Sustained and not sustained coalitions responded to a final and important question: "If you could start your coalition over again, what would you do differently?" Overall, there were three categories of responses that were repeated frequently. First, coalitions would diversify their membership. Specific examples included expanding to business, specialty care providers, private primary care providers and medical groups, and engaging all health systems in the community including competitors, consumer groups, and faith-based groups. The overall sentiment was that a more diverse membership would have better represented all perspectives of the community and the target population, as well as provided different types of knowledge, skills, and resources for the coalition. As discussed above, both sustained and not sustained coalitions emphasized the important role that institutional champions played in sustainability because of the resources and networks they offered.
Second, coalitions would establish more formal structures. The most frequently cited example was establishing formal contracts, MOUs, etc. with the member organizations that include a description of expectations and responsibilities for the member and the coalition. This desire for more formal structures was repeated in some interviews with coalitions wanting structure with formal agreeements such as a sustained coalition that reported that establishing financial roles at the beginning would help sustainability. Several coalitions also expressed a desire to increase the leadership structure through the executive committee or board of directors. Finally, several coalitions reported regret that the coalition did not establish as an independent not-for-profit.
The third frequently cited lesson learned was to focus the coalition’s mission and activities to concentrate on what the coalition did well and where it could make the greatest impact. Several coalitions stressed the importance of assessing activities regularly and being willing to let go of those that do not work well.
A common theme that emerged from not sustained coalitions during key informant interviews was the need to focus coalition activities on a common goal. Not sustained coalitions shared that main lessons learned included: "Have a clear plan about what you want to accomplish;" "have a clear goal;" "have tangible, ongoing activities to check off"; and "keep your eyes on the prize."
Additionally, coalitions frequently mentioned the need to look early and look broadly for funding sources to supplement large grants. Several coalitions also stressed the need to look for sources with longer funding cycles. A few coalitions mentioned the value of having a dedicated leader with connections throughout the community. Finally, a few coalitions emphasized the need for better data and more data support in order to improve the coalition’s capacity to measure, report, and disseminate its impacts for the community. In the interviews, a few coalitions also spoke about the need to use data to conduct assessments and to build a business case for the coalition.
Another reoccuring lesson mentioned by the coalitions was the need to build strong relationships. One coalition’s experience led them to say "the coalition needs to be based on solid relationships that have been built, or a commitment to build them, because that is what will last once the grant is over." The relationships also allow the coalition to widen the circle of their donor base because of the support from the other members.