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Coalition Administrative Issues
Topic Collection
November 8, 2022

Topic Collection: Coalition Administrative Issues

Preparing to respond to emergencies with the limited resources of a single hospital can be challenging to even the largest and most competent healthcare facilities. Healthcare coalitions (HCC) can not only save a jurisdiction precious human and financial resources, but they can also increase collaboration, cooperation, and improve community resilience by leveraging the healthcare, emergency management, and public health resources across a geographic area. Funding will come and go, and coalitions should work to become self-sustaining while also engaging their members in collaborative and educational efforts. Successful healthcare coalitions rely upon solid foundations that are built upon trust, experience, and best practices. The COVID-19 pandemic tested those foundations and existing relationships, providing lessons learned and the opportunity to incorporate them into future administrative components.

This Topic Collection was refreshed in November 2022 and includes examples of bylaws, plans, tools, templates, and information on sustaining and growing a coalition. This collection also contains guidance and lessons learned from administering and developing healthcare coalitions that can be implemented and modified by others. Access ASPR TRACIE's Healthcare Coalition Resources Page for links to related plans, tools, templates, Topic Collections, and webinars.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category. 

 

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Must Reads

Administration for Strategic Preparedness and Response. (2016). Health Care Preparedness and Response Capabilities for Health Care Coalitions. U.S. Department of Health and Human Services.
The guidance specific to these capabilities highlights what healthcare delivery system (e.g., hospitals, healthcare coalitions, and emergency medical services) have to do to effectively prepare for and respond to emergencies that impact the public’s health. Capability 1, Objective 1 includes discussion of stakeholders, roles, and potential structure of a coalition according to the cooperative agreement program.
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ASPR TRACIE. (2015). Strategic Development for Building Operational Healthcare Coalitions.
In this webinar, speakers share information on operationalizing healthcare coalitions and summarize requests for technical assistance received by ASPR TRACIE on healthcare coalition models and roles in response and recovery.
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ASPR TRACIE. (2017). Growing and Sustaining: A Discussion About Healthcare Coalition Financial Models. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
Speakers from healthcare coalitions across the country share their experiences using various financial models to sustain their healthcare coalitions in this webinar.
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ASPR TRACIE. (2019). Healthcare Coalition Resource and Gap Analysis Tool. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This tool is designed to help health care coalition (HCC) partners develop a common understanding of their resources and existing gaps, and strategies for prioritizing which gaps to close. Gaps may include inadequate plans or procedures, staffing, equipment and supplies, skills and expertise, and/or services. HCCs are encouraged to modify the template to reflect their coalition members, resources, and unique community attributes. A companion HCC Aggregator Tool allows information from multiple HCCs to be summarized to present an overall picture of a larger geographic area, including an entire state. (For a 508 compliant version of this tool, copy and paste this link into your browser: https://files.asprtracie.hhs.gov/documents/aspr-tracie-healthcarecoalition-resource-and-gap-analysis-pdf.pdf.)
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Eastern Virginia Healthcare Coalition. (2016). Eastern Virginia Healthcare Coalition Charter-Bylaws.
This document lists the characteristics and bylaws of the Eastern Virginia Healthcare Coalition. The structure of the document can apply across a spectrum of healthcare coalition types.
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  • James Newlun Did you use grant dollars to establish you bylaws and offset legal fees?
    4/1/2019 10:52:03 AM
Kansas Department of Health and Environment. (2013). Healthcare Coalition Charter Template.
This coalition charter template may be used by other coalitions as a model for developing their own charters. This modifiable template includes categories such as mission, membership, conducting business, leadership roles, and additional provisions. Guidance for coalitions as they complete the template is also provided in italics throughout the document.
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Maryland Department of Health and Mental Hygiene. (2014). Framework for Development of Healthcare Preparedness Coalitions.
This state-specific document is intended to assist health departments and healthcare system partners to identify gaps in preparedness, determine specific priorities, and develop plans for building and sustaining healthcare specific capabilities. It does not provide specifics about coalition administration but includes discussion of multiple examples from within Maryland, other states, and the District of Columbia.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2013). Medical Surge Capacity and Capability: The Healthcare Coalition in Emergency Response and Recovery.
This follow up to the landmark MSCC Handbook covers all aspects of a healthcare coalition and its role in response and recovery. Though slightly dated, this remains a “must read” for all coalition leaders and planners
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Walsh, L., Craddock, H., Gulley, K., et al. (2015). Building Health Care System Capacity to Respond to Disasters: Successes and Challenges of Disaster Preparedness Health Care Coalitions. (Abstract only.) Prehospital and Disaster Medicine. 30(2): 112-122.
Project staff interviewed nine healthcare coalition leaders for this project. The leaders shared lessons learned regarding challenges and successes, and the authors suggested additional research specific to the benefit of coalitions to the local community and improving capacity building.
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Coalition Bylaws and Governance

Bluegrass Healthcare Coalition. (2021). Bluegrass Healthcare Coalition Bylaws.
This document describes the governance structure, purpose, funding, member conduct, and other organizing principles of a Kentucky healthcare coalition. It may serve as a model for other healthcare coalitions’ organization.
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Central Florida Disaster Medical Coalition. (2016). Central Florida Disaster Medical Coalition Strategic Plan 2016-2018.
This document includes a list of the coalition’s board of directors, and strategic objectives from 2016 through 2018. These “SMART” objectives include measures, the name(s) of the person in charge, and an actions/status column.
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Central Florida Disaster Medical Coalition. (2019). Governance Policies.
This document describes the bylaws of the Central Florida Disaster Medical Coalition. It includes the following sections: Charter/Code of Ethics, Board Nominations/Elections Process, Board Onboarding Process, Member Recruitment and Onboarding, Communication, Financial Policies and Processes, Coalition Support Roles & Responsibilities, Risk-Based Project Funding Process, and Conflict Resolution.
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Central Florida Disaster Medical Coalition. (2022). Central Florida Disaster Medical Coalition Strategic Plan 2022-2024.
This document contains information on the vision and mission of a Florida healthcare coalition, a strengths, weaknesses, opportunities and threats analysis, strategic priorities, objectives, and includes several goals.
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Eastern Virginia Healthcare Coalition. (2022). Eastern Virginia Healthcare Coalition: Charter and Bylaws.
This document describes the governance structure of the Eastern Virginia Healthcare Coalition. It highlights the role of core organizations, partner organizations, meeting and voting procedures, and leadership (including a board of directors and work groups). The procedure for amending the bylaws is also covered.
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Florida Health. (n.d.). Florida Healthcare Coalition Task Force Healthcare Coalition Requirements. (Accessed 10/31/2022.)
This document describes Florida’s requirements for those healthcare coalitions participating in the Administration for Strategic Preparedness and Response National Healthcare Preparedness Program. Requirements are listed under seven functions (e.g., “Coordinate Healthcare Planning to Prepare the Healthcare System for a Disaster” and “Identify and Prioritize Essential Healthcare Assets and Services” and include resource lists that can help coalitions meet these requirements.
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Health Care Coalition of Orange County. (2019). Health Care Coalition of Orange County: Charter and Bylaws.
This document describes the organization of Orange County, California’s healthcare coalition. It highlights the purpose of the coalition, mission, protocols, and bylaws for the organization. The structure and governance of the coalition may be of interest to other counties when structuring their coalitions.
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Healthcare Coalition Council of King County. (n.d.). King County Healthcare Coalition. (Accessed 10/31/2022.) Center for Infectious Disease Research and Policy.
This presentation reviews how the coalition in King County, Washington defines coalition responsibilities; benefits to members; expectations of members; coalition governance; priorities; and planning issues. This was the original model used in the early formation of the King County Healthcare Coalition when it was based at Public Health- Seattle & King County. It is now known as the Northwest Healthcare Response Network and is a private 501c3 entity involving multiple counties.
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Healthcare Coalition of Southern Maine. (n.d.). Healthcare Coalition of Southern Maine Bylaws. (Accessed 10/31/2022)
These bylaws encompass the mission, membership organizations, coalition leadership, meeting details, and voting procedures of this southern Maine healthcare coalition.
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Knox/East Tennessee Healthcare Coalition. (2017). Knox/East Tennessee Healthcare Coalition Bylaws.
These bylaws include information on the geographic area the coalition covers, its mission, coalition structure, advisory body, voting operations, and procedures for amending the bylaws.
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Marin County Health and Human Services. (2018). Marin County Healthcare Preparedness Coalition Governance.
This healthcare coalition governance document covers the mission and goals of the coalition, funding, and organizational structure. It also discusses coalition leadership, including the steering committee, subcommittees, and executive leaders.
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Maryland Department of Health and Mental Hygiene. (2014). Framework for Development of Healthcare Preparedness Coalitions.
This state-specific document is intended to assist health departments and healthcare system partners to identify gaps in preparedness, determine specific priorities, and develop plans for building and sustaining healthcare specific capabilities. It does not provide specifics about coalition administration but includes discussion of multiple examples from within Maryland, other states, and the District of Columbia.
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National Association of County and City Health Officials. (2021). Statement of Policy: Healthcare Coalition Structure.
This document provides information on how to structure, define scope, and fund a healthcare coalition in accordance with the Administration for Strategic Preparedness and Response’s Hospital Preparedness Program. It details how to coordinate information sharing, resource support, and incident response.
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* National Association of County and City Health Officials and the Association of State and Territorial Health Officials. (2010). Healthcare Coalition Matrix.
This is a useful matrix that compares and contrasts a number of different healthcare coalition models. Please note that some links in the matrix are broken.
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North Idaho Healthcare Coalition. (2021). North Idaho Healthcare Coalition Charter and Bylaws.
This document covers the coalition’s mission, geographic area coverage, funding, membership, and executive committee. It also covers the role of regional readiness response coordinators, clinical advisors, and leadership.
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South Central Public Health District. (2017). By-Laws of South Central Healthcare Preparedness Coalition.
This document describes the organization and structure of Idaho’s South Central Healthcare Preparedness Coalition. It encompasses purpose, authority, and membership of the coalition.
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Southeast Minnesota Disaster Health Coalition. (2017). Our Coalition.
This webpage provides information on the specific coalition and links to helpful resources.
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Education and Training

Center for Domestic Preparedness. (n.d.). Healthcare Coalition Response Leadership Course. (Accessed 10/31/2022.)
This three-day course provides instruction and facilitated discussion in healthcare coalition preparedness, best practices, and lessons learned in establishing an effective healthcare-coalition framework and conducting healthcare-coalition planning. Participants will learn about developing indicators, triggers, and tactics for proactive coalition planning as well as strategies for leading coalition response and recovery.
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Guidance

Administration for Strategic Preparedness and Response. (2016). Health Care Preparedness and Response Capabilities for Health Care Coalitions. U.S. Department of Health and Human Services.
The guidance specific to these capabilities highlights what healthcare delivery system (e.g., hospitals, healthcare coalitions, and emergency medical services) have to do to effectively prepare for and respond to emergencies that impact the public’s health. Capability 1, Objective 1 includes discussion of stakeholders, roles, and potential structure of a coalition according to the cooperative agreement program.
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* ASPR TRACIE. (2017). Growing and Sustaining: A Discussion About Healthcare Coalition Financial Models. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
Speakers from healthcare coalitions across the country share their experiences using various financial models to sustain their healthcare coalitions in this webinar.
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* National Association of County and City Health Officials and the Association of State and Territorial Health Officials. (2010). Healthcare Coalition Matrix.
This is a useful matrix that compares and contrasts a number of different healthcare coalition models. Please note that some links in the matrix are broken.
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* Rogers, T. and Maloni, M. (2018). Health and Medical Coordinating Coalitions: An Introduction to the Western Massachusetts HMCC.
This document provides an overview of the Western Massachusetts Health and Medical Coordinating Coalition, including activities, benefits, and leadership roles.
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Lessons Learned

Barnett, D. Knieser L., and Errett N.A., et al. (2020). Reexamining Health-Care Coalitions in Light of COVID-19. Disaster Medicine and Public Health Preparedness.
This article uses a strengths, weaknesses, opportunities, and threats analysis to understand healthcare coalition (HCC) models’ performance during COVID-19. The authors include concrete recommendations for stronger coalitions including better evaluation of HCCs, reexamining existing HCC administration, and supporting future healthcare preparedness efforts.
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Devereaux, A., Yang, H., Seda, G., et al. (2020). Optimizing Scarce Resource Allocation During COVID-19: Rapid Creation of a Regional Health-Care Coalition and Triage Teams in San Diego County, California. Disaster Medicine and Public Health Preparedness.
The authors describe the rapid development of a healthcare coalition in response to the COVID-19 pandemic with a crisis care committee and other workgroups focused on sharing scarce resources, developing and training triage teams, and providing situational awareness.
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Harvey, M., Hunt, R., Hick, J., and Hanfling, J. (2011). The Role that Health Care Coalitions Play in Support of Mass Casualty Response. Annals of Emergency Medicine. 70(1): 106-107..
The letter in response to an article about hospital preparedness for a bombing event shares the vision of coalition functions during response including key aspects of response focus and structure that healthcare coalitions are positioned to provide for the hospitals and community.
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Walsh, L., Craddock, H., Gulley, K., et al. (2015). Building Health Care System Capacity to Respond to Disasters: Successes and Challenges of Disaster Preparedness Health Care Coalitions. (Abstract only.) Prehospital and Disaster Medicine. 30(2): 112-122.
Project staff interviewed nine healthcare coalition leaders for this project. The leaders shared lessons learned regarding challenges and successes, and the authors suggested additional research specific to the benefit of coalitions to the local community and improving capacity building.
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Plans, Tools, and Templates

ASPR TRACIE. (2015). Strategic Development for Building Operational Healthcare Coalitions.
In this webinar, speakers share information on operationalizing healthcare coalitions and summarize requests for technical assistance received by ASPR TRACIE on healthcare coalition models and roles in response and recovery.
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ASPR TRACIE. (2019). Healthcare Coalition Resource and Gap Analysis Tool. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This tool is designed to help health care coalition (HCC) partners develop a common understanding of their resources and existing gaps, and strategies for prioritizing which gaps to close. Gaps may include inadequate plans or procedures, staffing, equipment and supplies, skills and expertise, and/or services. HCCs are encouraged to modify the template to reflect their coalition members, resources, and unique community attributes. A companion HCC Aggregator Tool allows information from multiple HCCs to be summarized to present an overall picture of a larger geographic area, including an entire state. (For a 508 compliant version of this tool, copy and paste this link into your browser: https://files.asprtracie.hhs.gov/documents/aspr-tracie-healthcarecoalition-resource-and-gap-analysis-pdf.pdf.)
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DC Emergency Healthcare Coalition. (2022). Washington, DC Emergency Healthcare Coalition Templates.
The documents in this resource were provided to ASPR TRACIE by representatives from the Washington, DC Emergency Healthcare Coalition (DCEHC). While these may not be the most current documents used by the coalition, they are still considered robust templates and can be used by other for emergency planning purposes.
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Kansas Department of Health and Environment. (2013). Healthcare Coalition Charter Template.
This coalition charter template may be used by other coalitions as a model for developing their own charters. This modifiable template includes categories such as mission, membership, conducting business, leadership roles, and additional provisions. Guidance for coalitions as they complete the template is also provided in italics throughout the document.
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Region 3 Healthcare Coalition Alliance. (2022). Healthcare Coalition Alliance Region 3 Preparedness Plan.
This plan covers the coalition’s scope, mission, members, organizational structure, leadership, and community risks. It also discusses compliance and legal authority, and the coalition workplan. Note that this workplan is limited to preparedness as coalition response functions are discouraged in Florida.
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Uintah Basin Region Healthcare Preparedness Coalition. (n.d.). Inter-Healthcare Provider Master Mutual Aid Agreement. (Accessed 10/31/2022.)
This agreement facilitates the sharing of staff, equipment, supplies, and pharmaceuticals, and the transfer of patients during disasters affecting the rural Uintah Basin region. It may be used as a reference by other healthcare coalitions for developing coalition-specific memoranda of understanding.
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University of Kansas. The Community Toolbox. (n.d.). Chapter 5. Section 5. Coalition Building I: Starting a Coalition. (Accessed 10/31/2022.)
This toolkit—while not specific to healthcare—provides several resources on how to start a coalition. It includes a checklist, examples of how coalitions got started, various tools, and a PowerPoint presentation summarizing the major points of this Section of the toolkit.
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Research

Acosta, J., Howards, S., Chandra, A., et al. (2015). Contributions of Health Care Coalitions to Preparedness and Resilience: Perspectives From Hospital Preparedness Program and Health Care Preparedness Coalitions. Disaster Medicine and Public Health Preparedness. 9(6): 690-697.
The authors conducted a literature review and interviews with leaders from 22 coalitions and hospital preparedness programs. They determined five dimensions of success: strong member participation, diversity of members, positive changes in members' capacity to respond to or recover from disaster, sharing of resources among members, and being perceived as a trendsetter. They also listed barriers and suggest that coalitions develop a common typology that could be used to specify coalition capabilities and functions.
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Brown, L., Feinberg, M., and Greenbert, M. (2012). Measuring Coalition Functioning: Refining Constructs Through Factor Analysis. Health Education Behavior. 39(4): 486-497.
This article aims to understand factors which lead to successful functioning of community coalitions, in particular those associated with drug use prevention but with applicability of findings to healthcare coalitions. The authors use factor analysis to examine how leadership, relationships, task focus, costs and benefits, sustainability, and community support affect coalition function.
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Hupert, N., Biala, K., Holland, T., et al. (2015). Optimizing Health Care Coalitions: Conceptual Frameworks and a Research Agenda. Disaster Medicine and Public Health Preparedness. 9(6): 717-723.
The authors provide an overview of the Hospital Preparedness Program and healthcare coalitions in general. This is followed by a description of two frameworks they created to give coalition leaders improved insight into “how different enterprises achieve similar ends relevant to emergency response.” The authors also provide a research agenda related to coalition contribution to the healthcare system.
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Koch, A., Bohn, J., Corvin, J., and Seaberg, J. (2022). Maturing Into High-Functioning Health-Care Coalitions: A Qualitative Nationwide Study of Emergency Preparedness and Response Leadership. (Abstract only.) Disaster Medicine and Public Health Preparedness. 10(1-9).
The authors conducted a qualitative study and identified three factors related to "high-functioning" healthcare coalitions: (1) having an established and growing partnership, (2) being value-driven culture, and (3) being response ready.
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McElwee, J.A. (2012). Taking A Regional Healthcare Coalition Approach To Mitigating Surge Capacity Needs Of Mass Casualty Or Pandemic Events. Naval Postgraduate School Thesis.
This report provides a dated but detailed analysis of healthcare coalition development, comparing and contrasting three different coalitions. It uses a case study methodology to provide qualitative analysis of the coalitions, focused on governance, level of participation, and funding.
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Walsh, L., Craddock, H., Gulley, K., et al. (2015). Building Health Care System Capacity to Respond to Disasters: Successes and Challenges of Disaster Preparedness Health Care Coalitions. (Abstract only.) Prehospital and Disaster Medicine. 30(2): 112-122.
The authors interviewed nine healthcare coalition leaders to identify benefits and challenges related to healthcare coalitions and their ability to augment healthcare system preparedness for disasters. The article discusses promising practices for: stakeholder engagement; communicating value and purpose; simplifying processes; formalizing connections; and incentivizing participation.
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Return on Investment

Holt, C. (2014). Hospital Coalitions Save Money and Improve Care. Harvard Business Review.
The author explains how local and regional collaboration reduces healthcare costs and improves patient outcomes for healthcare coalitions founded for joint purchasing.
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* Rogers, T. and Maloni, M. (2018). Health and Medical Coordinating Coalitions: An Introduction to the Western Massachusetts HMCC.
This document provides an overview of the Western Massachusetts Health and Medical Coordinating Coalition, including activities, benefits, and leadership roles.
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Terndrup, T., Leaming, J., Adams, R., and Adoff, S. (2012). Hospital-Based Coalition to Improve Regional Surge Capacity. The Western Journal of Emergency Medicine. 13(5):445-52.
The authors examined the effect of a newly-developed regional healthcare coalition (in south Central Pennsylvania) on six surge capacity-related objectives. In a two-year period, the healthcare coalition improved areas under all objectives. The authors also found that designating and training a coordinator for the state healthcare volunteer database contributed to a significant increase in volunteer registrations from the participating hospitals.
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Sustaining Healthcare Coalitions

* ASPR TRACIE. (2017). Growing and Sustaining: A Discussion About Healthcare Coalition Financial Models. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
Speakers from healthcare coalitions across the country share their experiences using various financial models to sustain their healthcare coalitions in this webinar.
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Center for Leadership in Public Health Practice, University of South Florida Center for Leadership in Public Health Practice. (2013). Collaborative Partnerships and Your Community-Based Disaster Coalition - Identifying, Engaging, Motivating, and Sustaining.
This free online training course includes three modules focused on organizing a community disaster preparedness coalition or strengthening existing coalitions. The modules include: Identifying Collaborative Partnerships; Engaging, Motivating, and Sustaining; and Sustaining Coalitions. The training also includes a course overview and final steps.
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McCulley, K., Apodaca, R., Russell, M., et al. (2014). Healthcare Coalitions: Governance and Sustainability. National Association of County and City Health Officials.
This 2-hour webinar includes information on how healthcare coalitions are setting up their operational governance models. Speakers provide detailed information on the formation of their coalitions, (including key decision points and foundational documents), and highlight sustainability practices being implemented. A summary matrix of information presented is available for ease of reference. (Note: scroll to the bottom of the page to access the recording.)
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2013). Medical Surge Capacity and Capability: The Healthcare Coalition in Emergency Response and Recovery.
This follow up to the landmark MSCC Handbook covers all aspects of a healthcare coalition and its role in response and recovery. Though slightly dated, this remains a “must read” for all coalition leaders and planners
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Agencies and Organizations

CoalitionsWork.
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Northwest Healthcare Response Network.
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Southeast Texas Regional Advisory Council (SETRAC).
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Hospital Preparedness Program.
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This ASPR TRACIE Topic Collection was refreshed in November 2022. It was comprehensively reviewed in July and August 2017 by the following subject matter experts (listed in alphabetical order):

Eric Alberts, CEM, CHS-V, FPEM, FPEM-HC, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Corporate Manager, Emergency Preparedness, Orlando Health, Inc.; Patrick Ashley, MS, Virginia Department of Health; Craig DeAtley, Director, Institute for Public Health Emergency Readiness, MedStar Washington Hospital Center; Dan Hanfling, MD, Special Advisor, National Healthcare Preparedness Program, HHS/ASPR; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Richard Hunt, MD, Senior Medical Advisor, National Healthcare Preparedness Programs, HHS/ASPR Office of Emergency Management; Mark Jarrett, MD, MBA, MS, Senior Vice President, Chief Quality Officer, and Associate Chief Medical Officer (Northwell Health) and Professor of Medicine (Hofstra Northwell School of Medicine); Mary Russell, EdD, MSN, Emergency Services, Boca Raton Regional Hospital; and Donna Sasenick, MS, BSN, RN, CHEP, Senior Advisor, HHS/ASPR/OEM, Division of National Healthcare Preparedness. 

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