but that it's either in the works or being actively considered. If there's no action on an action plan, you need to provide the push to get it going.

Next steps.

There are a number of specific things - some of which you 've already started in that first meeting - that need to be done to make sure that the coalition keeps moving forward.

• Gather information. In order to plan for action, you need as much information about the problem or issue - and about the community - as possible. Many organizations, particularly those most involved with the issue at hand, are likely to have statistics or other info on hand. The U.S. Census can be a good source of demographic information, as can local colleges or universities and local government departments. The more information you can gather, the easier it becomes to define the problem, to know if you're addressing something that's actually a major community issue, and to plan a strategy that will address it effectively.
• Finish creating vision and mission statements. These can be hashed out in a small group after everyone has had input in a larger meeting, or you can actually try to generate them in the larger group itself (perhaps by splitting people up into smaller groups, then coming back together to reconcile differences). It's important that there be agreement on the wording and intent of these statements, because they will be the foundation of the coalition, referred to again and again over time as the group tries to decide whether to tackle particular issues. Everyone has to feel ownership of them if the coalition is to develop an identity.
• Complete an action plan. The coalition's action plan is, obviously, intertwined with both its structure and its vision and mission. In practice, coalitions often start with a sense of what they need to do, and their structures, visions, and missions grow from that.
• Finish the work of designing a structure for the coalition. Again, this has to be a shared task, with everyone having a chance to contribute ideas. There is such a broad range of possibilities here - from practically no governance to a very clear, formal hierarchy - that it's crucial that the group come up with a form that everyone can live with. Once a structure has been agreed upon, there may still be the need for writing bylaws and otherwise formalizing it.

The author has been a member of several coalitions. One was governed by a formal Board of Directors, with officers and an Executive Committee that included the officers and committee chairs. Another was essentially run by a paid director, with a good deal of input from coalition members, but only nominal oversight. A third was coordinated by a steering committee whose membership was open to any member of the coalition. All of these coalitions worked reasonably well, accomplishing their goals largely through committees or task forces. The first and third began without professional staff, and became successful enough that they were able to obtain funding for full -time directors. What all these coalitions had in common were strong leadership and a clear sense of where they were going at any given time. (The goals and purposes of all of them changed from time to time, in response to external conditions and the needs of their members and communities.) The need for strong leadership - whether individual or collaborative - cannot be overstressed. The ideal, in many ways, is to have the leadership dispersed throughout the coalition so that the departure of an individual doesn't create a vacuum. But however it's distributed, leadership is the one thing a coalition can't do without.

• Elect officers, or a coordinating or steering committee. Once there's agreement about the structure of the coalition, it's time for members to decide whether they want some sort of governing body, and to choose it so that the work of the coalition can go ahead.
• Examine the need for professional staff. Depending on the scope of its work plan, a coalition may feel that it needs professional staff - at least a coordinator - to be effective. If it has the resources, a community coalition may be able to hire a full- or part-time coordinator . Or it may see the need for one and set out to find the resources. In addition to direct grants to the coalition, one or more member organizations may be able to provide funding, or employers or other elements of the community may be willing to fund all or part of a coordinator's salary if the work of the coalition is relevant to their concerns.
• Determine what other resources - financial, material, informational, etc. - you need, develop a plan for getting them, and decide who's going to be responsible for carrying it out. If you already have funding for a paid staff person, finding resources may be one of her primary responsibilities...or it may not. A committee of the coalition may have that responsibility, or someone may simply take it on. Part of creating a strategic plan that encompasses your vision, mission, and action plan is looking at the resources you'll need to reach your goals and planning for obtaining those resources. Man may not live by bread alone, but it sure helps when he's trying to make a peanut butter sandwich.
• Start the hard work of maintaining the coalition over time. Once your coalition is a going concern, it still needs care and feeding. After it's been around for a while and had some success, people may start to take it for granted, or the original members may start to burn out or to get stale. Careful maintenance for the long term is an extremely important task.

General guidelines for getting a coalition off the ground.

In addition to the specifics above, there are some more general elements to starting a coalition:

• Communicate, communicate, communicate. Make sure that lines of communication within the coalition and among the coalition, the media, and the community are wide open. Open communication will assure that no one feels left out of the loop, and that everyone has the information necessary to make coalition efforts successful. Good communication with the media and the community will increase your chances for publicity and support when you need them.
• Be as inclusive and participatory as you can. Work at making the coalition a group in which anyone in the community will feel welcome, and continue to invite people to join after the first meeting. Try to involve everyone in the coalition in generating vision and mission statements, planning, and major decisions. The more people feel ownership of the coalition itself, the harder they'll be willing to work to achieve its goals, and the less likely they'll be to allow turf issues or minor conflicts to get in the way of the coalition's progress.
• Network like crazy. Try to involve, or at least to keep informed, as many other groups in the community as possible. Let them know what you're doing, invite them to coalition meetings (to make presentations, if appropriate, or just to see what's going on), invite them to join if they're interested, educate them about the issue. If groups in the community are informed about your work, they're more likely to be supportive, and to tell others about what you're doing as well. They may also have better connections to policy makers than you have, and may be able to help you approach them.
• Try, at least at the beginning, to set concrete, reachable goals. Success is great glue - achieving reachable goals early can help a coalition develop the strength to later spend the years it may take to pursue and achieve long-term goals.
• Be creative about meetings. Community activists and health and human service workers often feel that they spend their whole lives in meetings. If each coalition meeting can be different, and have some elements of fun to it, you'll be much more likely to retain both membership and interest in the coalition. Some possibilities include rotating the responsibility for meetings among the groups comprising the coalition; having only a small number of meetings a year, each with a particular theme, and doing most of the work of the coalition in committees or task forces; or regularly bringing in exciting presentations on the issue or in areas that relate to it.
• Be realistic, and keep your promises. If you're not sure you can do it, don't say you will. If you say you will, be sure you do.
• Acknowledge diversity among your members, and among their ideas and beliefs. Your coalition will probably mirror the cultural, economic, racial, ethnic, and religious diversity of your community, and will certainly represent a diversity of opinion. Not everyone will agree with everything the coalition does or wants to do, and sometimes the minority opinion will be right. Make sure to take everyone's opinion and restraints into account, and to use diversity as a spur to discussion, rather than a source of division.

By the same token, it's important that there be a mechanism for getting things done when there is a disagreement, whether it's a majority vote or something else. A long -term disagreement over strategy or tactics can hang up a coalition permanently, and make it totally ineffective.

• Praise and reward outstanding contributions and celebrate your successes. In addition to success itself, the celebration of success is a great way to cement the bonds among members of a coalition. Whether through individual or group awards, or through parties or other events, celebration of achievement will help your coalition thrive, and will give you a much-needed opportunity to remember that there's a reason you're doing all this.

In situations where issues are too large and complex for a single organization to address, a coalition of groups and individuals working together may be the solution. A coalition can develop a coordinated response to an issue, increase the efficiency of service delivery, pool community resources, create and launch community-wide initiatives, build and wield political clout to influence policy, and work effectively toward long-term social change.

Coalitions may form in response to:

• Significant or disturbing community events
• New information
• Changes in circumstances or regulations
• The availability of funding
• An outside threat to the community
• The need to create significant change in the community

Whatever the reason, coalitions can only form when the possibility - in the form of mutual trust and a perceived need - exists. They should encompass all stakeholders - those affected by the work of the coalition and by the issue it addresses - as well as community opinion leaders, policy makers, and community members at large.

To start a coalition, it's best to begin with a core group and work outward, pulling in the necessary members mentioned above, as well as a more general membership from the community and from other, more peripherally-involved organizations. Holding an exciting first meeting at which there are real accomplishments and/or the work of the coalition is set in motion will help to launch the enterprise successfully.

Even more important is following up before the second meeting to make sure that groups are doing the work they said they would do, that attendance won't fall off, and that new members will be added. Areas that must be addressed are

• An agreed-upon definition of the issue or problem the coalition is addressing
• The creation of vision and mission statements
• The development of an action plan
• The design of a structure for the coalition
• The need for professional staff

Finally, you have to continue to pay attention to some general rules for forming and running a coalition:

• Communicate openly and freely with everyone.
• Be inclusive and participatory
• Network at every opportunity
• Set reachable goals, in order to engender success
• Hold creative meetings
• Be realistic about what you can do: don't promise more than you can accomplish, and always keep your promises
• Acknowledge and use the diversity of the group

A coalition can be a powerful force for positive change in a community. If you can form one that lasts and addresses the issues it was meant to, you've done a major piece of community building work.

Online Resources

5-part series of coalition guides describes 5 stages of coalition development: pre-formation, formation, implementation, maintenance and institutionalization. Each guide describes what to expect, structure and overall strategy, tasks and products/outcomes.

Chapter 15: Community Organizing, Partnerships, and Coalitions in the "Introduction to Community Psychology" describes how and why communities organize, bottom-up and top-down approaches to community organizing, and the cycle of organizing.

Coalition Building  is a brief outline by Skipp Porteous, aimed specifically at forming coalitions to oppose the Religious Right.

Coalition Building . A brief but useful coalition-building outline from the Gay Straight Alliance.

The Coalition Effectiveness Inventory (CEI) is a diagnostic checklist for coalition staff and key leaders to assess coalition effectiveness.

Coalition Leadership by Tom Wolff offers a series of tips on building coalitions.

Community Partners, Inc ., a Massachusetts-based coalition-building organization. Links and publications.

Consultation on Coalition Building & Collaborative Solutions: A Practitioner’s View is a YouTube video of an SCRA webinar pressentation conducted by Dr. Tom Wolff.

Enhancing Effective Partnerships for Health Equity  from the Prevention Institute explores the power of partnerships for improving equity. It introduces the Eight Steps to Coalition Building, which can be used to develop a successful collaborative health equity effort.

A Guide to Coalition Building , by Janice Forsythe, is a paper on forming advocacy coalitions.

How Can We Build Partnerships that Perform - In this video from the Saigh Symposium: The Path to Powerful Partnerships, Pennie Foster-Fishman describes the complexity of community problems, and how we can more effectively address problems by understanding and addressing root causes.

Independent Sector  provides an excellent example of creating partnerships - it is a national coalition of foundations, corporate giving programs, and nonprofit organizations that joined together to strengthen the nonprofit sector. It sponsors initiatives and highlights research and policy news related to advancing the public good.

Is a Coalition Right for You? prompts 12 “yes” or “no” questions to determine if forming a coalition is the best option.

Home page of the National Coalition Building Institute .

A series of fact sheets on coalitions and coalition building from Ohio State University.

Office of Partnerships and Grant Services offers guidance on creating partnerships for grant purposes, with links to other materials on evaluating and improving collaborations.

Pan-Asian Coalition Building . An interesting essay pointing up the unresolved difficulties of a particular attempt at coalition.

Project Report - Community Coalitions in Action - the research report includes examples of collaborative efforts in Michigan to address the needs of children and youth in the late 1980s and early 1990s.

The County Health Rankings & Roadmaps Take Action Cycle, especially  Work Together , provides tips on how to engage diverse stakeholders from all sectors, and work with others to establish a coalition to address common goals.

Working Upstream: Skills for Social Change  - a resource guide for developing a course on advocacy for public health.

Print Resources

Coalition Building: One path to Empowered Communities .

Coalition Building: Is This Really Empowerment?

Kaye, G., & Wolf. T. eds.  From The Ground Up: A Workbook on Coalition Building and Community Development .

Wolf, T., & Foster. D.  Building Coalitions That Work: Lessons From the Field .

Wolff, T.  Coalition Tip Sheets .

Wolff, T., & Berkowitz Bill. (2000).  The Spirit of the Coalition . American Public Health Association.

All of the Print Resources are available for   Tom Wolff & Associates

• Developing Effective Coalitions: An Eight Step Guide

The Eight Steps to Effective Coalition Building is a framework for engaging individuals, organizations and governmental partners in addressing community concerns. The complete document offers concrete steps towards building effective partnerships, and provides tips for making collaborations and partnerships work. Rather than creating new projects or programs, effective coalitions can harness existing resources to develop a unique community approach and achieve results beyond the  scope of one single institution or organization.

Increasingly, the problems that communities need to resolve are complex, requiring comprehensive solutions. Addressing issues like health promotion and chronic disease prevention requires the inclusion of people from diverse backgrounds and disciplines. Working in partnerships, collaborations, and coalitions can be challenging-- but these can be powerful tools for mobilizing individuals to action, bringing community issues to prominence, and developing policies. In addition, these associations are an effective means of integrating health services with other human services, so that resources are not wasted and efforts are not needlessly duplicated.

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• 8 Steps to Coalition Building - full version
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Prevention Institute Tools are free to use. We also provide Services to help you use our tools and to advance healthy, safe, equitable communities.

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Developing Effective Coalitions: An Eight Step Guide

• Prevention Institute
• Larry Cohen, Nancy Baer, and Pam Satterwhite

“Addressing issues such as health promotion and chronic disease prevention requires the inclusion of people from diverse backgrounds and disciplines. Work in partnerships, collaborations and coalitions can be challenging but a powerful tool for mobilizing individuals to action, bringing community issues to prominence and developing policies. … The Eight Steps to Effective Coalition Building is a framework developed by Larry Cohen, et. al., for engaging individuals, organizations and governmental partners invested in addressing community concerns. [This guide] offers concrete steps toward building effective partnerships and provides tips for making collaborations and partnerships work. … Developing Effective Coalitions: An Eight Step 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. … Although the examples given in this paper are specific to injury prevention coalitions, most can be applied to coalitions working on a variety of health related issues.”

• Public Health

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Better together: Coalitions committed to advancing health equity

Sharron j. crowder.

a Indiana University School of Nursing, Indianapolis, IN

Andrea L. Tanner

Martha a. dawson.

b University of Alabama at Birmingham School of Nursing, Birmingham, AL

Irene C. Felsman

c Duke University School of Nursing, Durham, NC

Susan B. Hassmiller

d Robert Wood Johnson Foundation, Princeton, NJ

Lisa C. Miller

e Camden Coalition of Healthcare Providers, Camden, NJ

Susan C. Reinhard

f AARP Public Policy Institute, Washington, D.C.

Debra A. Toney

g Nevada Health Centers, Las Vegas, NV

The Future of Nursing 2020–2030 report identifies coalitions as a driving force for advancing health equity. Five coalitions provided insight into their accomplishments, lessons learned, and role in advancing health equity. The exemplar coalitions included Latinx Advocacy Team and Interdisciplinary Network for COVID-19, Black Coalition Against COVID, Camden Coalition, National Coalition of Ethnic Minority Nurse Associations, and The Future of Nursing: Campaign for Action. While all exemplar coalitions, credited relationship building and partnerships to their success, they used unique strategies for striving to meet their populations’ needs, whether the needs arose from COVID-19, racial and/or ethnic disparities, socioeconomic disparities, or other barriers to health. Research and policy implications for coalitions are discussed. Nurses play a critical role in every highlighted coalition and in the national effort to make health and health care more equitable.

Introduction

Coalitions are influential organizations with purposeful, collective actions and voices. Coalitions have been identified as “a means of pooling the abilities, expertise and resources of numerous stakeholders to positively affect community health” ( Granner & Sharpe, 2004 , p. 514). Today, more than ever, our nation needs the powerful actions and voices of coalitions to create a paradigm shift toward more equitable health care. Coalitions effective in shaping health behavior, realizing health outcomes, and addressing health inequities are purposefully built. Just as constructing a functional building requires time, money, resources, skills, and a collaborative effort among experts, the Future of Nursing 2020- 2030 report emphasizes the same requirements for creating and maintaining a sustainable, effective coalition. A variety of factors serve as facilitators for coalition formation, including commonalities in critical need, purpose, geography and/or community of influence, ethnicity, and profession. Two critical needs are health equity and access to high quality health care, especially for those negatively impacted by social determinants of health. Recent thrusts for coalition formation have included such topics as reproductive justice to decrease inequitable birth-related morbidity and mortality ( Bray & McLemore, 2021 ) and COVID-19 ( Michener et al., 2020 ). As evidenced by coalitions formed around both topics, coalitions can exist at the community, state, and national levels, but require a “hub” to coordinate activities and connect with stakeholders to increase coalition health equity capacity ( Brown et al., 2019 ; Inzeo et al., 2019 ).

Delving into the interworking of coalitions provides valuable insight about coordinating intersectional activities, addressing challenges, and creating effective strategies to promote change. Over the past two decades, a number of coalitions have approached community-level health concerns and health inequities. The Chicago Southeast Diabetes Community Action Coalition has been decreasing diabetes-related morbidity and mortality in Chicago's underserved neighborhoods ( Giachello et al., 2003 ). The Shape Up Under 5 committee of Somerville, MA has used a whole-of-community approach addressing early childhood obesity through internationally recognized social, environmental, and policy change to increase access to healthy food and physical activity ( Korn et al., 2021 ). What has been challenging has been determining what constitutes a successful coalition. A review of literature detailed six key principals of coalition-building that increase coalition effectiveness: (a) formal governance procedures, (b) strong leadership, (c) active member participation, (d) membership diversity, (e) inter-agency collaboration, and (f) group cohesiveness ( Zakocs & Edwards, 2006 ). Measuring the effect of a coalition on community health outcomes includes evaluating community changes, health or behavioral outcomes, and community capacity changes ( Kegler et al., 2020 ).

Nurses bring unique expertise and leadership skills that contribute to the health equity endeavors and outcomes of coalitions. This manuscript presents as exemplars five coalitions (see Table 1 ) including a description of their organizations and accomplishments, lessons learned, and roles in advancing the health equity agenda presented in the Future of Nursing 2020–2030 report. Representatives from the coalitions (Latinx Advocacy Team and Interdisciplinary Network for COVID-19 [LATIN-19], Black Coalition Against COVID [BCAC], Camden Coalition, National Coalition of Ethnic Minority Nurse Associations [NCEMNA] and The Future of Nursing: Campaign for Action [ Campaign ]) provided details of real-world coalition work from their vantage points and in their own words. Following a summation of coalition contributions, research and policy implications are discussed.

Exemplar Coalitions, Section Authors, and Websites

Description of Organization and Accomplishments

Anticipating the increased health disparities and inequities that would emerge for the Latinx community during the COVID-19 pandemic in March 2020 ( Rodriguez-Diaz et al., 2020 ; Rossen et al., 2021 ), Duke University clinicians convened a diverse group of stakeholders to discuss a coordinated approach to address these issues. A formal name was given to the group-LATIN-19 ( Martinez-Bianchi et al., 2021 ). An interdisciplinary executive team of Duke nursing and medicine faculty and two community-based professionals (a global management consultant and the director of Multilingual Resource Center at Durham Public Schools) leads the operations of Latin-19. The executive team meets weekly to discuss issues regarding communications, research initiatives, health profession student focused initiatives and to plan sustainable intervention strategies for the Latinx community. In addition, an elected advisory board of community stakeholders represents views of those outside the health system and advises the executive board.

In order to ensure sustainability of programs ( den Broeder et al., 2021 ) and support community resilience initiatives ( Fransen et al., 2021 ) beyond the COVID pandemic, the Latin-19 executive team developed two separate entities: a community based nonprofit corporation, and a hub for Latino health based in the Center for Population Health at Duke. These two entities work synergistically in an effort toward continued improvement of health equity for the Latinx community through advocacy, policy development, community based participatory research, and community outreach.

The LATIN-19 executive team hosts weekly meetings via an online platform (Zoom) with an average of over 70 participants. Participants in meetings comprise an interdisciplinary, multisector coalition representing academic institutions, healthcare systems, public health departments, public school systems, community-based organizations, government, faith communities, and others. Nursing faculty are at the forefront of planning and implementing community-based research initiatives, training of community health workers, and community-based health promotion and prevention events, including testing, and vaccination events.

The LATIN-19 initiative has contributed to a notable decrease in COVID-19 cases in the Latinx population in Durham County. Latin-19 community-based testing and vaccination events have made a significant contribution to the increase in vaccination rates from 5% in March 2021 to 57% as of September 1, 2021, among Latinx residents (i.e., those who have received at least one dose of vaccine). The LATIN-19 executive team developed public service announcements, conducted media interviews geared to community education, and improved access in Spanish to the 211-state hotline information related to health and human services and resources in local communities. Additionally, the team obtained a commitment by the Duke University health system to implement a Spanish language version of the digital patient portal (MyChart) and increased the hospital's Spanish language signage. LATIN-19 members at the Duke Schools of Nursing and Medicine integrate COVID-19 response initiatives into medical Spanish courses, mentor several cross disciplinary and/or cross program research teams and provide training opportunities from undergraduate to postdoctoral levels.

Lessons Learned

Challenges at the service level included a lack of COVID-19 testing and vaccination sites in Latinx communities; lack of infrastructure for services to the Latinx community; a historical mistrust of health systems by the Latinx population; lack of adequate Spanish translations of official information regarding COVID-19 and the vaccine leading to misinformation spreading through social networks; and lack of access to care following positive diagnoses for COVID-19 ( Njoku et al., 2021 ; Taylor et al., 2021 ). Additional challenges related to delivery of care and rolling out community level programs included overextension of nurses and other health care workers at community, academic, and health system levels, leading to exhaustion from continuous volunteer effort; and a lack of recognition of Latinx health priorities within the university requiring considerable team effort to compete for grants to support community engagement. Challenges in working with the community included building the trust of community organizations and maintaining sustainable partnerships; remaining vigilant in order to not overstep the authority of community led organizations; and competing for limited funding and other resources to support community level activities.

An effective strategy for overcoming a lack of information has been to remain constantly vigilant in tracking statistics for the Latinx community and subsequently following up with advocacy efforts, including phone calls to government officials, tweets, radio broadcasts, and the writing of opinion editorials for the press. Collaboration with community partners (including the County Health Department, Mayor's Hispanic/Latino Committee, Latino Community Credit Union, and Partnership for a Healthy Durham, and numerous community-based organizations) and support of local initiatives (such as community organization initiated pop-up clinics, community health worker trainings, and migrant farm worker outreach) has been key in the provision of consistent services to the community throughout the pandemic.

Advancing Health Equity

Advancing health equity requires a collaborative effort, across multisector groups. The LATIN-19 executive team recognizes that becoming trustworthy is vital in community engaged initiatives; this takes time and being present in the community. Nurses, and indeed all who work with vulnerable populations, must practice humility and vulnerability while listening deeply to questions and concerns of diverse community members when creating solutions together. Nursing is recognized as a highly visible and trusted profession, with a long history of leading at the frontline in public health emergency and response; the involvement of nurses in communicating public health information is an important strategy in approaching the lack of trust in marginalized communities ( Guilamo-Ramos et al., 2021 ). LATIN-19′s interactions have great influence on preparing the next generation of nurses and other health care professionals and the recruitment of a diverse workforce representative of the community served. Training the next generation of health equity pioneers is vital to ensuring a health workforce that is culturally and linguistically in tune with the Latinx community.

Long term goals for LATIN-19 include ensuring access to equitable, quality health care, increasing health literacy, and increasing community participation in research to enhance health outcomes for the Latinx population. These goals will only be achieved through collective leadership and trusting, collaborative partnerships and alliances that honor the voice of the Latinx community. Building and maintaining robust channels of communication with leaders in government as well as public and private health systems is essential in order to translate current needs, missed opportunities, and successes for the Latinx community into policy.

In order to share resources and maintain open collegial communication, LATIN-19 collaborates with the African American Covid Taskforce (AACT+, 2021), a group established at the onset of the pandemic to address specific needs of African Americans in the community. Members of LATIN-19 and AACT+ attend each other's weekly meetings, share lessons learned and support outreach efforts in the community. While many challenges are similar for these historically marginalized groups, each has its unique set of issues. Great care is taken to limit competition regarding funding sources and to maintain a collaborative relationship.

Black Coalition Against COVID-19

The BCAC was envisioned by Reed Tuckson, MD. During the AIDS epidemic, he was the Commissioner of Public Health in the District of Columbia. In March 2020, Dr. Tuckson convened leaders from the Historically Black Colleges and Universities (HBCU) medical schools and presidents from national organizations to form the BCAC. The coalition is a national health alliance of the four historical Black medical schools (Charles R. Drew University of Medicine and Science, Howard University College of Medicine, Meharry Medical College, and Morehouse School of Medicine); National Medical Association (NMA); National Black Nurses Association (NBNA); National Urban League, The Cobb Institute of the NMA, and BlackDoctor.org. “A Love Letter to Black America,” the BCAC's first national press release, was published by convening leaders who felt compelled to acknowledge lived experiences as part of Black communities. Although comprised of health care providers, community advocates, scientists, and organizational leaders, the BCAC developed the love letter to express its connection to communities where coalition members were born, live, work, play, worship, and transcend life.

For the first time, the BCAC created a national cross-sectional, science-based platform to inform and address health issues in Black communities by those that looked like the faces in the community. The BCAC's goal is to be the defining voice and go-to-source for the Black community ensuring accurate information, correcting misinformation, and dispelling disinformation. The BCAC strategy for success is to support local community activities while engaging with national healthcare leaders and organizations, including government entities. The emerging evidence around COVID-19 clearly demonstrated disparities and negative outcomes in Black and Brown communities ( Cuellar et al, 2020 ; Strickland et al., 2020 ; Washington & Cirilo, 2020 ). Two of the HBCUs have medical schools and nursing programs with a very diverse student population. However, the NMA and the NBNA have members in all geographical areas and are capable of delivering robust grassroot action campaigns by building on existing partnerships with local community leaders to deliver BCAC's national agenda.

Key to BCAC's success is having organizations with a rich history of community service and engagement such as the Urban League, NMA BlackDoctor.org, and NBNA. These BCAC organizations are sought for their expertise and years of service. NBNA has a collaborative community health model that is designed to address health disparities and improve health outcomes in Blacks and other minority populations. The model is also grounded in the concept of community inclusion, social justice, human caring, and health care as a fundamental human right ( Dawson, 2021 ). NBNA was working in the community before the COVID pandemic, and the current saying is, “those Black Nurses are everywhere.” Being everywhere is how to sustain a coalition, and more importantly build relationships. Nurses excel at both, which supports why nurses are the most trusted health professionals.

During its formative stage, the BCAC realized the strength in having similar, yet diverse groups, at the table to share resources: human capital, corporate contacts, fiscal support, and social media networks. Each organization added value and connections to support the coalition's intellectual and resource needs. BlackDoctor.org provided the technology this new coalition needed to reach the masses and act as the go-to social media site for those not wanting to visit medical, nursing, or other healthcare sites.

All co-convening members used their networks and reach to publish upcoming events.

The focus was continuous appraisal of the needs of the Black population across the country and quick dissemination of information and resources. Using collective human capital, BCAC increased its footprint and audience. Each group could also repost recorded events on their social media network. Coalition organizations with local chapters, such as NBNA, benefited from news outlets picking up a national story from the BCAC and connecting it to COVID-19-related events in the local community. This provided a valuable opportunity for local nurses to inform local conversations and communicate accurate data ( Dawson, 2021 ).

Another major outcome centered on sharing fiscal resources and contacts. For example, when CDC approached NBNA to provide a COVID-19 webinar, although financial support was available, the decision was made to shift this opportunity to the BCAC because of the technical support, speaker-ready bureau, and the network to promote events. Currently, the BCAC has achieved success because of the diverse, expansive expert network that is growing and changing to meet the needs of communities served in every state. Some of the partners include the Ad Council, Leading Age, Federal Drug Administration, American Red Cross, pharmaceutical organizations, faith-based entities, Robert Wood Johnson Foundation, Kellogg, Commonwealth, Kaiser Family Foundations, American Association of Retired Persons, Agency for Healthcare Research and Quality, National Dental Association, National Consumer League, National Council of Negro Women, MommiNation, American Hospital Association, Actor Equity, and other thought-leaders and influencer groups. Each partner helped reach critical audiences to move the Black and Brown communities from passive hesitancy to active listening and decision-making. BlackDoctor.org served as the engine for conducting surveys and collecting data. Early data demonstrated a positive shift in the number of people that would take the vaccine or self-reported an increase in knowledge about COVID-19.

Through BCAC, many organizations came together for the unified goal of addressing health inequities and lack of credible information during the COVID-19 pandemic. However, each organization continues to focus on their own mission, vision, and endeavors that also addresses health inequity, disparities, and workforce diversity. For example, NBNA has a collaborative mentorship program for nursing students (student connect forum), early career nurses (under 40 Forum), and mentor-mentee matching mid-career and specialty focus groups. After years of underrepresentation in the nursing workforce, NBNA uses strategies to increase nursing workforce diversity. The Mini Nurse Academy, experiential program targets third through sixth grade students. Early engagement and enrichment activities prepare young students for health and science-based occupations, namely nursing. The program has been piloted with two elementary schools in the southeastern UnitedStates Other multisector approaches include interacting with community colleges, universities, sororities, and fraternities, boys’ and girls’ clubs, and faith-based organizations. Additionally, enrichment camps and pop-up nursing academies will be offered during summer breaks and other times. These strategies support the Future of Nursing 2020-2030 report's workforce diversity recommendations.

The BCAC and NBNA are looking beyond COVID-19. Both organizations are building and expanding relationships in health policy, clinical research, social justice, health equity, and other spaces focusing on increasing healthcare workforce diversity, improving access to care, and addressing social and political determinants of health. NBNA and the Cobb Institute of the NMA are collaborating on adult vaccination research, another outcome of the BCAC. NBNA has long supported and advanced efforts to increase immunizations and vaccination across the lifespan. Coalitions look to what are keys to success, and one identified key is that, in Black communities, the tasks of eliminating health disparities and improving health outcomes is larger than any one group; coalition-building and collaboration across boundaries are critical. To move the needle in addressing health inequities, the focus must center on a community asset-based engagement approach. That out of box approach requires building blocks to sustain community initiatives where people live work, play, worship, and transcend life. Therefore, the call to action is to address social and political policies that create conditions that lead to poor health outcomes and inequities. NBNA's position within the BCAC and ongoing activities demonstrates its’ commitment to addressing health inequities and the Future of Nursing 2020-2030 report's recommendations.

The Camden Coalition

The Camden Coalition of Healthcare Providers (Camden Coalition) addresses complex health care needs through several local, state, and national efforts. At the local level, the flagship Camden Core Model ( Camden Coalition, 2021a ) provides person-centered, trauma-informed care that improves patients’ ability to manage their chronic health conditions, navigate the fragmented healthcare and social services systems, and achieve their individual goals for well-being. The coalition identifies patients with frequent hospital or emergency department admissions using real-time data from the Camden Coalition Health Information Exchange, ( Camden Coalition, 2021b ) and staff members meet patients at the hospital bedside or in a community setting to offer care coordination services. Enrolled patients receive a customized care plan and services from a community-based team of nurses, social workers, and community health workers for an average of 90 days.

The standardized methods and resources that nurses, and other team members, use in the Camden Core Model were eventually codified into a care planning toolkit. Knowledge of the techniques and practices that were more effective with patients, including methods for building authentic healing relationships with clients, evolved into what is now called COACH ( Camden Coalition, 2021c ). This five-part framework trains staff to problem-solve with patients to effectively manage their chronic health conditions and reduce preventable hospital admissions. Led by senior members of the nursing team, COACH trainings have been given to both teams and individuals at health systems large and small across the country. COACH trainers have subsequently transferred their subject matter expertise into a virtual course that will launch in 2022. Attendees will be able to earn CEUs upon completion of the virtual course.

In 2020, joining forces with state lawmakers and other partners, the Camden Coalition — along with Healthy Greater Newark ACO, Trenton Health Team, and the Health Coalition of Passaic County — became certified via state legislation as a Regional Health Hub ( Camden Coalition, 2021d ). Envisioned as a coalition of non-profit organizations dedicated to improving healthcare delivery and health outcomes for New Jerseyans, Regional Health Hubs join with consumers and stakeholders to improve outcomes for Medicaid covered patients.

Camden Coalition launched The National Center for Complex Health and Social Needs ( The National Center, 2021 ) to share experiences in the emerging field of complex care and highlight complex care innovations and breakthroughs across the country. The National Center serves as a professional home for individuals and organizations caring for people with complex health and social needs, uniting and amplifying their efforts to improve care nationwide. The National Center's Senior Advisor is Lauran Hardin, MSN, CNL, FNAP, FAAN. She provides consultation services for health systems adopting best practices from the field of complex care. She also guides institutions in the economic potential of stabilizing complex patients through retraining and/or redesigning existing resources in the healthcare system.

Camden Core Model care team members have extensive experience in Camden and similar communities, and many of the coalition's LPNs and community health workers come directly from these communities. In response to COVID-19, the Camden Coalition established “pop-up” testing sites in high-risk Camden neighborhoods that were staffed by Coalition nurses. As testing transitioned to vaccination, LPNs and community health workers provided vaccines while Coalition navigators connected participants with other social needs to available resources. These opportunities identified the need for better coordination among partners and a larger role for community-based organizations to leverage existing relationships for more equitable and patient-centered strategies.

Additional lessons learned were related to leveraging clients’ trust in the organization and its partners. A mixed methods study design, which included a Camden community survey, was used to understand specific vaccine attitudes and insights. The results informed outreach and navigation efforts, and the development of both a COVID Community Ambassadors Program ( Gomez & Kane, 2021 ) and vaccine confidence training for providers ( Camden Coalition, 2021e ). Camden Coalition nurses trained Community Ambassadors to address vaccine hesitancy with their friends, family, and peers. To increase vaccination rates for children 12 and older, Coalition nursing staff led efforts to recruit Youth Ambassadors and worked with the school district to staff vaccine events at schools. They also assisted locally owned pharmacies to provide much-needed staffing support to the city and county Departments of Health.

Additional lessons learned have been garnered through the integration of coalition effectiveness research. The results of a randomized control trial showed little variability in 180-day readmission rates between Camden Core Model clients and other patients receiving standard care, but there was an increase in a variable important to participants-access to public benefits ( Finkelstein et al., 2020 ). Furthermore, qualitative data from the study provided insight into the complexity of clients’ needs, clients’ experiences with health systems, and the importance of building authentic relationships with clients. Coalition nursing staff played a significant role during the course of the RCT, both as interventionists and leaders of care teams.

The Camden Coalition joined with partners to address inequities in maternal health outcomes, access to cancer screening and treatment, challenges in access to healthy food, connections between healthcare and the faith community, youth tobacco use prevention, school attendance, improvements to the built environment, and more.

The coalition created My Resource Pal, an online social services database of Camden area resources. The free site is accessible for both individuals looking for direct services for free or reduced cost as well as providers connecting patients to food, health, housing, transportation, employment services, and more. The coalition also participates with social services network Aunt Bertha to integrate My Resource Pal into the Health Information Exchange. This partnership allows providers to access social needs information, refer patients to local resources, and access past social services referrals for a more cohesive record of patients’ social needs.

Camden Coalition also created ecosystems of care ( Noonan, 2019 ), both within Camden and across the country. Such ecosystems are co-designed with consumers and require connectivity and interdependence across sectors, professions, and fields. Furthermore, the Camden Coalition recognizes that the path to health equity will not be forged by a single organization or individual. Instead, through multi-sector, interdisciplinary coalitions working together to transform systems, they can serve individuals’ and communities’ needs.

The NCEMNA is the only coalition in the UnitedStates that represents the diverse needs of one million racial and/or ethnic minority nurses. NCEMNA is comprised of five national organizations (Asian American/Pacific Islander Nurses Association, National Alaska Native American Indian Nurses Association, National Association of Hispanic Nurses, NBNA and the Philippine Nurses Association of America ) with a commitment to advocating for equity and justice in health care as a unified voice in the UnitedStates.

In 1998, NCEMNA was introduced to the national health leadership and organization community with the initial directors (Dr. Betty Smith Williams, Dr. Bette Keltner, Dr. Kem Louie, Dr. Antonia Villarruel, and Ms. Lolita Compas) representing their organizations. The initial and continued activities of NCEMNA focus on eliminating racial and ethnic disparities and increasing the number of minority nurse researchers. NCEMNA leaders built on existing contacts with both private and public organizations. They identified areas of mutual concern and sought to establish partnerships. These included: Collaborative Workshops with the National Institute of Nursing Research to develop a research and training agenda related to eliminating health disparities and increasing the pipeline of minority nurse investigators, Symposia at the American Academy of Nursing, publication of five white papers on the status of ethnic minorities’ health and recommendations for nursing research in Nursing Outlook, Biennial American Nurses Association presentation “Eliminating the Nursing Shortage: Ethnic Minority Nurses an Untapped Source,” Aetna/NCEMNA Scholar Program, $50,000 Grant, and receipt of a $2.4 million National Institutes of Health, National Institute of General Medical Sciences 5-year grant for a program to increase ethnic nurse scientists.

The mission of NCEMNA is to “Be the unified body advocating for equity and justice in healthcare.” The coalition's vision is “ To be a leading voice and driving force for ethnic minority populations.” Over the years, the NCEMNA mission has continuously pursued as the member associations act as a unified force advocating for equity and justice in nursing and health care for ethnic minority populations. The NCEMNA Board of Directors and its officers maintain active efforts to promote ethnic minority nurse leadership in areas of health policy, practice, education, and research and to implement leadership development and mentorship programs.

NCEMNA describes a number of accomplishments since its formation. To confront health care disparity and inequality in the U.S., NCEMNA focuses on advocacy and public awareness as well as strengthening collaboration and linkage among ethnic minority groups, other organizations, and stakeholders. NCEMNA has produced several position statements, articles, and panel presentations related to violence, racism, and COVID-19. NCEMNA is at the forefront for leading change through its representation on a number of alliances including Nurses on Boards Coalition, the Future of Nursing 2020-2030 report, National Commission on Racism in Nursing, and the Future of Nursing Equity, Diversity, and Inclusion Steering Committee.

NCEMNA uses its’ partnerships, collaboration, and synergy to lead, inspire, and influence. NCEMNA strives to work together to realize the member organizations’ shared goals and be successful in meeting the challenges of building a healthier community, free of racism, health disparities, and inequities that lead to poor outcomes. The coalition continues to use effective strategies to advocate for those initiatives that are important to NCEMNA. The coalition is the voice for the voiceless, those unheard, and underserved, for the purpose of advocating for policy change, resources, a diverse workforce, and cultural congruency.

There is a growing awareness that limited health-care coverage and lack of access are only part of the reason why health disparities exist. Many of the strongest predictors of health are social, economic, and environmental factors. Reducing disparities requires national leadership to engage a diverse array of stakeholders; facilitate coordination and alignment among federal departments, agencies, offices, and nonfederal partners; champion the implementation of effective policies and programs; and ensure accountability ( Centers for Disease Control and Prevention, 2013 ). Therefore, NCEMNA collaborates on innovative engagement activities that take advantage of the expertise, proven track record and experience of the NCEMNA member associations. The member associations address disparities through advocacy, strategic multicultural approaches, community and provider engagement and technological advancement.

NCEMNA's established goals remain especially relevant for today's health equity challenges and include: (a) the development of a cadre of ethnic nurses reflecting the nation's diversity; (b) advocacy for culturally competent, accessible and affordable health care, (c) promotion of the professional and educational advancement of ethnic nurses, (d) education of consumers, health care professionals and policy makers on health issues of ethnic minority populations, (e) development of ethnic minority nurse leaders in areas of health policy, practice, education and research, and (f) endorsement of best practice models of nursing practice, education, and research for minority populations.

The Future of Nursing: Campaign for Action

In 2010, AARP Foundation and AARP, the nation's largest nonprofit, nonpartisan organization dedicated to helping people 50-plus seek and create wellness in all aspects of life, joined the Robert Wood Johnson Foundation (RWJF), the nation's largest philanthropy devoted to building a Culture of Health, to launch the Future of Nursing: Campaign for Action . The Campaign is a national initiative to ensure everyone in America can live a healthier life, supported by nurses as essential partners in providing care and promoting health equity and well-being. Guided by recommendations from a 2011 Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, the Campaign built a network of national and state coalitions comprised of leaders from nursing, health, business, education, and other sectors to strengthen the nursing profession (Campaign for Nursing, n.d.-aEditor: Note that this citation is not highlighted.). The Campaign has coalitions in nearly every state and the District of Columbia and is coordinated by the Center to Champion Nursing in America, also an initiative of AARP Foundation, AARP, and RWJF. The Campaign is led by director Susan B. Hassmiller, PhD, RN, FAAN, at RWJF, and chief strategist, Susan C. Reinhard, PhD, RN, FAAN. The Campaign for Action has achieved many milestones including: (a) creation of a broad network of national and state coalitions that include more than 1,000 businesses, health organizations, hospital systems, insurers, private companies, and non-profit organizations; (b) modernization of state laws and regulations so nurses can practice to the top of their training and education, improving care for 84 million people in 24 states (up from 11) ( Campaign for Action, 2021a , August 5); (c) placement of more than 10,000 nurses on boards or decision-making bodies ( Nurses on Boards Coalition, 2021 ); and (d) diversifying the nursing workforce so that it more closely reflects the communities it serves. The percent of white nurses in the RN workforce declined about 6% from 2009 to 2019, while the percentage of Hispanic, Black, and Asian nurses in the RN workforce nudged upwards in that same time frame, increasing by 3.34%, 1.74%, and 1.12%, respectively. Additional promising data show the number of pre-licensure registered nursing school graduates from underrepresented groups increased by almost 80% in that same time frame ( Campaign for Action, 2021b , September 18).

The Campaign credits its success to a number of key strategies. These strategies include the partnering and institutional commitment of three respected and powerful organizations, funding and fundraising technical assistance for state/local coalitions and relationship building through convenings, learning collaboratives and other programs. The Campaign also relates its success to the creation of simple, succinct “ Campaign imperatives” that served as its North Star; messaging relevant not only to nurses but to a consumer and/or public audience; and the use of measurable short and medium-term dashboard goals to maintain the Campaign's focus.

The Campaign has learned many lessons through its nation-wide coalition building efforts. When the Campaign launched in 2010 to implement IOM recommendations, the work was focused on strengthening the nursing profession by advancing education, leadership, and scope of practice, among other recommendations. Much of the focus was on nurses and the nursing profession. It became important to change the narrative and speak about these issues in a way that made them relevant to anyone who has ever sought health care: nearly everyone. The Campaign carefully tracked its progress on more than two dozen national measures on a dashboard ( Campaign for Action, 2021c , September 15) updated twice a year for all to see on its website. Finally, the Campaign also learned that it is often impossible to get everyone on board for new undertakings but going with a “coalition of the willing” is effective.

The Future of Nursing 2020-2030 report identified eight competencies essential for nurse leadership in achieving health equity, and one of them was “leading multi-sector partnerships” ( National Academy of Medicine, 2021 ). This is a central tenet to the Campaign's work, along with a commitment to working with diverse and broad-based partners to eliminate health disparities. Advancing health equity will require the involvement, ideas, and energy of people and organizations from every walk of life. The Campaign is poised to tap the thousands of organization partners from the past decade, as well as align endeavors with AARP, which shares the same priority of eliminating health disparities.

The Campaign identifies the health equity agenda as everyone's agenda, not owned by nurses or any individual sector. Influencing the health equity agenda requires thinking creatively, across sectors, state lines and political divides to eliminate health disparities, tackle institutional racism, and create a nation where all have a chance at wellness.

Summary of Exemplar Coalitions

Communication and messaging strategies, partnerships with members of the community in need, responses to COVID-19, and funding streams vary among the five exemplar coalitions. While the coalitions differ in their approaches, their success is based upon understanding of, commitment to, and entrenchment in their population of interest. This steadfast commitment to their populations is also seen in the myriad of research strategies and policy initiatives employed to achieve their health equity goals. Whether face-to-face or virtual-only meetings, community COVID-19-focused or nursing-centric organizations, each coalition assesses their population's needs and meets them in innovative, relationship-building ways. An aspect needed for coalition sustainability is innovative sources of funding, whether funds are self-raised, government-supported, or contributed by foundations. Despite differences in their approach, these exemplar coalitions share a unified message of the profound influence of collaboration, which resonated in the language of each community coalition: (a) Latin-19, “long-term goals will only be achieved through collective leadership and trusting, collaborative partnerships and alliances that honor the voice of the Latinx community;” (b) BCAC, “in Black communities, the work of eliminating health disparities and improving health outcomes is larger than any one group; coalition-building and collaboration across boundaries are critical;” (c) Camden Coalition,“ the path to health equity will not be forged by a single organization or individual. Instead, through multi-sector, interdisciplinary coalitions working together to transform systems, they can serve individuals’ and communities’ needs.” Furthermore, NCEMA and the Campaign identified as key roles their engagement with broad-based partners in order to advance health equity.

The Future of Nursing 2020-2030 report referred to coalitions as an “empirically based intervention,” referencing a Disparities Leadership Program evaluation study involving coalition leaders of disparity-eliminating stakeholders from 31 different states ( Betancourt et al., 2017 ). Unfortunately, evidence supporting the benefits of coalition activities historically lacked consistency in reporting coalition characteristics ( Anderson et al., 2015 ), use of valid and reliable tools to measure their effects ( Granner & Sharpe, 2004 ), and outcomes beyond coalition members’ perceptions of desired behavior change ( Zakocs & Edwards, 2006 ). To be able to increase the rigor of coalition effectiveness research, future research questions must explore two critical questions: (a) whether the synergistic interaction of multiple sectors impact behavior and health outcomes and (b) if coalition activities alone or conjunction with other approaches are more effective than other approaches at impacting community change ( Kegler et al., 2020 ).

Beyond coalitions being the mechanism that addresses structural change toward health equity ( Brown et al., 2019 ), coalitions can partner with groups doing health equity and structural intervention research, serving as facilitators of community engagement in and trust of research. One example of coalition partnership in research is community-based participatory action research which is considered not only a research method but also a process and an outcome ( Giachello et al., 2003 ). Coalitions can also partner with academic and professional organizations for other research endeavors, including conducting research, recruiting participants, and supporting community members as leaders in research. When translating research into nursing practice, nurse leaders can connect with coalitions for mutually beneficial partnerships. In so doing, nurse leaders, researchers, and health care system partners should embrace the expertise coalitions espouse regarding their members, target populations, and communities. Providing nurse support for coalition health initiatives and including the voices of coalitions in health care delivery decisions that impact coalition-supported communities, is critical to advancing health equity.

Health policy and advocacy activities are fostered by bidirectional relationships between coalitions and policymakers. Coalitions as stakeholders can inform policies and provide the “lived experiences” as they engage with legislators and state and local officials to benefit their specific populations. Coalition members educate policy makers about critical issues such as the inequitable impact of COVID-19 on certain populations or the need for maternal postpartum coverage up to one year. The power of the people is seen as coalitions, especially those comprised of diverse groups, come together with collective voices to influence policy decisions. That reflects the power of many versus the power of one group. Such coalition efforts have influenced advancement of such federal legislation as the Black Maternal Health Momnibus Act (2021) and Maternal Health Quality Improvement Act (2021) . Leaders of coalitions also engage in dialogue regarding the need for local, state, and federal funding. That advocacy can provide varied perspectives and the evidence for more informed policy decision making. On the other hand, the direction can change so policies cause coalitions to be created or inform coalition endeavors. We must continue to prepare nurses for critical roles in coalitions including being actively involved in policy arenas where decisions are made and conducting research. Coalitions that focus on the nursing profession are also critical in elevating the presence and voices of nurses in governmental and legislative environments. These advocacy efforts benefit not only nurses but the health equity of those they serve.

Building influential coalitions that improve health equity requires the use of innovative strategies at local, state, and national levels. Interwoven in the real-world coalition work presented are the critical roles nurses must assume if we are to create solutions for the health inequities that exist in our society. Nurses have opportunities to lead initiatives and collaborate with other organizations as we address the needs of communities, partner with coalitions for health equity and community engaged research, and advance health equity dialogue in policy arenas. Through the Future of Nursing 2020-2030 report, the call to action has once again been sounded for nurses to not just identify health inequities but to lead and contribute to improving health equity for the sake of our nation.

Authors' Contributions

Sharron J. Crowder: Conceptualization, Writing-Original Draft, Writing-Review & Editing; Andrea Tanner: Conceptualization, Writing-Original Draft, Writing-Review & Editing; Martha A. Dawson: Writing, Original Draft, Writing-Review & Editing; Irene Felsman: Writing-Original Draft, Writing-Review & Editing; Susan Hassmiller: Writing-Original Draft, Writing-Review & Editing; Lisa Miller: Writing-Original Draft, Writing-Review & Editing; Susan Reinhard: Writing-Original Draft, Writing-Review & Editing; Debra Toney: Writing-Original Draft, Writing-Review & Editing.

This article is published as part of a supplement sponsored by Academy Health, with support from the Robert Wood Johnson Foundation.

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Eight keys to success in building an effective coalition

We share our lessons learned in building a diverse, effective advocacy coalition for global health r&d..

Editor’s note: This is the second post in a two-part series on the history of GHTC and lessons learned by the organization in coalition building. The series coincides with the launch of a case study examining GHTC as a model of successful coalition building in the global health space. The first post explores the history of GHTC.

"If everyone is moving forward together, then success takes care of itself." ~ Henry Ford

Inspiring words. But if you have ever worked with a group before, you know, getting everyone moving forward together is a task that is easier said than done.

Through our over a decade of experience building and operating a coalition for global health research and development (R&D) advocacy, GHTC staff and members have learned a lot about what it takes to enable a group of organizations to work together effectively as a coalition to enact policy change. While there is no silver bullet that guarantees smooth sailing in building a coalition, there are value systems and operating structures that can be put in place from the start to make the journey less choppy.

From interviews with current and former staff and members, we’ve pulled together a list of what we think are the top eight keys to success for building an effective coalition.

1. Establish a core set of shared principles 

You can only move forward together if you first agree on what direction to take. GHTC learned this early in our coalition’s formation. As GHTC achieved initial success and membership ballooned, it became increasingly challenging for the coalition to achieve consensus and agree on areas of advocacy to pursue. To counter this paralysis, GHTC established terms of reference to define the principles that would guide the coalition’s advocacy agenda and a membership application requiring all members to endorse those terms. “Having terms of reference and a clear vision for members is key,” said Kaitlin Christenson, former founding director of GHTC. “It helps members understand what they can expect from the secretariat of [the] coalition and agree on issues of focus—what the coalition’s purpose is and is not and what it will and will not pursue.” Establishing these principles early ensured that GHTC’s work could move forward in areas of agreement, rather than stagnating around sources of dissension.

2. Pursue membership diversity

While it is important to agree to a set of common principles, it is equally as critical to ensure that a wide range of perspectives is represented among a coalition’s membership. GHTC has benefitted from a broad membership base of global health R&D actors and stakeholders who have experience in different health and technology areas and across the continuum of product development. Not only does this ensure that GHTC truly represents the voice of the global health R&D community, but it expands the coalition’s understanding of complex policy issues, enabling GHTC to knowledgably speak to and advocate for policies that could strengthen global health R&D.

3. Identify the right convening organization

It is critical to choose a convening organization or secretariat that not only has resources to serve as a convener, but also one whose interests are best aligned with the coalition’s mission and best insulate the coalition from internal schisms.

4. Elect a representative steering committee

Establishment of a representative steering committee has been critical to GHTC’s ability to make informed decisions and translate those decisions quickly and efficiently into action. GHTC’s steering committee is elected by members with seats on the committee reserved for different types of GHTC member organizations (product developers, advocacy organizations, etc.), thus ensuring it is representative of the breadth of the coalition’s membership. The committee is a critical forum and mechanism for strategy development and guidance without depending on consensus from every coalition member for every decision.

5. Remain transparent and member driven

Decision-making within GHTC’s organizational structure is an intentionally transparent process—every GHTC member has the opportunity to offer an opinion on a decision or policy position through surveys, calls for feedback, or open discussion, even if it means that GHTC avoids taking a stance in an issue area in response to member disagreements. As a result, members have remained engaged and invested in GHTC’s work, preserving the strength of the coalition’s collective voice.

“GHTC is very good at giving its members a chance to provide input,” said Jodie Curtis, executive vice president at District Policy Group and a consultant who works closely with GHTC. “There are no hidden agendas, no sense that GHTC [secretariat staff] wants to hold all the power; it is a very transparent organization.” To remain member driven, GHTC staff prioritize regular communication with members through regular meetings and more informal interactions.

6. Secure a dedicated staff and source of funding

In its earlier days the coalition was constrained because its members were not able to dedicate the consistent amount of time and resources needed to maximize its effectiveness. In 2009, PATH received a grant from the Bill & Melinda Gates Foundation to fund GHTC which enabled it to hire full-time, dedicated staff to manage day-to-day activities. Having this dedicated staff allows GHTC’s members to focus on contributing to the coalition’s overall strategy and advocacy content and amplifying its work and ensures all members have the capacity to remain up to date on and involved in the coalition’s activities.

7. Conduct active education and relationship-building efforts

A coalition is only as strong as its connections and relationships. GHTC’s staff prioritizes relationship building with key decision-makers and their staff, meeting regularly with them and organizing meetings and events where they can interface with GHTC members. Members also appreciate the direct access these relationship-building efforts offer them. “As a member, it certainly helped to have others who were strolling the halls of Congress more frequently than we were and who knew how to get a lot of things done in DC,” said Holly Wong, principal deputy assistant secretary for Global Affairs at the US Department of Health and Human Services and former vice president at IAVI—a GHTC member. “It was like having an extra staffer to run those advocacy activities for us.”

8. Stay connected to the broader advocacy community

While GHTC maintains its focus on R&D advocacy, its staff and members are constantly working to understand the broader global health landscape, including development aid infrastructure and systemic issues, and to make sure the coalition has a seat at the right tables it needs to exercise influence. GHTC attends external functions and joins other coalitions and working groups as a member, not only to ensure that the voice of global health R&D is heard in these forums, but also to learn more about what is happening in other areas of the field and how it can shape its priorities to better support the changing environment. “To be effective, a coalition needs to make an effort to be an active member of the broader global health sector,” said Christenson.

About the author

Marissa chmiola ghtc.

Marissa manages the development and implementation of the coalition’s communications activities, overseeing GHTC’s digital presence, media outreach, events, publications, and internal communication practices. She also manages GHTC's monitoring, evaluation, and adaptive learning and donor reporting... read more about this author

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5 change management rules for building a world-class guiding coalition

In 1992, Bill Clinton’s presidential campaign was shaped around a phrase that James Carville, Clinton’s campaign strategist, had coined for the internal audience: ‘It’s the economy, stupid’.

The phrase was to become a constant reminder for a campaign that was steered by a dynamic team of change-drivers. Policies, speeches and public appearances were all driven by this simple idea.

The high-level advisers that drove the successful presidential bid were 100% clear of what needed to be done. And they made that simple and clear to all who came in contact with them.

Clinton’s campaign team was led by what Professor John Kotter would define as a dynamic guiding coalition.

Like all effective leaders, Clinton knew that he could never implement new strategies on his own. As every change manager knows, it takes a powerful guiding coalition.

The missing link

All this might seem obvious, but it is frequently one of the weakest parts of a change programme and a key, early reason why so many fail. There is a temptation for programme leaders and programme sponsors to “just get on with it.”

The programme seems on track and the clock is ticking, so surely everyone will follow the logic.

Unfortunately programmes don’t work like that. This lesson needs to be learned over and over again, often at great cost.

Breaking down this mindset is key to delivering a successful change outcome.

In the early stages of a change programme, everyone seems to agree with the concept of building, sustaining and supporting a guiding coalition, yet all too often it’s never fully implemented.

Despite everyone’s best intentions, there’s a world of difference between understanding the need for a guiding coalition and actually executing on it.

The responsibility for this failure can be laid at many doors: leaders who are too busy; sponsors who get ahead of everyone else; impatient programme teams; programme managers who don’t want to cede control.

There are many, understandable reasons for avoiding this step, but the impacts and resulting challenges to the programme are consistently dire.

Somewhere between understanding and executing

Put simply, the guiding coalition is an easy notion to grasp, but surprisingly hard to do well. Yet the success of a change programme hinges first and foremost on the quality of the team that guides it.

As a consequence, the composition, alignment and coordination of this guiding coalition is key. A misaligned, ill-fitting, uncaring team can cause the entire programme to flounder or grind to a halt.

How the Air Force does it

John Michel, the US Air Force Brigadier General who oversaw a 15-nation scramble to build a modern Afghan air force, understood this only too well.

According to Michel, the guiding principles behind his work in Afghanistan are as applicable to executives in a corporate setting as they are on the battlefield. He firmly believes that organisations that fail to create a shared language for change, and that don’t spell out very well-defined priorities and shared measures of success, are often the ones that fall short.

This is central to the role of the guiding coalition: to ensure a common understanding, a common goal and agreement on the expected benefits.

His maxim is that the time taken to explicitly and implicitly communicate how you intend to forge forward helps squeeze out ambiguity.

Yet very few attribute the success of a change management programme to the brilliance of the guiding coalition.

There are few, if any, white papers or case studies that focus on the transformative value of the team behind the change. The literature would suggest that people will jump on board the change programme and effortlessly engage in a shared ambition for change.

In fact, the guiding coalition are the unsung heroes of change management; the team that relentlessly ensures that change is occurring on a daily basis.

So let’s take a closer look at what the ideal team should look like.

1, The Dream Team

Pulling together a team of people committed to changing the way an organisation operates requires engaging people from all levels, divisions and locations within the business.

Ideally, this team should reflect the requirements of the task, be highly committed and comprise people who can drive the change across all relevant constituencies within the company.

Diversity, too, is essential. Not just diversity in thinking, but also in approach.

The team needs to be composed of people who have strong vision and process capabilities as well as high credibility with others within the organisation.

These people will need to be influential in helping others adopt the changes. And they need to be trustworthy.

2. Change must trump ‘business as usual’

The guiding coalition must include people who are able to ensure that the change is delivered over and above the ongoing ‘business as usual’.

In most changes there is a requirement that business continuity is maintained and sustained. Too much management and too little leadership can cause an imbalance, particularly if we take the view that management is about a set of processes that ensure that complex business systems keep running.

Leadership, on the other hand, defines the future and aligns people with the new vision. Both are essential components.

So change needs to be driven within the machinery of the business, but the highest level of leadership needs to deliver, and support, a clear vision and objective.

3. A fine balancing act

This is why it’s so important to assemble a group that’s prepared to act as the guiding coalition.

Doing so early and engaging them in the process requires additional skills and subtlety, too. If you ask too much of your key leaders and managers, you will unnecessarily overload their agendas, and risk losing their interest.

However, if they aren’t active participants in creating the plan and vision, they risk paying lip-service to the task of ‘guiding’.

It’s about getting the balance right.

The coalition should neither be stacked with work and meetings nor starved of vital opportunities to build momentum for the change.

4. Keeping engagement alive

Once the guiding coalition has been appointed and has contributed to building the plan and vision, they need to remain actively engaged with it. Without this sustained participation, the guiding coalition will inevitably meet resistance to change.

Buy-in can erode over time as other, seemingly more pressing issues arise, so it’s important to set up a structure whereby the team can work outside of the normal hierarchy with a direct reporting line to senior leadership.

Likewise, encouraging the coalition to participate in off-site team-building activities is another way to coordinate team efforts and keep the group focused.

5. Keeping it simple

Final word to Brigadier John Michel: “If leaders aren’t vigilant, anything from a military unit to a small business or corporation has a tendency to get unnecessarily complicated over time”.

He advocates celebrating simplicity as a way to fight organisational entropy.

It was relatively easy for Michel to reinforce this point, as 98% of the air force he was training had no private transportation. They had to have finished for the day in time to catch the last bus in the afternoon.

This meant that he and his military advisers had to build a sophisticated, modern-day air force around a bus time table. It’s a great example of guiding coalition being alive to the need to maintain flexibility, agility and adaptability.

The guiding coalition drives a change programme. And change ensures sustained competitive advantage and ongoing organisational success.

But nobody said it would be easy...

David Ferrabee

David is a partner with change management experts, Able and How

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“Managers owe it to others to reflect on the impact they are having”

Chartered Manager of the Week Professor Sara Spear CMgr MCMI on self-reflection (and becoming a better manager)

Highlights – 5 September

Today’s management challenges: happiness, generation gaps and “cocky” employees

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We reveal the candidates who stood out to the judges

Read all about it! 2024’s best management writing (and podcasts), revealed!

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We’re really proud of all of the managers, employers and training providers who choose to work with CMI, so here we’ve arranged a selection of their success stories.

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Helpful tips to keep in mind when building and managing a coalition

Simplify support. Make it easy to demonstrate support for the coalition by sharing materials they can adapt.

Allow enough lead time. Give partners plenty of advanced notice before hearings, meetings, votes, and other time-bound events.

Be inclusive. If yours is not an organization led by and representing Black, Latinx, Native American, or Asian communities, make sure to do your due diligence to build meaningful and mutual collaborations with organizations that are. Seek out diverse youth advocates, health care providers, and legislative allies to reflect impacted populations.

Plan around their availability – not yours. Some organizations cannot meet during a 9-5 workday. Others may have difficulty making it to your meeting location and paying for travel expenses. Many students are not available until after school hours and may need to prioritize paid jobs over volunteer activism, so try to have some money for compensating youth advocates for their time and talent.

Shine together. If you are developing media outreach or materials for lawmakers, ask your partners to provide quotes and a spokesperson – and help train spokespeople if possible! Providing equitable opportunities for all partners to shine is part of your job as a campaign leader – regardless of their size or the amount of time they can devote to the campaign.

Share the credit. Consider it a success when your coalition partners broadcast their leadership of your campaign. If others want to take even a little credit for the good work you are doing together, that is a huge victory. Embrace it!

Own the negative. If something bad happens along the way, own it at the coalition leadership level.

Show gratitude. Every time something good happens, make sure to thank your coalition members for making it possible.

Treat every coalition partner like a long-term asset, not a short-term convenience. If you are an effective advocate, this will not be your last campaign. How you treat and include other organizations in this campaign will impact your future campaigns as well.

Click here for our Organizer’s Checklist for Effective Coalition Meetings.

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Case Study for Building a Coalition for Woodson Foundation MGMT 591

Case Study: Building a Coalition MGMT591 First of all, in order to successfully build a coalition for Woodson Foundation, we should be aware of the necessary stags of group development that we are going to go over:

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Article Contents

Introduction, the political organization of advocacy coalitions, a research agenda for advancing advocacy coalition scholarship, conflict of interest.

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Advocacy coalitions as political organizations

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Daniel Nohrstedt, Tim Heinmiller, Advocacy coalitions as political organizations, Policy and Society , Volume 43, Issue 3, September 2024, Pages 304–316, https://doi.org/10.1093/polsoc/puae005

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Conceptually, advocacy coalitions are referenced in several policy process theories and frameworks to describe groups of actors that share beliefs and coordinate efforts to influence public policy. In the past decades, advocacy coalitions have received increased attention as a concept and a theoretical approach to understanding collective action in the policy process. In this study, we argue that despite its growing popularity, past empirical research has mainly focused on identifying and describing advocacy coalitions while largely overlooking their role and impact as political organizations. Many of the core premises and assumptions about advocacy coalitions hereby remain understudied and untested. Here, we depart from the Advocacy Coalition Framework (ACF) to discuss the political organization of advocacy coalitions by focusing on four dimensions: (1) a basis for engagement in joint strategies, (2) capacity to mobilize political resources, (3) ability to gain influence in policy processes, and (4) perceptions of advocacy coalitions as a political entity. We briefly review the theory and evidence of each dimension and conclude that several core assumptions about advocacy coalitions yet remain to be empirically tested to enable further conceptual specification and theory development within the ACF and beyond. To this end, we propose a research agenda with suggested research questions, designs, and methodological considerations for advancing empirical research on the role and impact of advocacy coalitions in different cases and contexts.

That policy actors coordinate their attempts to influence public policy with other actors with whom they share the same beliefs is an established insight in the public policy literature. This is the backbone of the Advocacy Coalition Framework (ACF) research program, which uses the term advocacy coalition to describe constellations of policy actors who share beliefs and coordinate political behavior. The notion of advocacy coalitions has gained wide traction beyond the ACF and is frequently used in studies to simplify the hundreds of actors who engage in any given policy issue.

Meanwhile, unresolved questions still linger about the role of advocacy coalitions in public policy-making. A core premise of the ACF is that policy actors act instrumentally; by joining forces with other actors, the chances increase that one will become influential and ultimately successful in translating those beliefs into policy. Consequently, the nature of advocacy coalitions has received considerable theoretical and empirical attention. Yet, although these efforts have contributed important advances, this research would benefit from more specification regarding the role of advocacy coalitions as political organizations.

The idea that actors pool resources and coordinate strategies with other actors to gain influence is recognized by other policy process theories beyond the ACF. The narrative policy framework, for example, emphasizes the role of policy actors who act collectively to pursue policy narratives ( Shanahan et al., 2011 ). In punctuated equilibrium theory, so-called policy monopolies—policy subsystems dominated by actors collectively pursuing a single interest—are crucial in understanding policy change ( Jones & Baumgartner, 2012 ). Similarly, within political sociology, scholars have focused on coalition formation among grassroots groups in pursuit of common goals, particularly how organizations within social movements pool resources to maximize public support ( Levi & Murphy, 2006 ; Tarrow, 2005 ). Interest group research also depicts the formation of lobbying coalitions as a group strategy to exert influence in public policy-making ( Hojnacki, 1998 ; Hula, 1999 ).

While the coalition concept is frequently employed in different literatures, we focus here on its usage within the ACF, which remains the leading research program for studying advocacy coalitions across countries and issue areas. The ACF assumes that policy actors in a coalition engage in joint activities, most fundamentally coordinating resources and strategies, and that they sometimes are influential as their beliefs are translated into policy programs. Advocacy coalitions are thus a form of collective action and political organization. However, past research has only partially addressed these assumptions. For example, while many studies have documented belief systems of policy actors and, to some degree, their coordination, fewer studies have investigated whether actors actually share resources, engage in joint strategies, and gain influence. Also, very few studies have analyzed policy actors’ awareness and recognition of advocacy coalitions, including whether coalition members perceive themselves and their opponents as competing advocacy coalitions.

The aim of this study is to take stock of research regarding advocacy coalitions as a form of political organization and, based on experiences from previous research, propose a future research agenda. We focus on key assumptions about advocacy coalitions within the ACF and explore how previous studies have examined these assumptions, including what methods have been employed, what the main findings are, and what knowledge gaps remain. We focus explicitly on four dimensions of advocacy coalitions as political organizations. These dimensions—strategies, resources, influence, and awareness—are directly derived from the ACF and help determine to what degree an advocacy coalition operates as a political organization:

Strategies —whether coalitions serve as an organizational base for actors to engage in joint strategies to realize their policy-oriented beliefs

Resources —whether coalition actors mobilize and pool resources in a coordinated fashion

Influence —whether coalitions as a collective are able to shape the policy process

Awareness —whether actors within and outside coalitions perceive them as a collective political entity.

For each dimension, we describe concepts and assumptions within the ACF, identify dominant themes in past research, exemplify methods employed, summarize key findings, and highlight remaining knowledge gaps. Our study does not conduct a systematic review of past ACF applications. Instead, we draw insights from previous ACF literature reviews and supplement these reviews with closer examinations of ACF applications relevant to each organizational dimension. To ensure that all relevant applications were identified, keyword searches in Google Scholar were conducted for each of the four dimensions. For example, ACF applications addressing the influence of advocacy coalitions were identified using the keyword search “coalition influence,” “ACF + influence,” and “advocacy coalition + influence”. Similar searches were also conducted for strategies, resources, and awareness.

The paper makes three contributions. First, we seek to revitalize scholarly debate regarding the validity of advocacy coalitions to describe actor constellations in policy processes. This clearly goes beyond the ACF and relates to the bigger challenge within political and policy science about how to describe the organizational basis of collective action in public policy-making. Previous work ( Weible & Ingold, 2018 ) has distinguished advocacy coalitions from other established forms of political organization in policy-making, including, e.g., iron triangles, networks, epistemic communities, and social movements. Such comparisons require careful consideration of the basic characteristics of advocacy coalitions and whether those are supported by empirical evidence. This is a crucial ontological issue for the ACF.

Second, we encourage continued empirical research to advance insights into advocacy coalitions. Despite the central importance of advocacy coalitions as a base for joint political action, progressive development of the ACF depends on empirical studies that carefully investigate those actions. This is important to advance theory development within the ACF, for example, by corroborating whether actors actually resort to the types of resources and strategies that are identified by the framework and to what degree they do this in a coordinated manner. More work on how coalition members use strategies can also offer new insights regarding how they search and process information about the policy process to advance their beliefs ( Luxon, 2017 ).

Third, we encourage more discussion around innovative methodological approaches. We recognize that the study of strategies, resources, influence, and awareness is demanding and brings major challenges to empirical research. This is ultimately a collective enterprise for the discipline to find research strategies that enable us to access and study the inner world of coalitions. Addressing these empirical challenges requires concerted efforts by scholars to exchange experiences and best practices.

Advocacy coalitions can be considered political organizations insofar as they engage as collective entities in policy processes. This stems from the ACF’s assertion that an advocacy coalition represents a base for collective action that provides added value to its members, who are better off participating in a coalition than acting on their own. Political organizations have several general attributes, which derive from the broader political science literature and apply to advocacy coalitions. First, a political organization is constituted by a group that seeks to influence policy decisions. Second, a political organization seeks to promote broader collective values of society rather than narrow sectarian or economic self-interests. Third, a political organization seeks to communicate their position to governments. Fourth, members of a political organization voluntarily contribute resources to a group that seeks a common good. Fifth, a political organization requires persistent leadership to be able to look after the interests of its members over time. Sixth, a political organization pursues different techniques for influencing public policy-makers ( Berry, 1984 ; Börzel, 1998 ; Knoke, 1990 ; Moe, 1980 ; Olson, 1965 ; Salisbury, 1994 ; Schlozman & Tierney, 1986 ).

These attributes all apply to the description of advocacy coalitions. Sabatier (p. 133) defines advocacy coalitions as “composed of people from various organizations who share a set of normative and causal beliefs and who often act in concert” ( Sabatier, 1988 ). Coalitions adopt one or several strategies to further their objectives and engage in coordination in attempts to translate their beliefs into public policy programs. The ability to do so depends, in part, on a coalition’s resources, such as money, expertise, legal authority, and supporters, and therefore, coalition members could be expected to jointly mobilize resources over time.

Several core insights emerge from this archetypical description of advocacy coalitions. To start with, in the ACF, advocacy coalitions are more than merely a descriptive heuristic to simplify the study of complex policy processes—they represent a base for collective action among actors who share policy beliefs and seek to have those beliefs adopted into policy programs As stated by Zafonte and Sabatier (p. 479), “If there is no coordinated behavior, there are no advocacy coalitions” ( Zafonte & Sabatier, 1998 ). Coordination, in their view, involves various joint activities to alter political strategies in pursuit of similar goals, including the development, communication, and implementation of a common plan of action. In addition to such “strong” coordination, coalition members could also engage in “weak” coordination by monitoring each other’s political behavior and adjusting their political strategies to make them complementary in pursuit of a common goal.

From this follows that advocacy coalitions are defined by what their members do together , organizing for collective action in policy processes. Below, we scrutinize four key dimensions associated with advocacy coalitions as political organizations.

The ACF assumes that coalition members jointly pursue various political strategies to alter the behavior of governmental institutions ( Sabatier & Jenkins-Smith, 1993 , p. 212). Understanding how actors collectively choose and exploit strategies is thus fundamental to advocacy coalition behavior. Strategy choice depends on coalition opportunity structures, particularly the openness and level of consensus in a polity ( Aamodt & Stensdal, 2017 ; Kübler, 2001 ). ACF studies have specified several types of strategies, including, e.g., the formulation of a persuasive testimony to alter agency rules or budgets; change the role occupants of various positions; change public opinion, demonstrations, and boycotts; and gradually alter actors’ perceptions via research and information. Coalitions are also expected to prioritize any given strategy that maximizes benefits at the lowest cost possible ( Sabatier & Jenkins-Smith, 1999 ).

Exploitation of strategies is a joint activity involving several advocacy coalition members. However, the nature and scope of these joint activities have been less articulated. For instance, in a recent update of the concept of advocacy coalitions ( Weible et al., 2020 ), strategies were not included as a key attribute of coalitions. Conceptually, joint activities may refer to two different types of collective actions: coordination (formulating a shared goal and developing, communicating, and monitoring a common plan) and the execution or implementation of specific strategies that coalition members have agreed upon. Meanwhile, the ACF does not offer any explicit hypotheses concerning the usage, role, and importance of political strategies in the policy process. This might explain why strategies have been subject to limited empirical work in previous ACF research, which is confirmed by past ACF applications. The degree to which members of coalitions collectively engage in coordination and implementation of joint strategies thus remains an important research avenue.

A review of 161 applications globally 2007–2014 ( Pierce et al., 2017 ) found a small number of applications that discuss how coalitions may alter their political strategies. Among 131 applications concerned with pathways to policy change specifically ( Pierce et al., 2020 ), a total of 25 (19%) pointed to the role of minority coalition strategy change, while 18 (14%) identified dominant coalition strategy change. Other reviews of ACF applications in Latin America ( Ma et al., 2020 ), South Korea ( Jang et al., 2016 ), Japan ( Ohno et al., 2022 ), Africa ( Osei-Kojo et al., 2022 ), and natural resource policies ( Sotirov & Memmler, 2012 ) have reported no or very limited evidence regarding coalition strategies. The conclusion from these reviews, however, is not that advocacy coalitions do not engage in joint strategies, they just confirm that strategies have not been a major focus in past research.

There are, however, studies that do investigate strategies specifically. Olofsson (2022) used survey data to investigate how actors representing different beliefs about hydraulic fracturing in Colorado engaged with different strategies for conflict expansion or containment. The study focused on actors’ engagement choices regarding eight different strategies (e.g., brokering agreements between parties and coordinating political tactics with allies) and the perceived effectiveness of those strategies ( Olofsson, 2022 ). Studying the same case, Heikkila et al. (2014) analyzed framing strategies employed by industry and environmental groups. Based on coding of policy documents, their analysis showed how representatives of these groups portrayed themselves and their opponents as victims and villains, respectively. The study demonstrates the utility of narratives as expressions of actors’ strategies in contentious policy issues ( Heikkila et al., 2014 ).

In another study, Luxon (2017) explored advocacy coalition actors’ capabilities to strategically respond to opportunities or threats in policy-making via beliefs and information about the policy process per se. A comparison between how advocacy coalitions in France and Sweden responded to the European Union’s 1992 Habitats Directive suggested that forestry advocates behaved differently in the two countries; while the forestry coalition in France took pre-emptive strategic action in anticipation of the Directive, the Swedish forestry coalition did not. The study, which relied on secondary sources and policy documents, underscored the importance of process-oriented beliefs as a basis for understanding coalitions’ strategic choices ( Luxon, 2017 ).

Previous studies of advocacy coalition strategies have employed different analytical approaches and data, ranging from surveys, document analysis, and secondary sources, which have enabled insight into strategic actions by advocacy coalitions. Some previous work focuses on coordination, yet we are not aware of any study that examines joint planning of political strategies. Similarly, studies have explored what strategies coalition members utilize, but few of these, if any, focus on whether coalition members jointly engage in the execution of strategies.

One of the raisons d’etre of advocacy coalitions is to facilitate joint resource use among actors sharing similar policy core beliefs and policy objectives. “Resources refer to the accessible capacity of policy actors within a coalition to influence policy processes” ( Weible et al., 2020 , p. 13). Resources have been a fixture in the ACF since its inception, one of two factors (along with strategies) identified in the flow diagram as affecting coalitions’ ability to influence the decisions of governmental authorities in policy subsystems. Joint resource use is so essential to the nature of advocacy coalitions as political organizations that Weible et al. (2020) identify it as one of the concept’s five key attributes.

ACF research on coalition resources did not gain momentum until the mid-2000s with the development of a resource typology. Introduced by Sabatier & Weible (2007) and based on earlier work by Sewell (2005) and Kelman (1987) , the typology identifies six distinct coalition resources: formal-legal authority to make policy decisions, public opinion, information, mobilizable troops, financial resources, and skillful leadership. Based on this typology, ACF scholars have investigated the possibility of a resource hierarchy ( Jenkins-Smith et al., 2014 ) and have generally found the formal-legal authority to make policy decisions as distinctly important from the others. Nohrstedt (2011) first identified this in Swedish policy-making, and the finding has been reiterated in cases from Germany ( Leifeld, 2013 ), the Philippines ( Montefrio, 2014 ), Canada ( Heinmiller, 2016 ), Bulgaria ( Sotirov & Winkel, 2016 ), Ghana ( Heinmiller et al., 2021 ), and Ukraine ( Blatt & Schlaufer, 2021 ), among others. Coalition actors also seem to be aware of formal-legal authority’s uniqueness, having shown a willingness to deploy other coalition resources in efforts to gain formal-legal authority ( Wiley et al., 2021 ).

Coalition resources feature in many ACF explanations of policy change but are mostly treated as “secondary components” supplemental to the “primary components” in the ACF policy change hypotheses. More specifically, a change in the distribution of coalition resources is one of several potential intervening links between primary components and policy change (or stasis) identified in ACF applications. Pierce et al. (2020) found in their literature review that a change in the distribution of coalition resources was evident in 46% of policy processes featuring internal shocks, 26% of processes involving external shocks, 22% of processes characterized by policy-oriented learning, and 20% of processes involving negotiated agreement ( Pierce et al., 2020 ).

The ACF assumes that advocacy coalitions are formed, at least in part, because actors sharing beliefs pool their resources to work more effectively in pursuit of their common policy goals, but the extent of resource pooling and the challenges involved are understudied. No studies investigate the extent of joint resource use within advocacy coalitions; instead, the tendency is to identify the resources of individual coalition members and ascribe these resources to the collective coalition, with little observation of joint use. Directly investigating joint resource use could tell us a lot about advocacy coalitions as political organizations and could go far in addressing Schlager’s early and influential ACF critique ( Schlager, 1995 ). It is reasonable to expect that different resources entail different collective action problems and that coalitions with a small proportion of members sharing resources would be different from coalitions with a large proportion of members sharing resources. Investigating these organizational dimensions could provide further understanding of fundamental and practical variations among advocacy coalitions.

Advocacy coalition influence in the policy process has long been a core focus of the ACF as well as in other fields, such as social movement and interest group research ( Heaney & Leifeld, 2018 ; Van Dyke & Amos, 2017 ). Examining whether coalitions gain influence is central to these literatures, given that actors are better off working together than individually. Coalition influence can be best defined by distinguishing it from the related concept of coalition goal attainment: both involve an advocacy coalition successfully instating one or more of its policy-oriented beliefs in a government program, but influence implies that a coalition effected the instatement (i.e., causation), while goal attainment holds that the instatement occurred without much—or any—effect from a coalition (i.e., correlation) ( Betsill & Corell, 2001 ). Coalition influence thus requires coalition agency or difference-making in one or more parts of the policy process, be it agenda-setting, formulation, or implementation.

Coalition influence thus gets to the core of ACF claims about the relevance of advocacy coalitions as political organizations, but the concept has been little studied. ACF literature reviews mention coalition influence but do not identify it as a line of inquiry for advancing the ACF research program. However, this has not prevented some studies from bringing coalition influence into question and calling for further investigation and clarification ( Heinmiller & Hennigar, 2022 ; Nohrstedt, 2011 ).

A handful of existing studies try to get at the question of coalition influence using a variety of methodological approaches. Aamodt (2018) , for instance, tries to observe coalition influence using a case study approach and trace evidence. In this approach, coalition influence is indicated when “…information from the coalitions is used in policy processes and documents, including coalition members’ participation in writing and adopting policies” ( Aamodt, 2018 , p. 378). Heinmiller (2023) also uses a case study approach but relies on historical variance and within-case comparison, comparing a subsystem in an early unitary phase with a later competitive phase to try to determine whether this change—and the emergence of a second advocacy coalition—was difference-making in policy processes. Fischer (2014 ; 2015 ) takes a completely different approach to isolating coalition influence, utilizing Qualitative Comparative Analysis (QCA) and an intermediate level of cases ( n  = 11) to investigate causal configurations between subsystem structures and policy change/stasis.

All these investigations find at least some evidence of coalition influence, but ACF scholars have thus far overwhelmingly focused on coalition presence, not coalition influence. Identifying the presence of advocacy coalitions is clearly necessary for establishing coalition relevance and influence, but it is not sufficient. Further work is needed to clarify the role and impact of advocacy coalitions as political organizations, and comparative work will be an important part of this. For instance, comparative studies can explore how stable system parameters and coalition opportunity structures affect coalition influence across diverse institutional, social, and cultural contexts, building our understanding of how and why some coalitions are more influential than others ( Nohrstedt et al., 2020 ).

Greater attention to coalition influence could furthermore improve our understanding of the “underdeveloped” links between resources and influence ( Weible et al., 2020 ), provide greater insight into minority coalitions and their impacts on policy, and assist in mapping the bounds of coalition efficacy, relative to other political organizations, such as political parties. Of the four organizational dimensions discussed in this paper, investigating and establishing coalition influence is probably most important for overcoming lingering skepticism about the value of studying advocacy coalitions.

Awareness refers to the perception of advocacy coalitions—by their members, opponents, and other policy actors—as a collective entity in the policy process. Whether these actors describe advocacy coalitions as a viable and impactful collective would provide a basic empirical validation of their intersubjective existence. Conversely, if no one recognizes the existence of coalitions, then their role and impact can be disputed. The importance of awareness, however, goes beyond the existence of coalitions as an ontological issue. Mutual recognition of a coalition would arguably affect the ability of its members to exploit it as a basis for gaining influence in the policy process ( Weible & Ingold, 2018 ). The awareness of coalitions also has implications for democratic governance, especially if members of coalitions represent communities that lack the means to actively participate in the policy process. In these cases, the recognition of advocacy coalitions is crucial as a path to representation and influence ( Nohrstedt et al., 2023 ; Weible et al., 2011 ).

The importance of awareness applies to all types of coalitions, ranging from belief coalitions, which is essentially a group of policy actors sharing the same beliefs without any coordination, to a full-blown constellation of actors with all the other attributes present ( Weible et al., 2020 ). Our conception of awareness resonates with the argument in the policy network literature that various networks provide a reliable description of actor relationships as a form of governance ( Börzel, 1998 ). It is also related to reputational power with a focus on actors’ perceptions of the relative power of individuals and collectives, including policy networks ( Fischer & Sciarini, 2015 ).

Limited research has been devoted to awareness of advocacy coalitions, but two dominant streams can be noted. First, studies interested in relational aspects of advocacy coalitions focus on actors’ perceptions of other individuals and/or organizations. This is related to reputational power and often analyzed in surveys where respondents are asked to indicate who they see as powerful or influential ( Babon et al., 2014 ; Ingold, 2011 ; Ocelík et al., 2019 ; Wagner & Ylä-Anttila, 2018 ). A second stream includes studies that ask respondents directly whether they participate in coalitions. These studies suggest that the majority of actors who share similar policy beliefs reported that they engage in formation and maintenance of coalitions ( Elgin & Weible, 2013 ). One study ( Weible & Heikkila, 2016 ) found that coalition building is the most important activity compared with other joint actions, for instance, participating in public meetings, disseminating research and reports, and taking legal action.

There are other aspects of the ACF that relate to awareness. Some work on the devils shift—the notion that that coalition actors view opponents as more evil and powerful than they actually are—has focused on how members of coalitions perceive members of opposition coalitions. These studies indirectly address awareness of coalitions by the views of opposing actors, yet they assess the devils’ shift by asking respondents to rate the power of their opponents, which focuses on individual actors and not necessarily on opposing advocacy coalitions as collective entities ( Fischer et al., 2016 ; Gronow et al., 2023 ; Nilsson et al., 2020 ; Pattison et al., 2022 ).

Studying the awareness of advocacy coalitions is one way to advance insights into coalitions as political organizations, including their public visibility, i.e., whether they are publicly recognized political organizations or more tacit in nature. Future work could ask relatively basic and straightforward questions about the membership and importance of advocacy coalitions. For example, do members of advocacy coalitions view their opponents as a coherent coalition? If so, does this affect their political strategies, i.e., are strategies different than if opponents, as a collective, are considered less coherent or less coordinated? One may also ask if members of one coalition perceive the membership of an opposing coalition in the same way as the members of the opposing coalition? Future studies could also examine how policy actors who do not engage directly in policy conflicts perceive the composition and relevance of advocacy coalitions. This could be studied by interviews or surveys targeted at actors who are not defined as members of any coalition. Document and news media analysis could also be used to trace public portrayal of coalitions in terms of groups of actors who take joint action.

Advocacy coalitions are not heuristics; they are a type of political organization whose presence in policy processes is empirically falsifiable. This sets coalitions apart from heuristic constructs, such as “streams” in the multiple streams framework, that are used to make sense of the overwhelming complexity of policy-making but have no independent ontological existence. Advocacy coalitions, as artifacts of policy processes, have such independent existence, and this article argues that it is time to take them more seriously as a type of political organization, considered alongside other organizational types such as political parties and social movements.

Taking advocacy coalitions seriously as a type of political organization calls for the investigation of some fundamental but underexplored questions. Some of these are conceptual, building on past work to clarify the conceptual boundaries of advocacy coalitions and, more so, identify coalition subtypes that meaningfully capture variance in key dimensions of coalition organization ( Weible et al., 2020 ). Some of the questions are empirical, such as investigating the prevalence of advocacy coalitions within and across various polities. Coalition presence has been documented in hundreds of ACF studies, but coalition prevalence is yet to be investigated anywhere. This means shifting focus from documenting coalitions based on shared beliefs and coordination to studying their role and impact in policy processes. Addressing such basic questions could (dis)confirm the relevance of advocacy coalitions as political organizations, without necessarily (dis)confirming the precepts and theories of the ACF itself.

Treating advocacy coalitions as political organizations also suggests a research agenda based on some of the key dimensions of coalition organization, such as their resources, strategies, mutual awareness, and policy influence. In this study, we defined these organizational dimensions, summarized what is already known about them in the ACF literature, and identified some of the most glaring knowledge gaps. Here, we outline some of the most pressing research questions suggested by our analysis and identify promising methodological approaches for tackling them. These questions and methods are summarized in Table 1 , along with example studies that illustrate different analytical approaches, and should be considered illustrative of a research agenda rather than exhaustive.

Suggested research questions and methodological considerations in future research.

A common thread in our findings is the need to further explore—conceptually, theoretically, and empirically—the breadth and depth of collective action within advocacy coalitions. The ACF assumes that actors pool resources, jointly strategize, have mutual awareness, and can gain policy influence, but the mechanics of the collective action involved are under-observed and under-theorized. We still know little, for instance, about how resource pooling, joint strategizing, and reputation management vary across coalitions, nor do we know much about the factors facilitating or inhibiting them. We also know little about the relative centralization/decentralization of coalitions’ organization, although it is reasonable to presume that such organizational differences exist and affect coalition behavior. Furthermore, the assumption underlying all work on advocacy coalitions—that they exercise influence in policy processes—has barely been probed, and we still have a lot to learn about the bounds of coalition influence and the factors affecting it. Altogether, this echoes the criticism by Schlager from nearly 30 years ago that studies of advocacy coalitions still have not done enough to address issues of collective action ( Schlager, 1995 ).

Addressing these questions will require a range of research designs and methods, some new to the ACF literature and some extensions on longstanding approaches. Given the considerable amount of work already done on coalition resources and strategies, meta-analyses of existing studies could prove to be very useful. Meta-analyses would push beyond current literature reviews, using peer-reviewed scholarship as data for focused evaluations of assumed or theorized coalition attributes and behaviors. Meta-analysis is probably less viable in investigating coalition awareness and influence, given the limited numbers of empirical studies on these topics.

All dimensions of coalition organization could benefit from approaches aimed at expanding the depth and breadth of current knowledge, with the inevitable trade-off between these goals. Depth of knowledge can be gained from small and mid “ n ” research designs based on carefully selected case studies, structured comparisons, and QCA. Admittedly, most of the existing ACF literature is already small “ n ,” so this may seem an odd recommendation. However, existing research is yet to take full advantage of advances in qualitative methods that trace causal mechanisms ( Bennett & Checkel, 2014 ) or utilize set-theoretic analysis, counterfactual analysis ( Mahoney, 2021 ), Bayesian inference ( Fairfield & Charman, 2022 ), or fuzzy-set QCA ( Ragin, 2009 ), all of which show promise. Breadth of knowledge can be gained from large “ n ” research designs and statistical analysis that can identify generalized patterns of coalition organization. Statistical techniques such as regression and cluster analysis are common in the ACF literature but are mostly employed to identify the advocacy coalitions in a single policy subsystem at a given timepoint. If employed to analyze many subsystems and/or timepoints, these techniques offer greater promise in providing a broader understanding of coalition organization and influence. This sort of large “ n ” research design is rare in the ACF literature, an exception being a recent study by Fullerton et al. (2023 ). Most importantly, scholars employing small “ n ” and large “ n ” research designs must interact, work together, and learn from each other; each provides an essential perspective on advocacy coalitions, and each is half-blind without the other.

Greater attention to the political organization of advocacy coalitions can advance knowledge and potentially new insights into policy processes. This can aid theory development within the ACF and beyond. Existing and future work on coalition resources, strategies, awareness, and influence has implications for established ACF theories that we are just beginning to understand. Take ACF policy change theory, for example. Considerations of coalition influence raise questions about variations in coalition influence in the “bottom-up” policy change pathways described in the first policy change hypothesis (outlining necessary but insufficient sources of policy change) vs. the “top-down” conditions for policy change outlined in the second hypothesis (policy change imposed by a hierarchically superior jurisdiction) ( Nohrstedt et al., 2023 ). It seems reasonable to expect that coalitions would have more influence in “bottom-up” processes than in “top-down” processes, but this is something to be investigated rather than assumed.

Analyzing advocacy coalitions as political organizations also provides something of a check on the insularity that threatens all theoretical approaches. Because the framework and its attendant theories are built around the concept, there is always a danger of overconfidence in ACF scholarship concerning the importance of advocacy coalitions in policy processes or the extent of their collective action in deploying resources and strategies. Analyzing advocacy coalitions as political organizations investigates rather than assumes coalition importance and coalition collective action, providing a check on potential ACF hubris. In the process, basic ACF assumptions and tenets are subjected to empirical testing, ensuring that the framework is constructed on firm foundations.

While we hope to revitalize debate and research on the political organization of advocacy coalitions within the ACF research program, what we propose here is also part of a greater scholarly effort to describe and explain the organizational basis of collective action in public policy-making. Understanding who gets to participate and who is influential in policy processes are fundamentally important questions for democratic governance. What resources and strategies actors have reveal important insights into power relationships and the politics of public policy-making. These are classical themes in political science. In this perspective, exploring advocacy coalitions as political organizations can add to our understanding of forms of political engagement and collective action in different policy areas and political systems.

D.N. was funded by the Swedish research council Formas, grant 2020-01551, and Marianne and Marcus Wallenberg Foundation, grant 2022-0049, and T.H. by Social Sciences and Humanities Research Council of Canada, grant 435-2020-0287.

None declared.

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Case Study Building A Coalition

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