Step 3: Build the Stakeholder Group Structure

Stakeholder engagement can take many different forms, and the structure for your stakeholder group should align with your goals. You may find that you have volunteer stakeholders with skill sets to help you organize the group, or you may want to bring in specific staff or consultants to help. The tools listed in the box provide useful tips for organizing stakeholder engagement efforts, including strategies for facilitating better engagement, methods for building the necessary structure, and lessons learned from existing stakeholder engagement initiatives.

There are six tasks involved in building the stakeholder group structure:

1. Develop a group identity.
2. Define each stakeholder’s responsibilities and overall timelines.
3. Establish a suitable governing body for the group.
4. Form workgroups to generate products.
5. Establish strategies to keep stakeholders engaged.
6. Plan for sustainability.

Task 3.1: Develop a group identity

Developing a clear identity for the stakeholder group helps promote cohesion and can help make the group known to the broader public. To facilitate this element of your engagement, explore the following:

• How might stakeholders differ in what they see as the mission of the group?
• What common ground exists that can help you reach consensus on the group’s mission?
• Which key members of the child health quality and policy community, external to the stakeholder group, do you want to be familiar with your group?

Key Considerations:

• Developing a charter¹¹ or similar document outlining the stakeholder group’s vision and priorities can help ensure that all members have a common understanding of the group’s mission.
• Solidifying the group’s identity allows the group to become more well-known in the child health care community and provides additional credibility. This can lead to new sources of funding and greater integration and involvement with other child health care initiatives.
  • Spending time together at a retreat or workshop can help forge team spirit and a sense of common goals.
  • Several strategies can help solidify the group’s brand or identity. Examples include the development of logos, taglines, and a Web site.

Task 3.2: Define each stakeholder’s responsibilities and overall timelines

In order for the group to work efficiently and meet its targets, it is important to clearly define responsibilities and timelines for all stakeholders. You may want to ask yourselves:

• Are there some responsibilities that are best taken on by one person, and are other responsibilities better suited to a small group of stakeholders?
• How can you best match the knowledge and experience of the stakeholders to the specific tasks that need to be accomplished?
• When do you need to make specific recommendations or develop products so they are both timely and useful?

Key Considerations:

• Help stakeholders clearly understand their responsibilities. Be explicit about:
  • The number and frequency of meetings or conference calls in which they will be expected to participate.
  • The type and amount of work they will be asked to do between meetings.
  • The timeline for completing each activity or product.
• At the outset of the stakeholder engagement, take an inventory of the areas of expertise and skills of stakeholders so that you can match them to specific tasks or focus areas. This will allow you to best utilize the knowledge and experience that stakeholders bring to the group.
• Consider having members of the governing body (Task 3.3) or State staff members hold one-on-one conversations with stakeholders. It takes time, but it can be valuable to mutually decide on the best role for that individual or their organization in contributing to the group.
• Instead of asking open-ended questions or issuing broad requests for stakeholders to complete tasks, try approaching busy individuals by asking focused questions or requesting assistance with a task that is specific or time-limited.
• Clearly communicate timelines for any activities or products and include stakeholders in setting timelines.
  • Clear timelines and milestones assist in keeping the group focused on its goals and increase the likelihood that deadlines will be met.
  • When you map out a timeline for an entire activity or product, include a buffer to accommodate unforeseen circumstances. This helps you avoid underestimating the amount of time needed.
  • Make sure to reserve enough time to solicit and incorporate the perspectives of all relevant stakeholders.
• As discussed in more detail in Step 5, evaluating how well stakeholders understand their responsibilities lets you make any necessary adjustments.

Task 3.3: Establish a suitable governing body for the group

It may be useful for a smaller set of members to serve on a governing body of the stakeholder group, such as an executive board, to help guide and manage the group. In deciding whether or not to do so, as well as how to structure such a body, you may want ask the following:

• Does the size, workload, or timeline of the stakeholder group indicate that a governing body may be necessary to keep all stakeholders focused on the agreed-upon goals and timelines for outputs?
• What authority would the governing body have? What would it be expected to accomplish?
• What is the most appropriate method of selecting stakeholders to serve on the governing body? Election? Volunteers? Appointment by State staff?
• Are there members that should be included in the governing body for political reasons?
• Are certain perspectives crucial to include in the governing body?
• What qualities should you look for in members serving on the governing body?
• Should there be a chair or cochairs of the governing body? If so, how will these individuals be selected?

Key Considerations:

• Governing bodies are particularly useful when:
  • The group has a multi-stakeholder structure with broad representation.
  • Multiple planned activities will be happening simultaneously.
  • The stakeholder group is planning on focusing on more than one area of QI.
  • The timelines require quick turnaround on decisions the group must make. It is faster and easier to convene a governing body than an entire group.
• A governing body can assist the stakeholder group by:
  • Drafting and reviewing meeting agendas.
  • Ensuring individual members and the group as a whole stay on task.
  • Supporting communication across different workgroups.
  • Soliciting, synthesizing, and representing the other stakeholders’ opinions and feedback.
  • Driving strategic planning for the group, including plans for securing funding and ensuring the long-term sustainability of the QI initiative(s).
  • Handling time-sensitive issues that arise between regular meetings.
• There may be specific qualities you need from the members of the governing body, but generally, a governing body needs members who:
  • Are impartial; in other words, members who have the ability to put aside personal priorities and listen to others carefully and without bias.
  • Are respected by others in the stakeholder group and in the community.
  • Are strategic thinkers and are able to align QI priorities with the knowledge, skills, and attitudes of involved stakeholders.
  • Are enthusiastic about the QI activity.
  • Can commit the necessary time.
  • Have visibility at the State level to secure and maintain external support for the stakeholder group.
• Consider using time-limited or rotating positions to ensure a diverse mix of representative stakeholders.
• Consider having the full stakeholder group or the governing body itself choose one or two members to serve as the chair or cochairs.
  • Select chairs with demonstrated communication skills with diverse groups.
  • The chair(s) would lead and facilitate meetings and be responsible for communication between the governing body and the larger stakeholder group.
  • If using a cochair system, ensure that each chair represents a different perspective or role within the stakeholder group (for example, one chair could represent providers and one chair could represent the public policy community).
• Consider different ways of providing those serving on the governing body with additional support, such as:
  • Providing leadership training.
  • Offering administrative support from State staff or the institutional home.
• For some stakeholder groups, a separate governing body may not be necessary.
  • When operating without a governing body, you can effectively manage the group by focusing on clearly defining stakeholder responsibilities (Task 3.2) and maintaining effective communication (Task 4.1).
  • An alternative route would be to hire a professional facilitator for at least some meetings. This approach may require some additional resources, but it can be quite effective in team building.

Task 3.4: Form workgroups to generate products

Although sometimes it is important for the entire stakeholder group to make a decision or undertake a task together, certain activities may be better accomplished through establishing workgroups. Questions you may want to ask include:

• Are there discrete activities that would be managed more effectively by a separate workgroup?
• What resources (described under Task 1.2) would be needed to support the workgroup(s)?
• Would each stakeholder be expected to serve on at least one workgroup?
• Would all volunteers be welcome to serve on a workgroup?

Key Considerations:

• Smaller workgroups can help the larger stakeholder group by:
  • Focusing on generating a specific product, such as developing a tool for use outside the stakeholder group.
  • Conducting an environmental scan (Task 1.4) or other research needed to help the larger stakeholder group reach a decision.
  • Allowing stakeholders to participate in specific activities that align best with their interests and expertise.
• The structure and membership of the workgroups can vary based on particular needs and circumstances.
  • Workgroups can work in between meetings of the full stakeholder group, allowing:
    • Quicker progress to be made on the activities and products.
    • Meetings of the full stakeholder group to focus on larger issues.
  • You can augment workgroups to include people who are not a part of the full stakeholder group (for example, other community members with particular knowledge or expertise they can contribute to the workgroup’s activities).
  • You may want to assign paid staff to each workgroup to provide administrative support and to help ensure the group remains on task.
  • These workgroups may be permanent if there are long-term activities that could be served with such a structure. Alternatively, you could dissolve or reorganize workgroups after completion of the activity.
• It is important to communicate roles, responsibilities, and timelines clearly to each workgroup as a whole, as well as to the individual members of those groups.

Task 3.5: Establish strategies to keep stakeholders engaged

You will need different strategies to keep different stakeholders engaged. For this task, ask the following questions:

• What is motivating the stakeholders to be a part of this group?
• How might engagement strategies vary across different types of stakeholders?
• Do the sources of the funding or other regulations place restrictions on what you can offer to stakeholders to maintain engagement (for example, payment, refreshments, continuing medical education credits)?

Key Considerations:

• Seek and, where feasible, establish reliable sources of funding to implement stakeholder recommendations, as this gives stakeholders confidence that their work will be used to improve the quality of child health care.
• Provide additional training or education. This can also level the field for stakeholders from different backgrounds and experience by, for example, ensuring that they are all comfortable with and understand the language being used or by helping nonclinical stakeholders understand clinical issues.
• Encourage the stakeholder group’s leader(s) to use face-to-face conversations with individuals to build personal relationships and maintain connections with stakeholders.
• Report back to stakeholders on how their input and products have made a difference, assuring stakeholders that their work is valuable.
• Provide “value-add” benefits to stakeholders. For example, you can provide:
  • Information on grant opportunities.
  • Ideas for grant proposals and letters of support.
  • Time for networking with each other.
  • Opportunities to hear from substantive experts.
  • Opportunities to share concerns with State leaders and other decisionmakers and to submit written input on State and Federal policy issues.
• Establish reciprocal support arrangements, such as an agreement to collaborate or at least to consider collaborating on initiatives of interest to individual stakeholders.
• Provide some kind of financial support, including covering membership dues to a relevant organization, providing a stipend (for example, for transportation or child care expenses), or paying for stakeholders to attend a related conference.
  • This is especially important for parent or family stakeholders, who are more likely to be volunteering their time as opposed to attending meetings during their paid work time. Stipends for families demonstrate that family input is valued as much as input from organizational representatives.
  • Providing some kind of financial support may not be possible due to the source of funding, the institutional home, or other regulations to which the group must adhere.

Task 3.6: Plan for sustainability

Planning for sustainability is very challenging, and it should begin at the very outset of the engagement. Ask yourself the following questions:

• How long do you need to maintain your stakeholder group? Is it only long enough to finish a discrete task or activity, or do you want to create a self-sustaining, permanent stakeholder group (Task 1.3)?
• Which of your current resources are time-limited?
• What additional resources will you need in the future to continue and possibly grow the efforts of the group?
• What elements of your engagement could cause burnout among your stakeholders, and how can you modify these elements to encourage sustained involvement?

Key Considerations:

• One of the greatest challenges to sustainability is securing adequate funding to maintain stakeholder initiatives after the initial funding source has expired. Not only does securing funding allow you to continue your QI efforts, but as discussed in Task 3.5, having adequate funding can be helpful in engaging stakeholders.
  • Consider diversifying your funding sources early on. Sources could include grants from Federal or State governments or private foundations and support from other institutions that stand to benefit from your QI efforts (for example, hospital systems and payers).
• Be sure to balance efforts to obtain new funding with work that supports current activities.
• Working with an outside organization or contractor who has experience in applying for funding can be helpful.
  • You also may be able to build discrete revenue streams into your QI efforts, both to support those efforts and, more generally, to support stakeholder engagement. For example, you could ask participants to pay a registration fee for Webinars or learning collaboratives produced by the QI initiative. However, you need to monitor this strategy carefully to avoid excluding individuals who are unable to afford even modest fees.
  • If the group can produce concrete products that have a measurable impact, you can improve the potential for securing additional funding.
• Early on, you may want to ask the governing body or a particular workgroup to specifically focus on planning for sustainability.
• Guard against burnout by keeping demands on stakeholders reasonable. If the demands or scope of the group change, revisit Step 1 to determine if changes in the size of the group may be necessary.
• If stakeholders unexpectedly leave the group, conduct exit interviews to determine why they are leaving. Use information from periodic assessments to be responsive to members’ concerns (Step 5).

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