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7/12/22, 10:30 AM Building Buy-In and Communicating with Stakeholders Transcript

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Riverbend City ® Activity

Building Buy–In and Communicating with Stakeholders

Introduction SAMC Clinical Unit Non-Clinical Stakeholders Conclusion

Introduction Your policy proposal was well received by the senior leadership at St Anthony Medical Center, and now they would like you to prepare a presentation for one of the stakeholder groups affected by your proposed ideas. The purpose of this presentation will be to inform the group about the future of organizational policy and practices, the current performance shortfalls, and a rationale for why the new policy and practices are needed.

As you move through this simulation, think about the responsibilities and needs for the various roles. Some of these needs may conflict with other stakeholder groups' needs. How can these conflicts be reconciled? What does leadership need to understand about the different stakeholder needs?

SAMC Clinical Unit

Clinical Stakeholders

7/12/22, 10:30 AM Building Buy-In and Communicating with Stakeholders Transcript

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Some stakeholder needs may conflict with those of other groups. Be sure to consider how or if these conflicts can be reconciled.

Comments Harold Liss Physician I've got to tell you, the last thing physicians want to hear about is more metrics or targets or benchmarks. We're getting buried under metrics and they always seem to be about squeezing more out of us. Burnout is a real problem and that actually has serious implications for quality and patient safety. Physician compensation structures are just focused on requiring or entreating physicians to do more, more, more. That kind of thinking contributes to a lot of the problems we're seeing in terms of wasteful practices. Most doctors are going to do the right thing most of the time, but the environment is becoming one where decisions are driven by profit over quality care and the culprit is often the fee-for-service system.

Janie Poole Clinical Nurse You won't find a nurse in this organization who doesn't support quality improvement efforts, but I'll be honest, most of the nurses I know feel like these initiatives just mean more work for nurses. If you are proposing changes to a clinical procedure or workflow, you will need to be very clear about how it actually imrproves on the current process. Are you solving a real problem or something that just looks like a problem?

Another thing to consider is staffing. We talk about staffing ratios all the time and the fact of the matter is that if you want to see improvements in quality, do something about staffing. That's the most important area you could target.

The nursing profession has been looking at quality assurance for decades. We're trained to be particularly sensitive to those aspects of patient care where the quality of nursing care delivered has a clear impact on patient outcomes. That's why nursing unions and professional

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organizations are so focused on staffing levels. We know that nurses are the front line for patient care, but we need to have an environment that supports our ability to provide quality care.

Tara Jennings Nurse Informatics Consider something like an EHR dashboard that provides real time clinical indicators for a particular unit. These indicators might include fall risk; pressure ulcer risk; medication information… there are so many indicators that could be tracked. The point is that individual nurses, unit nurses, and nurse managers all benefit from these kinds of solutions, but they also need to be part of designing and developing clinical processes because they are so close to the actual workflow.

Vickie Vasquez Care Coordinator Obviously, the details of your plan are important, but in general, you should know that care coordination can often be a key strategy for quality improvement. Care coordination — particularly for conditions like COPD or diabetes — has the potential to improve the effectiveness, safety, and efficiency of a person’s experience with a health system. Well-designed care coordination can deliver improvements, not only for patients, but also for the health care system, the insurance providers, and other third-party payers.

Now that you've spoken with some clinical stakeholders, answer the following questions: Who seems to be the best audience for your presentation?

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Your response:

yes The person who would be the best audience for your presentation will be highly dependent on the focus of your policy proposal in earlier assessments. In general, the best person to present to will be the stakeholder who is both the target audience of your policy proposal and in a position to champion your proposal.

For example, if your policy proposal focused on improving patient flow within the hospital, then Vickie Vasquez might be your best choice. Ultimately, when choosing stakeholders to present to, what is important is that you are able to identify what their stake in your policy proposal is, how they could help you to champion it, and how you can craft your message to best appeal to their views.

What are the areas of significant difference between stakeholders?

Your response:

yes There are a number of areas of difference between the stakeholders. Some of those areas are:

Harold Liss wants fewer metrics, while Tara Jennings is pushing for a new or wider utilization of an EHR dashboard. While both Janie Pool and Vickie Vasquez are seeking quality improvements, Janie thinks that quality should be addressed with improved staffing ratios, whereas Vickie proposes pursuing care coordination improvements. Tara Jennings proposes that nurses at all levels should be involved in designing and developing any new dashboards. Janie Pool might argue that dashboards are not necessarily solving a real problem, but what looks like a problem.

SAMC Offices

Non-Clinical Stakeholders

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What should Vila Health leadership understand about the issues these stakeholders are raising?

Comments Deborah McNary Community Advocate First and foremost, thank you for talking with me about this! So much of my work is centered around reacting to health care systems rather than working with the people within those systems. So my primary focus is elder care, so knowing how your policies and focus affect your older patients is important. It's also important for us to be able to communicate with you as you're shaping policies and policy changes. Even if it doesn't seem apparent that there's a connection to community health advocates, there might be. Are there metrics you're tracking that perhaps we could help support, such as eye exams or foot care for diabetic patients? Could care coordination efforts for behavioral and mental health patients be looked at from another angle? The biggest issue, in my opinion, is that the health care system be willing to extend the conversation outside the organization — but before the decisions are made, not after.

Ruby Young Board Member The thing to remember when looking at any of these issues is that the governing boards often have very complex obligations. Board members are expected to put measures in place to track and respond to the organization’s quality of care performance, obviously. But we are also expected to track and lead efforts around cost reduction, reimbursement, and reasonable levels of care. So, fiduciary responsibility is— much as people don't want to hear this — as important an issue for the board as is patient care. We're expected to balance these things, to preserve the integrity of the organization.

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Now that you've spoken with some non-clinical stakeholders, answer the following questions: Should either of these stakeholders be considered for the presentation?

Your response:

Yes Whether or not either Deborah or Ruby should see your presentation will largely depend on the focus of your policy proposal from previous assessments.

If your policy focuses on the elderly, or community or public health concerns, even tangentially, then it might be worth presenting to Deborah. If the policy change is more internally focused, it might not be as valuable.

If your policy has, or could use, a fiduciary viewpoint, it might be valuable to present to Ruby Young. This is both from a buy-in and feedback standpoint.

What areas of significant difference are there between these stakeholders and those in the first group?

Your response:

Yes There are a number of areas of difference between this group of stakeholders and the first. Some of those areas are:

This group of stakeholders seems to have broader views on health care and the organization than the first group. This group could help champion and give feedback on your policy proposal. However, it is unlikely that they would be directly involved with its implementation.

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If your proposal needs financial resources, Ruby Young is likely the only stakeholder who could mobilize those resources.

Conclusion

As you've seen, the issues you're exploring affect various stakeholder roles in very different ways. As you prepare your presentation, consider why you chose to focus on the group you selected and how their needs relate to the needs of the other stakeholder groups you heard from. You should also consider how to create buy-in from the chosen stakeholder group, perhaps by highlighting how your policy and guidelines will benefit their work. You may find it helpful to download the responses you made in this activity for later reference.

Licensed under a Creative Commons Attribution 3.0 License (https://creativecommons.org/licenses/by-nc-nd/3.0/)