Management of Diversity in Health Care Coalitions

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Bryan K Breland
March 31, 2015

After more than a decade of focused effort to improve disaster preparedness in the health care sector, hospitals have improved remarkably in their ability to prepare for and respond to dramatic increases in patient loads following catastrophic events. Recognizing those successes, the Assistant Secretary for Preparedness and Response (ASPR) for the Department of Health and Human Services transitioned grants and funding for disaster and emergency preparedness from individual hospitals to wider community efforts. ASPR proposed that shifting the focus from hospitals to health care coalitions would transform community health preparedness and response in much the same way.

The ASPR intentionally offered only limited guidance on how organizations – public and private – would work together. This flexibility allowed coalitions to form and operate the way that was thought best by the participants. Many took on very formal structures, drafted charters and bylaws, and appointed officers and committees. Others were loosely organized and adopted information exchange and network-building as their primary purpose. Regardless of form, diversity of organizational representation in coalitions is widely accepted as a coalition strength. While partnerships between hospitals has inherent value, partnerships that included public health, local government, police, fire, EMS, transportation, private-sector businesses and organizations and others allow for a more comprehensive approach, offer depth of resource and provide insight on community perspectives of large scale events.

Perspective is likely the greatest strength of a diverse workforce. Assumptions made by organizations regarding the priorities and planning of other involved agencies can waste resources during crisis events or, worse, cause failures in the execution of one’s own emergency plans. Organizational diversity in coalitions facilitates communication during the planning phase, where the cost of failure is much lower.

But with all of its strengths, diversity can present challenges. Diversity makes the process of planning stronger, but not necessarily easier. Diversity of organizational perspective almost invariably means having a coalition with members that have dissimilar opinions on coalition governance, goals, objectives, priorities and purpose. While improved community health outcomes or reduced loss of life following a catastrophic event are objectives shared by the membership, there may be dramatic differences of opinion on how the coalition might best achieve those objectives. Each organization has a specific interest in the operations of coalition and this interest may or may not align with the other members of the group.

In a recent study, I considered this diversity of interests among members of several health care coalitions formed to improve community response to large-scale disasters involving pediatric patients. Organizational diversity was rather low in some coalitions, having members representing hospitals and public health agencies exclusively. The most diverse coalition in the study had members representing 14 different organization types. Opinions on the need for formalized process varied among organization type, with hospital and governmental constituents representing that they were comfortable with large, formal organizations and private physicians preferring small, informal settings. Members from different organizational types also held different opinions on the importance of coalition operations that ensure fair and impartial representation in the coalition, how important it was that members have a shared vision and jointly develop measures of coalition success.

Beyond the difference that one can attribute to the type of organization represented, there are notable differences in the opinions of individuals based on whether they identify themselves as leaders in the coalition effort or simply members of the coalition. Those appointed as leaders in the coalition more often responded that the purpose of a coalition is information sharing, but members indicate the coalition should serve a response function. Leaders also believe more often that soliciting participation and ensuring that the group is representative of the response community is more important than did the general membership.

Also, the opinions of the membership were different depending on the member’s level of participation, meaning how involved one is with the coalition’s efforts to promote change. Those indicating high levels of participation believe it is more important to have trustworthy leaders, encourage participation and that success measures should be defined by the membership collectively. Not surprisingly, those with low levels of participation more often concluded that the coalition did not improve communication between member organizations.

We often speak of advantages and disadvantages, of strengths and weaknesses. While surely we can say that diversity of perspective in the membership of health care coalitions indeed has advantages and strengthens our ability to provide for community resilience, I propose that the diversity of interests that accompanies it should be viewed as neither a weakness nor disadvantage. By identifying and managing the divergent interest of our members, we can actually strengthen the commitment to coalition success.

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Author: Bryan K Breland, DrPH, JD, MPA, is an assistant professor in the Department of Health Service Administration at the University of Alabama at Birmingham. His current research focuses on emergency preparedness in health care organization and systems. You can reach Dr. Breland at [email protected].

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