Step 1: Define the Goals, Scope, and Institutional Home of Your Stakeholder Engagement Process

The first step of the engagement process can be broken down into four tasks:

1. Define the goals.
2. Explore the feasibility.
3. Establish the scope.
4. Choose an institutional home.

Task 1.1: Define the goals

Your decision to formally engage stakeholders should be based on clearly defined goals, not just a general sense that engagement is a good idea or is expected. Defining these goals will help you explain to potential stakeholders, collaborators, and other supporters, including funders, why their support is needed. The following overarching questions may help guide your discussion with decisionmakers in your State:

• How will engaging stakeholders help you prioritize and achieve your programmatic goals?
• What would be the outcomes of a successful stakeholder process?
• Are there specific products or activities you want or need to generate through engaging stakeholders?
• Are there examples of successful stakeholder engagement that you want to borrow from?
• Are there alternatives to a formal stakeholder engagement process that could achieve the same goals?
• What are the drawbacks of not establishing a stakeholder engagement process?

Key Considerations:

• Consult the logic⁷ or key driver model⁸ for your QI initiative, if you have one, or consider developing one if you do not. The logic or key driver models can help you visualize a roadmap for your initiative, including how stakeholders could contribute to the activities and which outputs you need for your initiative to have the impact you want. These models also may be useful tools for communicating with stakeholders and potential funders.
• If one of the purposes of the stakeholder group is to define a QI initiative, it could be helpful to identify your State’s leading priorities in health care QI for children. Try:
  • Consulting relevant peer-reviewed and grey literature (such as evaluations of local programs or annual reports from child-serving organizations) specific to your State that may identify crucial gaps in care for children.
  • Reviewing media coverage about quality gaps in care for children.
  • Checking whether other organizations have already identified key gaps in the quality of child health care in your State.
  • Reaching out to policymakers, academic institutions, providers and their professional organizations, and others who work in child health care who may identify other needs that are not reflected in any current literature.
• Although you need to establish goals at the outset, your goals may evolve over time.
  • Stakeholders may dive deeper into the issues and discover new needs or opportunities for improvement.
  • Goals may also evolve during the process of gathering input and securing support and buy-in from the stakeholders that are participating in your group.
• Think about any potential products you may want to generate or activities you may want to sponsor during the course of stakeholder engagement. Consider the audiences for these products and activities, such as pediatricians and family physicians, policymakers, the media, and families.

Task 1.2: Explore the feasibility

Even with well-defined goals for your stakeholder engagement process, you must assess both what financial resources and other resources you will need to make that vision a reality and how practical your plans are. You can start by answering these questions:

• What resources will you need to accomplish your goals? Are those resources currently available, and if not, how could you obtain them? Will those resources continue to be available through the entire stakeholder engagement period?
• What are the political risks of embarking on a stakeholder engagement process? Conversely, are there any political risks associated with not having a stakeholder engagement process?
• Do you have the capacity—either internally or through a consultant—to identify and overcome forces opposing the engagement process?
• What might facilitate achieving your goals? What might hinder it? For example, are there statutory timeframes, existing partnerships, or other factors that could influence your ability to engage stakeholders?

Key Considerations:

• To avoid underestimating the cost of starting and sustaining a stakeholder engagement process, make a list of resources the stakeholder group may require to succeed. These could include:
  • Meeting space.
  • Staffing (administrative and professional).
  • Consultant services.
  • IT support for Webinars or teleconferencing.
  • Refreshments.
  • Creation and maintenance of a Web site.
  • Printed materials.
• Some individuals or organizations may feel threatened by the presence of a new QI initiative, and you may encounter some resistance to your stakeholder engagement process. Try to identify them in advance and plan to address their concerns.

Task 1.3: Establish the scope

The scope of the engagement includes many different components, such as the size, composition, duration, and reach of the group as well as the breadth of child health care issues included. Establishing the scope of your stakeholder group will help ensure that the structure of the group is well-suited to what you want to accomplish. To establish scope, you may want to ask:

• Does the goal require a sustainable, overarching structure to support stakeholder involvement in QI efforts?
• Is the stakeholder group needed for a specific, time-limited QI activity or product?
• Does the QI initiative necessitate both a sustainable structure and more short-term task forces?
• What size stakeholder group is optimal?

Key Considerations:

• The scope of your stakeholder engagement process will vary depending on your goals. Table 1 illustrates how your goals could help determine the scope of your stakeholder engagement process.

Table 1. Relationship of Scope to Goals

• You’ll have to consider tradeoffs when selecting an optimal size for your stakeholder group. As a rule of thumb:
  • Larger groups enhance your opportunity to include diverse perspectives and allow you to leverage the full array of stakeholders to further QI efforts.
  • Smaller groups make it easier to schedule meetings and stay focused on tasks.

Task 1.4: Choose an institutional home

Many times, stakeholder engagement will be conducted as part of a program housed within a specific State department or agency. However, you also may consider making another organization your institutional home, as doing so can provide a strategic benefit or needed financial or human resources for the group. You may choose to make another organization your group’s institutional home by:

• Expanding an existing group at the organization by adding new members or adding your goals to their priorities.
• Forming a new group under the organization’s auspices to support your particular QI initiative.

Each option, however, presents its own challenges. When selecting an institutional home where you can base your stakeholder group, ask the following questions:

• Do you have the financial (as well as nonfinancial) resources to support the group on your own?
• Are there existing organizations or coalitions that already represent the key stakeholders?
• Are the goals of these groups compatible with your goals?
• Why would these groups be interested in addressing your agenda? What can you contribute to the effort?
• What resources might existing groups be able to contribute?
• Are there any funding, statutory, or other considerations that would inhibit collaboration?
• Would the stakeholder group be more credible to potential stakeholders or end users of the group’s work if it had some independence from your organization? If so, which organizations are seen as most credible?
• How important is it for your group to be based in an organization focused on child health, as opposed to in a more general health organization?
• How important is it for you to retain control of the stakeholder engagement process? How important is it for you to be the visible lead for the process?
• What mechanisms are available to ensure that the group is responsive to your needs (for example, a memorandum of understanding, cooperative agreement, or contract)?
• What opportunities are created if you are freed from administrative responsibilities?

Key Considerations:

• Consider conducting an environmental scan⁹ to learn what stakeholder collaborations are already underway in your State. If such groups already exist, you have options to help improve coordination within your State and reduce duplication of effort.
• Although the State may not be viewed as a neutral location for the home of the stakeholder group, you can still ensure that the group’s leadership or governing body (Task 3.3) is inclusive.
  • An environmental scan can help you locate other organizations that you may be able to use to identify stakeholders or disseminate findings or products of the group.
  • You can also ensure that stakeholders benefit from such an arrangement. Benefits could include access to policymakers and better dissemination options for recommendations or products.
• A shortage of needed resources may be a determining factor in how much you collaborate with—or house your stakeholder engagement process within—another organization. Review the necessary funding and staffing levels needed to accomplish your goals to examine how partnering with another organization can fill your resource gaps (Task 1.2).
• If all QI initiatives for child health care are based in one organization, you may be missing important, diverse perspectives that should be included in your initiative.
• Make sure that any organization your stakeholder group collaborates with is seen as a welcoming and neutral place for all stakeholders you want to engage. For example, if the institutional home of your group is a children’s hospital, check that stakeholders who are not involved in the care of hospitalized children feel welcome and comfortable.
• If other stakeholder groups exist that do not meet your needs and you want to sponsor a new group, strategize how to avoid duplications and overtaxing the stakeholder community. This issue can be particularly acute in small States or communities where the same pool of individuals is asked to participate in multiple groups. One strategy is to be deliberate in the timing of your efforts, either by sequencing activities or by planning the overall schedule to accommodate key stakeholders.
• You may also want to have a formal method of tracking the work of other stakeholder groups to assess changes in their priorities or staffing and address overlap if it arises.

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