The 7 Cs: lessons for effective coalitions – and strong marriages

Most work that aims to solve intrinsically complex challenges tends to be, well, intrinsically complex. Throughout my public health career, I’ve seen some of those complexities up close. I’ve also seen that while global health challenges come in multiple forms, they share at least one non-negotiable truth: that for global health to succeed, it needs strong coalitions.

Whether it’s finding a cure for a disease, preventing death in children, distributing vaccines in the remotest parts of the world or – as we’ve been seeing the last 18 months – trying to stop a devastating pandemic, these efforts require the work of more than one individual or institution. And more often than not, they require the work of many. But simply knowing that collaboration between people, institutions, countries – or all three – is necessary, does not make the work of coalitions any easier.

Coalitions are just like a marriage. It’s very easy to get into one. But very hard to make it work. Whenever I say this, raised hands follow. “I don't think it's hard to make a marriage work,” I usually hear. "We've been married 10 years and we've never gone to bed angry. We've never really had a fight. It's not hard. It's not hard at all." My mistake was always trying to argue the point. And for many years I did. Until one day I came to a realization, and that is, some people just don't tell the truth.

Though divorce statistics around the world vary, some countries see more than 70 percent of unions crumble. Coalitions can fail at even higher rates. But knowing that coalitions, like marriages, are difficult can be a great way to start making them a little less so. There are barriers that, if identified and removed, can make coalitions more effective. A great summary of these barriers was organized by James Austin, a wonderful Harvard Business School, Professor Emeritus. He deserves the credit for identifying what he called the “7 Cs.”

Culture. People from different countries have markedly different cultures and backgrounds. They often don’t even speak the same language. Add to this the cultural differences, biases and prejudice – perceived or otherwise – between players from the public and private sector in any given environment, and there are infinite potentials for misunderstanding and ultimately, failure. Knowing the culture of coalition partners, and working to understand them well, gives coalitions a starting chance.

Conflicting goals. For a coalition to be successful, it needs to have a shared overriding goal that all participants agree on. If coalitions want to mobilize 250,000 people in India to vaccinate a population, or eradicate a disease, they need to focus and agree on a single, unified objective. Unfortunately, a lot of times coalitions aim for 10 to 15 goals and, even worse, they outline goals that conflict with their members’ individual ones, making it impossible to push forward in the same direction. That's why it is essential to have clarity around an overriding objective that is shared and embraced by all members.

Confusion. With so many moving parts, coalitions can often begin with confusion about roles and responsibilities, about who is responsible for what, and about the actual problem being addressed. If coalitions fail to adequately diagnose the problem and landscape early on, they end up working behind a veil of confusion. Clarifying the problem, determining the steps to be taken, and communicating clearly are the antidote to the confusion that can keep coalitions from succeeding.

Control. No one wants to give up control, whether they are a large multinational or a small nonprofit with a limited budget. And that is understandable – organizations are accountable for the resources they bring to the table, so they want to ensure their contributions are well spent. This is why coalitions must work to trust their partners, so they can relinquish the false sense of security born from an equally false belief that their perspective – or contribution – always trumps that of their partners.

Capabilities. Many of us want to be seen as being good at everything. We're reluctant to admit that other people may just be better than us in certain areas, let alone all areas of a given project. Add to that the common misconception that the most capable people in the room are just like us: they think like us, they talk like us, they act like us, and they work like us. This bias often leads people to believe that, anyone who is dissimilar to them is not as smart or as capable. The truth is, we are all different and we can benefit from the various capabilities that complement our own.

Competition. When brought together in a group, we often believe that we settle into collaborative mode when, in reality, we’re in a covert attack position, ready to show that we're the best. The most important prize is the credit we aspire to receive. Credit for an idea, credit for a thesis, credit for an answer. That can lead to fierce competition, the kind that is the antithesis to collaboration, and that can become a real barrier to finding the best solutions.

Costs. Oftentimes, we're not realistic about what the real costs of something will be. In global health, we have a bad habit of designing from a poverty mentality, where everything is done on a shoestring budget, because we’ve seen health expenditures deprioritized in government. The result? Most donors, whether it is a private foundation, a bilateral government, or a multinational organization, allocate costs by how many cases are prevented, how many people are cured, how many wells are drilled. Not by the cost of the effort of a coalition. Because funders so often fail to allocate the real costs that are required to build and sustain the coalition, we expect the work of coalitions to get done in the partners’ spare time – time that is not realistically available. Undervaluing coalitions is endemic and this undercuts their chance of success.

Understanding the 7Cs may just be the start. I've always appreciated a quote that's commonly attributed to Einstein, after he was supposedly asked what he would do if he had just one hour to save the world from a horrible disaster. Legend has it he thought for a minute and then replied: “I would spend the first 55 minutes understanding the problem, and the next five minutes, figuring out the solution.” Understanding the problems and potential pitfalls that can doom coalitions will be invaluable in helping lead coalitions to success. Understanding the problems and potential pitfalls that can doom coalitions will be invaluable in helping you lead your coalition to success. Like a long marriage, coalitions too face winding journeys that can be bumpy. The first mile is when groups come together and define a clear and compelling goal, strategy, structure, membership, and management. The journey, when progress and inevitable setbacks occur, requires good management of programs, meetings, and people. Then there’s the last mile, when coalitions actually achieve their goals and look back and reflect.

Like a marriage, the strongest coalitions are those between people who bring different skills and perspectives to the partnership. They are also honest and must learn to trust each other. This may mean more arguments and discussions, but it will likely produce better products. Because again, most work that aims to solve intrinsically complex challenges tends to be intrinsically complex. But most work that is important, much like a marriage, and certainly like global health, requires attention and intention if it is to be successful. And successful they should be. After all, our future depends on it.