Case eleven. Children's hospitals' response to national coalitions: the creation of their own cooperative.

Over the past several years, national coalitions and multi-hospital systems have been expanding and increasing in popularity. These organizations have offered the member hospitals services and resources to enhance the competitive position of the member hospitals. As these coalitions have grown, they have approached children's hospitals but, in most cases, to be an affiliate of one of the general acute care hospitals. The services of these coalitions are designed to enhance the general acute care centers and have not been refined to address the needs of children's specialty centers. As children's hospitals around the country assessed how they should work with these national coalitions, they were faced with several challenges. These coalitions did pose a potential competitive threat to the children's hospitals. But, at the same time, the coalitions did not offer services to the children's hospitals that would justify membership and the large outlay in dues. Faced with this dilemma, a group of children's hospitals came together to develop a formal national coalition for children's hospitals. This case provides an excellent example of and the opportunity to explore the implementation of a collaborative strategy designed to create competitive advantage for each of the collaborators.