Barry Dornfeld
Principal
Sara E. Miller
Senior Manager
Why sustainable change requires more than vision—it needs a well-designed strategic coalition.
The most ambitious change initiatives rarely fail because of misguided strategy or insufficient resources. They often fail because leaders underestimate what it takes to mobilize diverse stakeholders in complex institutional environments where authority is diffuse, forces for integration are weak, and timelines for change are short and unpredictable.
We see this pattern across sectors: healthcare networks implementing new care models, university consortia whose members pursue shared academic goals, advocacy organizations attempting to build field-wide movements, or foundations coordinating multi-site initiatives. The vision is compelling, the need is urgent, and early enthusiasm is high. Yet somewhere between conception and implementation, momentum stalls and priorities shift. Meetings become harder to schedule, pilot programs launch but don’t spread, good intentions meet institutional reality and competing calls on attention, and progress slows.
The Challenge of Loosely Coupled Systems
The problem isn’t a lack of agreement on goals—it’s underestimating the complexity of what organizational theorists call “loosely coupled systems[1]” and what it takes to create change in these organizations. Stakeholders may share broad interests in these environments but operate with fundamentally different priorities, governance structures, timelines, and organizational constraints.
Consider the dynamics in any multi-institutional change effort and what it takes to sustain momentum. For example, CFAR coordinated a national campaign several years ago designed to advance the field of family medicine, a sector characterized by a complexity of shifting forces and influences, making intentional change challenging. The “Family Medicine for America’s Health” campaign involved seven associations and organizations dedicated to this complex and multi-pronged effort, all of which brought both common and divergent interests to the effort. Our work was to integrate efforts into a series of shared initiatives designed to allow these organizations to participate at varying degrees in the efforts most aligned with their mission – a complex and ultimately successful project that offered us many lessons learned.
Traditional approaches to multi-stakeholder change often focus on getting everyone to agree on the same detailed strategy and plan. However, our experience suggests a different approach: building coalitions that allow participants to engage in various ways, at different levels, while focusing on elements of the change process that interest them most without requiring universal agreement on every component and detail.
The Campaign Approach to Coalition Building
The most successful multi-stakeholder change efforts we have observed, designed, and facilitated operate more like campaigns than traditional strategic initiatives. These campaigns include several distinctive elements:
Organizing around a unifying theme: Rather than prescriptive plans, effective coalitions organize around a compelling strategic theme that invites interpretation and allows different stakeholders to see how their existing work connects to the larger effort. This creates conditions of “pull” – inviting organizations into the effort — rather than the “push” of ideas onto others.
Building on existing momentum: Instead of imposing change from outside, successful initiatives look for places where elements of the desired future are already emerging within, even if not fully formed. These “found pilots” provide evidence of viability and create natural starting points for broader adoption.
Creating graduated participation: Not everyone needs to be all-in from day one. Effective coalitions create multiple entry points—from informal collaboration to formal partnerships to leadership—allowing commitment to deepen over time as trust builds and results become visible.
Treating resistance as information: Rather than viewing skepticism as opposition, coalition builders use it as data about real implementation challenges. Stakeholder concerns about new initiatives might reveal governance processes that require different approaches. Organizational hesitation might highlight resource constraints that need addressing.
Disciplined flexibility in action: This approach requires “disciplined flexibility”—maintaining strategic direction while remaining responsive to emerging opportunities and changing conditions. In our work with the mentioned above, we learned that success came not from identical implementation across all associations, but from allowing each organization to contribute their unique strengths focused on issues that mattered to them most—some concentrated on practice transformation, others on payment reform or technology development—while maintaining shared momentum toward common strategic objectives.
In this type of campaign, one organization might excel at program development and execution while another focuses on policy advocacy. A foundation might support research initiatives but not direct service delivery. Rather than forcing identical commitments across all participants, successful coalitions allow diverse contributions toward shared objectives.
The key is designing initiatives where stakeholders can engage with what energizes them most while contributing to the broader effort. This means creating governance structures that accommodate different levels of participation, sweeping people into the effort at strategic moments, developing metrics that capture varied forms of progress, telling powerful stories about change that garner excitement, and building learning systems that allow early experiments to inform broader strategy.
From complexity to momentum: Whether you’re coordinating change across multiple institutions, building support for policy initiatives, or implementing new practices within complex organizations, the principles remain consistent: start with existing energy built on individuals’ and organizations’ interests, create pull for different forms of participation, learn from early experiments, and strategically expand the coalition of engaged stakeholders.
The gap between vision and sustainable change is not just about better planning or more resources. It’s about understanding how change happens in complex systems and building initiatives that work with those dynamics rather than against them. Success comes not from perfect alignment but strategic coordination that allows diverse participants to contribute their unique strengths toward shared aspirations.
CFAR has spent nearly four decades helping organizations navigate complex change initiatives across healthcare, higher education, and other sectors where multiple stakeholders must coordinate action. Our Campaign Approach to Change represents our methodology for driving change in ways that adapt to diverse organizational settings.
[1] A term often traced to the scholar of organizational behavior Karl Weick.