An Assessment of the Sustainability and Impact of Community Coalitions once Federal Funding has Expired. Vision Guiding Action


Sustained coalitions were asked about their overall agreement with several statements to assess vision guiding action, shown in Exhibit 13. Over 85 percent of the sustained coalitions agreed or strongly agreed with all statements, except for the statement that "vision, mission, and goals are understood by residents and institutions in your community" to which 72 percent of the sustained coalitions agreed with the" Additionally, seven percent responded "not applicable" to that item compared to one to three percent for all other statements. The high level of agreement with the survey questions was supported by several statements from coalition leaders and partners during the key informant interviews and site visits.

Vision Guiding Action in a Sustained Coalition
A sustained coalition that exemplifies the concept of vision guiding action reported that their partners are highly motivated to accomplish the coalition’s mission of improving health care for underserved populations. The coalition was comprised of a range of social service agencies, community organizations, and hospitals systems that traditionally did not collaborate. As a result of their commitment to improving health care in their community, the partners developed a sophisticated network of charity care for uninsured patients. Prior to the HCAP grant, a culture of donated care existed in the community; many hospitals and providers were providing free care to patients. The HCAP grant was an opportunity to develop a coalition that focused on the issue of improving care for the underserved and uninsured in their community, and formalize the existing network of donated services. Through its case management and access activities, the coalition has created a coordinated system of care for uninsured patients, and as a result, decreased duplicative and fragmented care. An employee of a hospital partner in the coalition summarized the power of their mission-driven focus: "[There is] no fighting, because the bottom line is we’re all here for the same purpose. The patient is first and we try to do what we can."

Sustained coalitions frequently discussed the importance of having a vision, mission, and goals that are shared by member organizations. During a site visit with a sustained coalition, the coalition leader explained that a key to their sustainability has been that members share a common purpose "to serve the patients and [create] a continuum of care." A member organization of a sustained coalition also pointed out that they continue to participate in the coalition because they are committed to pursuing activities to achieve the coalition’s vision, mission, and goals: "It is [a] commitment the Board and CEO have made to the community."

Another sustained coalition emphasized that their mission has been an important facilitator of their outcomes as well as their sustainability. A key informant explained that "outcomes in health is the bottom line, but you have to go through the process of keeping the partnership together…to [get to] the outcomes." This coalition is located in a county that is geographically isolated, increasing the need for collaboration within the community. One key informant said, "I don’t think that the federal government or the state is going to come and solve our problems…We have been the ones to solve our own problems."

Additionally, several coalitions noted that the coalition must have a "mission driven reputation" that resonates with the community and target population. For example, a key informant from a sustained coalition said that "we have….a reputation now for being a go-to place for people who have no other means of accessing healthcare." Another sustained coalition shared that it has had such an impact that when a discussion of cutting the coalition’s program arose, the community rallied to "support the fact that having kids insured is saving [the] county a lot of money."

Exhibit 13: Sustained Coalitions Vision Guiding Action
Your coalition’s: % Strongly Disagree % Disagree % Agree % Strongly Agree % No Opinion/Not Applicable
vision, mission, and goals are documented. (n=112) 2 4 28 65 1
vision, mission, and goals take into account what is happening in the community. (n=113) 3 2 24 71 1
member organizations agree on the coalition’s vision, mission, and goals. (n=113) 2 2 31 64 2
member organizations are committed to pursuing activities to achieve the coalition’s vision, mission, and goals. (n=112) 2 4 41 52 2
vision, mission, and goals are understood by residents and institutions in your community. (n=113) 4 17 54 18 7
vision, mission, and goals are periodically re-evaluated or updated. (n=113) 5 8 40 45 2
activities are evaluated in relation to its vision, mission, and goals. (n=113) 4 8 38 48 3

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