Health Care Coalitions:  Turf Issues

Health Care Coalitions: Turf Issues

Every group of professionals that we work with will have their own group dynamics.  Sometimes the groups we work with are quiet; some are very vocal.  As a coalition leader, we need to have the skills to work with all types of professionals on the spectrum.  Everyone will have different personalities and have different work ethics, passions, and ideas.  It's important to never disregard one's thoughts or ideas on moving forward or cause any mistrust within your coalition members.  On the other hand, if you have new members or a new concept to present and barriers are arising, you need to get to the heart of the matter and resolve the issues.

Before I dive deeper into this month's barrier, let me recap previous articles from the Coalition Building; Looking at Barriers One by One series:

  • Coalition Building; Looking at Barriers One by One:  Failure of Structure and/or Leadership - If you have a breakdown in leadership, your coalition will be the one that suffers and so will your cause.  On the other hand, if you have a great leader and no organizational structure, again your coalition and cause will be the ones that fail.  To be successful, you will need both good structure and great leadership for your healthcare coalition to be successful.
  • Coalition Building; Looking at Barriers One by One:  Poor Links to the Community - When all the structures, policies, and procedures are in place AND you have built a strong foundation within your coalition and are still struggling to reach your community, you may need to focus on reaching/strengthening relationships with people and agencies in your community outside the coalition.  Having a Poor Link to the Community could divert your ultimate goals and lead you back to working on the "buy-in" barrier.
  • Read Coalition Building; Looking at Barriers One by One:  Gaining Buy-in.
  • 2014 Goal:  Coalition Building - A stronger, more resilient community requires connecting people and organizations through preparedness coalitions, so that they can cohesively respond to protect people in disasters.
  • Coalition Building:  Getting Started - A few years ago, there was a shift in the preparedness world when Assistant Secretary for Preparedness and Response Hospital Preparedness Program (ASPR/HPP) and the Center for Disease Control and Prevention (CDC) began aligning capabilities, agencies, and focusing on building partnerships.  It was the beginning of the whole community approach to health and medical emergency response....

When introducing a new concept or working with new coalition partners, most of the time all project goals and planning move forward seamlessly.  Ideas and resources can be shared, and outcomes can be accomplished when everyone is on the same team and same page.  However, there are times when something or someone is new, we are all not on the same page, and the coalition progress is hindered.  In this case, it may be caused by turf issues....but what causes it and can it have that big of an impact on your coalition?

Turf Issues


Turf issues can create big barriers in a coalition.  Allowing barriers to fester or engaging in passive aggressive behavior will quickly drain the vitality out of a coalition and make collaboration nearly impossible.  When turf issues arise, the Ohio State University's Coalition Facilitators Guide states that this can cause partners to not:


  • Be as open and receptive to new ideas.
  • Share resources and burdens.

What is a turf issue?  The term "Turf Issues" defined by the online Free Dictionary states that the word is a slang word that means, "The range of the authority or influence of a person, group, or thing; A geographical area; A territory."  As you can imagine, some coalitions are very specific to certain geographical areas and causes.  When someone comes in, it may appear that they are trying to take over the territory, or take away business or take over the original cause.  This may also come off as competition and may cause feelings of mistrust between coalitions.  This leads to the beginning of turf issues.



So how do you get around turf issues without creating more drama?  The Prevention Institute developed a guidance document specifically targeting turf issues called, "The Tension Of Turf: Making It Work for the Coalition."  This guide discusses, in more depth, what turf issues are, why they are natural, potential problems, and ways to overcome the issues.  In brief, the Prevention Institute gives ten tips on overcoming turf issues, which I've listed below:



  • Acknowledge potential turf issues.  Before forming a coalition, it is important to have honest conversations with participants about the history of relationships between potential members and their organizations.
  • Talk details.  Openly discuss members' reasons for being at the table and share information about their respective organizations.  Develop a collaborative document that includes the goals, roles, and investment of each partner, and include a budget and timeline.  Circulate this document to the board and staff of each coalition member.
  • Shape collective identity.  Make sure all are invested in each others' success and the coalition’s success.  Discover how the individual work of the members fit into the coalition.  AKA - Share the limelight!
  • Make fair decisions.  Have a fair decision-making process and follow this practice consistently.
  • Seek funding for coalition coordination.  While everyone will share this responsibility, it is important for the coalition to have a sustainability plan.
  • Reward members and celebrate successes.  Recognize that if you bring people together, you should give them something in return so they feel like it’s worthwhile for them.
  • Build bridges.  It is sometimes easy to forget that coalition members are people, not just members of organizations.  Trust, respect, and amicability must be a high priority.  When coalition members like each other, work flows more smoothly; pay attention to the atmosphere you create.
  • Remind participants of the big picture.  When turf issues arise, certain members, based on their role or professional identity, can be effective in re-unifying the group and reminding it of its common goals.
  • Make struggles overt.  Turf battles can only be addressed if members admit they are there.  Recognize that there is an issue and overcome it.
  • Encourage flexibility.  The more rigid people are, the harder coalition cooperation will be.  Creating an open environment where members feel comfortable with diverse perspectives and with conflict is critical.

While neither the coalition or new partners are at fault for having the feelings that turf issues arise from, as a coalition leader it is your duty to get to the root of these issues and figure out how to resolve the issues at hand, so that the coalition can move forward.  A good leader always finds a way to move projects forward, especially during times of difficulty and, hopefully, before the emergency occurs.  During an emergency is not the time to have conflicts or feelings of mistrust between coalition partners, which is why we need to work hard to get to the bottom of them beforehand.  Stay tuned for next month's barrier on Previous Bad Experiences.

Tsoetsy Harris, MPH, MEP

Tsoetsy Harris, MPH, MEP

Independent Consultant

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In all we do, we seek to reduce human suffering and loss of life caused by disasters.

We get it done by connecting the preparedness efforts of healthcare organizations, emergency management agencies, and public health departments through effective, financially self-sustaining healthcare coalitions.

Yes, we believe healthcare coalitions are the path forward.

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