No More Committees – Coalitions as a Mechanism for Co-Design and Co-Production

Background: A common response to address an issue in healthcare is to strike a committee. However, implicit in committees, is a hierarchical structure whereby there is upwards reporting and accountability. That is, a committee is typically accountable to a single higher authority. In integrated care, with multiple actors, a situation where one entity holds power, does not enable true co-design or co-production.

 

Approach: In order to create a mechanism for true co-design and co-production, where there is equality of relationships, we have evolved a coalition model. This model, like a committee, starts with a purpose, which may be for information exchange, activity coordination or to accomplish a task. Experientially, we have found that establishing a common vision (as per the first pillar of integrated care), a common understanding of the equality of relationships, and facilitation of relationships, is important for the functioning of a coalition.

 

In addition, we have also found the use of co-chairs, or rotating co-chairs, also facilitates the equality, and even equity, of relationships. Despite equality between partners, it is necessary to typically have one partner designated to provide administrative support for the coalition. Whenever possible, the public voice is included in an equitable manner, understanding that typically services and initiatives are designed meet their needs.

 

Results: We have used to coalition model to enable communication and coordination within the health and voluntary sector, family caregiver serving organizations, professional organizations and between primary care and the health system. These coalitions have been highly functional and in one case (professional organizations) the relationships created within the coalition led to the sunsetting of formal meetings as interactions evolved to direct daily interactions between partners. Experientially, in all cases, we found that membership in the coalition grew as existing members identified other partners with similar mandates.

 

Surveys of the partnerships found that all members valued the structure and function of the coalitions and particularly valued the ability to interact with the health system in a more collegial and informal manner. Decisions and agreements made within the coalition could be enacted rapidly without the need for formal committee-type hierarchical approvals. This was particularly valuable during Covid when actions could occur within hours after meetings. We have further found that initial successful collaboration leads to success in more substantial initiatives.

 

Implications: The coalition approach seems to be a much better approach to enable collaboration and coordination between organizations involved in the provision of integrated care. It can be widely implemented across most health and social care systems but does have certain prerequisites in order be effective. These include a shared vision and the opportunity for relationship-building which leads to trust. In particular, from the perspective of the health system, there needs to be comfort in doing things differently, eschewing the “need to be in charge”, and “giving up (perceived) power”. When in place, coalitions enable true co-design and co-production.