Stakeholder Engagement

About 3 years ago, I tried to pull together a coalition of providers to work together across the continuum of HCV care to increase the number of people who were screened, received patient navigation, linked and retained in care, cured, and prevented from re-infection. No one group does all of these activities so it required active collaboration and coordination between stakeholders. We got off to a good start with a meeting with various stakeholders to discuss the shared resources and opportunities to collaborate to assist with mutual challenges. But the coalition quickly lost steam for several reasons. The stakeholders were spread out across almost 5,000 sq miles, they were participating voluntarily, there was no good time for regular meetings (either during the work day or after hours), the coalition didn't seem to be a priority relative to other commitments, and all this made it hard to show any tangible progress towards our goals, which left people feeling less motivated. So I feel like I got off to a good start with identifying stakeholders and what resources they offer. But I need to find a way to try to keep the coalition engaged and active for the long-term.

I have not had many opportunities to participate in stakeholder engagement - however in one large grant I was on we were trying to build a coalition to take over the grant's work amongst our community partners once the state-level funding ended. The largest problem all the community partners were facing was financing these programs after the current grant ended. From the lessons this month I can see now how we really lacked any promoters to help us secure more funding - we had ample defenders in the communities who were interested in seeing the programs continue but no one with the level of power to move funding at the state level. Additionally, state employees in Massachusetts are not allowed to advocate (as promoters or defenders) - we prepare a report and then hope that others will take up the charge of getting additional funding. Thinking back now, had we been able to secure some publicity in a state newspaper like the Boston Globe, we might have been able to get more attention and support for our programs from general citizens which might have helped get something passed at the state legislature level.

I have had several experiences with engaging stakeholders, some were more successful than others. One of the (mostly) successful stakeholder engagement projects was when NJ received Ebola funding, and the HAI Program received funding that created our new ICAR (Infection Control Response and Assessment) team. Within the grant requirements, we had to create a subcommittee that pulled together stakeholders within the state DOH and also external to DOH. The various funding streams also required some the partnerships (ie working with preparedness group), which made some of the stakeholder engagement more successful. We had great/informative collaborative quarterly meetings for about a year. But as the attendance to the in-person meetings started to dwindle, there was lackluster involvement with the virtual subcommittee meetings. People who were not at the in-person meetings were NOT as engaged as those in the room. These meetings occurred PRE-PANDEMIC, so in thinking about starting these up again, the stakeholder engagement would need to start back at the beginning.

I have had different experiences with stakeholder engagement in my career. The most recent has been with long-term care stakeholders in the COVID-19 response. As the state agency, we have developed numerous guidance documents around long-term care, from surveillance and testing, to infection prevention recommendations and visitation. Each time we developed something new, we engaged with facilities themselves on a weekly call, biweekly meetings with long-term care provider organizations, and periodically, advocacy groups. While not all were enthusiastic about the guidance we provided, having a regular audience with them, providing our justifications, and hearing their concerns often was enough to get their buy in. Because the provider organizations work so closely with their members, they could notify us of potential problems and help us strategize solutions. It is often a lot of work to have regular audiences with stakeholders, it ultimately was well worth it and made the roll out of new guidance successful.

My most recent experience trying to elicit stakeholder engagement came in the form of a Legionellosis Response Team where we reached out to other DOH offices to recruit. We were hoping for consistent engagement from the state public health lab as well as Environmental Health, Drinking Water, and Healthcare-Associated Infections. Ultimately, we suffered from partnerships that did not align. While much of epidemiology is investigative and requires taking extra precautions based on specific circumstances, other aspects of public health are much more regulatory. Because these other offices did not have regulatory requirements related to legionellosis, we were unable to develop any true engagement. As the team picks up work on the LRT again in a post-emergency environment, we will definitely pull from some of the lessons learned in this month's reading.

One component of our grant was to facilitate data discussions with our local stakeholders who perform the patient testing for antimicrobial resistance at their clinic sites. I set up recurring (bimonthly) meetings with leaders of the different specialty areas (clinic, lab, field workers) to present data dashboards to them with quality assurance measures, such as how often they were missing an opportunity to collect a sample (certain criteria had to be met) and the reasoning behind it. They found this measure especially important because the medical director of the clinic was able to target her team huddle conversations around processes/workflows that needed to be improved in order to collect samples at appropriate times. 

I also recently used feedback from my coaching session with Kara to try new ways of talking about data with the clinic leadership, because I often felt like I was talking "at" them. By using more specific questions like "What part of this did you like/did you find helpful?" or "What do you think could be improved?", instead of just "Any feedback or comments?", this made the dialogue feel more natural. Those more specific questions are ones that a person would probably already have an answer formed in their mind, so when you ask it, it comes out easily, rather than them having to think/search for an answer. 

If anyone would like to see the data dashboards, I could share screenshots!

I had similar experience as Prabhu, several times actually, that the engagements and partnerships started well, but then quickly fell apart. Our lessons learned were 1) there need to be a balance between width and depth of stakeholders’ engagement; and 2) if the stakeholder is an organization (true most of the time), which person to connect to in the organization makes a difference. 

A tip that seemed to have worked for us is to break down a project by several objectives/activities, and engage different stakeholders accordingly. For example, our community health assessment (CHA) has a steering committee, data committee, communication committee, etc. One organization may have representations at different committee, but by different persons. This has helped us schedule meetings and maintain stakeholders’ interest level.