Step 2: Determine Whom To Engage

Your answers to the questions in Step 1 will determine which stakeholders you should engage. Different types of stakeholders can offer vastly different perspectives on the same issues. Drawing together a group without understanding what each member brings to the table can undermine your engagement efforts.

There are three tasks involved in making sure the right stakeholders are present:

1. Determine the specific types of stakeholder voices you need.
2. Identify and recruit stakeholders.
3. Monitor the group’s membership.

Task 2.1: Determine the specific types of stakeholder voices you need

The types of stakeholder voices you will need to succeed will vary depending on the specific expertise you require, political considerations, the scope of the engagement, and many other factors. In making this determination, questions you should ask include:

• Based on your program’s logic or key driver model (Task 1.1), what types of stakeholders are critical for success? What expertise is necessary?
• Who has the political or professional clout to make change happen?
• Who is able to do the work needed for the QI initiative?
• Who must be included for the stakeholder engagement process to be credible and transparent?
• Who might oppose changes if they are not engaged early to address their concerns?
• Who might be affected by changes and should, therefore, have a voice in the process?
• Are there regional and national organizations whose buy-in is important or who have important expertise or resources?
• Are there stakeholders outside the health care field, such as public schools, the juvenile justice system, and colleges and universities, who also have a role in child health?

Key Considerations:

• In QI initiatives for child health care, the necessary stakeholders may include:
  • Other State departments and agencies that have a stake in Medicaid and CHIP.
  • Parents and other caregivers.¹⁰
  • Clinicians, including pediatricians, family physicians, nurse practitioners, physician assistants, and nurses.
  • Staff from school-based health centers or other school-based health initiatives.
  • Researchers.
  • Family and child advocacy groups.
  • Professional societies.
  • Payers.
  • Policymakers
  • Other child service providers (such as educators, places of worship, and social welfare agencies).
  • Adolescents who would be affected by your initiative.
• Use what you learned from your environmental scan (Task 1.4) to help determine which stakeholders will be important for your initiative. The scan also may help you identify areas of expertise and skills that can help your initiative succeed.
• Once the initial group of stakeholders is formed, you may want to conduct a gap analysis to ensure no groups have been overlooked. To complete a gap analysis:
  • Compare the list of participants with other groups of stakeholders in child health care.
  • Conduct informal conversations with current members of stakeholder groups.
  • Consult the logic or key driver model for your QI initiative (Task 1.1) to identify critical players (for example, who is responsible for each of the drivers) and which populations are most affected.
  • Include a discussion of who might be missing at your first stakeholder meeting.

Task 2.2: Identify and recruit stakeholders

Once you have identified the types of stakeholders needed for your initiative, you will then need a plan for finding and recruiting individuals who fit your criteria. Questions you should ask include:

• How can you find stakeholders who can represent their respective organization’s views and who will have the time to commit to the group?
• Are there State agencies or other organizations that you can leverage to identify stakeholders?
• What groups or individuals can help you reach out to and recruit family representatives?

Key Considerations:

• Recruit stakeholders who are decisionmakers within their own organizations and thus have the authority to represent their organizations in your effort. However, some may already be spread too thin to commit the necessary time.
  • Do not hesitate to invite someone because you think they are too busy. Often, those who are passionate about the issue will make the necessary time.
  • Clearly communicate anticipated time commitments and workload to potential stakeholders to avoid recruiting stakeholders who are already overburdened.
  • If you determine a stakeholder is already too busy, ask who the potential stakeholder would recommend with comparable perspectives, expertise, or experiences.
• Look for leaders or trusted representatives from communities that you identified with your environmental scan.
  • Individuals who are officers of organizations bring administrative authority but potentially have less time for a major commitment.
  • Private citizens might be beneficial to include as stakeholders because they do not have a specific institutional interest to promote and also may have more time. However, they may have less experience with formal stakeholder efforts.
  • Regardless of where participating stakeholders come from, it’s important to build trust and help ensure communication with all members of communities of interest.
• Seek a blend of both experienced and inexperienced stakeholders.
  • Individuals with less experience as stakeholders may represent relevant organizations that have not historically been included in such efforts. New perspectives may help move efforts forward, but you may need to take some time to bring such individuals up to speed.
  • Involving individuals with a blend of experience will likely result in higher engagement of participants, and it also provides an opportunity for less tenured stakeholders to be trained as leaders of their constituencies.
• Ask local chapters of national organizations and other stakeholder groups to help you identify enthusiastic, engaged leaders who also have the necessary experience and expertise.
  • These organizations can include associations of providers, such as local chapters of professional organizations, and family and consumer advocacy organizations.
  • Consider members of committees or task forces that have been organized by State or local government or who have been part of advisory committees for other efforts, such as grants or other related projects. These individuals will be leaders of their community, and they will also have experience being a part of a similar entity.
• To identify family members, consider using the following strategies:
  • Ask providers if there are any individuals from a family advisory council or peer support program at their practices that they would recommend as a stakeholder.
  • Ask staff from family and consumer advocacy groups if they can find a suitable representative from among their constituency. Depending on the particular individual, he or she may be able to speak from direct experience and present a genuine “family voice.”

Be prepared to communicate to potential stakeholders the “story” of your QI initiative succinctly—what you want to accomplish and how their involvement will help you do so. Enlisting senior leaders of organizations that are involved with or support your initiative to tell this story to potential stakeholders can be a powerful recruiting strategy.

Task 2.3: Monitor the group’s membership

If your group will be meeting for more than just a few months, it is a good idea to periodically assess whether the composition of your stakeholder group still matches your needs. You may have to recruit new stakeholders to bring new perspectives or to replace members who are no longer able to participate. You also may need to ease out members whose expertise is no longer needed. If the group will exist for only a short period of time, you may not need to reassess its membership. In assessing how the group can be sustained and strengthened, ask:

• How has the membership changed over time, or how is it likely to change in the future?
• How have the goals of the group evolved?
• Does the expertise of the group’s members match the current goals of the group? Are any voices missing?
• Has the size of the group proved to be unwieldy or inadequate?
• How has your political context changed? Did an election bring new individuals into office? Has there been a change in the leadership of your institutional home?

Key Considerations:

• If your stakeholder group will be permanent or long-standing, you may want to ask stakeholders to serve in the group for a specified term, allowing new members to cycle through the group.
  • Establishing terms may be a useful strategy for easing out stakeholders who are not working well within the group.
  • Terms would also allow you to bring in new expertise as needed without having to continue to grow the size of the stakeholder group.
  • Evaluating each member’s actual contribution to the group as compared to what you expected he or she would contribute can help you identify candidates for rotating off the group.
• You may want to conduct a gap analysis from time to time to ensure that all necessary stakeholders continue to be included (Task 2.1).
  • New stakeholders can provide fresh perspectives to your group to ensure that products continue to be relevant and meaningful to your group’s audiences.
  • Continuously engaging new stakeholders also ensures that you’ll have stakeholders ready to fill leadership roles when current leaders move on.
  • If certain members were selected to contribute to specific products, you may consider replacing those members as each product is completed.
  • Assess the tradeoffs between adding new voices with the potential inefficiencies of increasing the size of the group, as well as the tradeoffs between having consistent membership over time with the energy and fresh viewpoints new members can provide.

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