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Engaging Stakeholders to Improve the Quality of Children’s Health Care | Agency for Healthcare Research & Quality (AHRQ)

Engaging Stakeholders to Improve the Quality of Children’s Health Care | Agency for Healthcare Research & Quality (AHRQ)

AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

Engaging Stakeholders to Improve the Quality of Children’s Health Care

Implementation Guide Number 1

This Implementation Guide includes suggested steps and tips for implementing initiatives for improving child health care quality from the CMS-funded national evaluation of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Quality Demonstration Grant Program.
By Ellen Albritton, Margo Edmunds, Veronica Thomas, Dana Petersen, Grace Ferry, Cindy Brach, and Linda Bergofsky


About This Guide
The Important Role of Stakeholders
An Approach to Stakeholder Engagement
Step 1: Define the Goals, Scope, and Institutional Home of Your Stakeholder Engagement Process
   Task 1.1: Define the goals
   Task 1.2: Explore the feasibility
   Task 1.3: Establish the scope
   Task 1.4: Choose an institutional home
Step 2: Determine Whom to Engage
   Task 2.1: Determine the specific types of stakeholder voices you need
   Task 2.2: Identify and recruit stakeholders
   Task 2.3: Monitor the group’s membership
Step 3: Build the Stakeholder Group Structure
   Task 3.1: Develop a group identity
   Task 3.2: Define each stakeholder’s responsibilities and overall timelines
   Task 3.3: Establish a suitable governing body for the group
   Task 3.4: Form workgroups to generate products
   Task 3.5: Establish strategies to keep stakeholders engaged
   Task 3.6: Plan for sustainability
Step 4: Convene and Disseminate
   Task 4.1: Establish methods and schedules for convening and communicating with stakeholders
   Task 4.2: Generate concrete activities, products, and measurable outcomes
   Task 4.3: Disseminate products and achievements of your stakeholder group widely
Step 5: Assess the Quality and Results of the Engagement
   Task 5.1: Identify the purpose of the assessment
   Task 5.2: Select or create a sustainable and user-friendly assessment strategy
   Task 5.3: Field the assessment periodically and create a plan to encourage responses

The CHIPRA Quality Demonstration Grant Program

In February 2010, the Centers for Medicare & Medicaid Services (CMS) awarded 10 grants, funding 18 States, to improve the quality of health care for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). Funded by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), the Quality Demonstration Grant Program aims to identify effective, replicable strategies for enhancing the quality of health care for children. With funding from CMS, the Agency for Healthcare Research and Quality (AHRQ) is leading the national evaluation of these demonstrations.

The 18 CHIPRA quality demonstration States are implementing 52 projects in five general categories:

  • Using quality measures to improve child health care.
  • Applying health information technology (IT) for quality improvement.
  • Implementing provider-based delivery models.
  • Investigating a model format for pediatric electronic health records (EHRs).
  • Assessing the utility of other innovative approaches to enhance quality.
The CHIPRA quality demonstration began on February 22, 2010, and will conclude on February 21, 2015. The national evaluation of this demonstration started on August 8, 2010, and will be completed by September 8, 2015.

Additional information about the national evaluation and the CHIPRA quality demonstration is available at http://www.ahrq.gov/policymakers/chipra/demoeval/.

About This Guide

We have designed this guide to help State officials and other program administrators engage and partner with stakeholders in initiatives to improve the quality of child health care.1 Stakeholders can include a wide range of individuals and organizations, such as caregivers, clinicians, advocacy groups, and policymakers.By engaging stakeholders in your quality improvement (QI) initiatives, you can help ensure that the initiatives are implemented effectively, achieve intended outcomes, and contribute to sustainable changes in the quality of child health care.
This guide describes a five-step approach to engaging stakeholders:
  1. Defining the goals, scope, and institutional home of the engagement.
  2. Deciding whom to engage.
  3. Building the structure of the stakeholder group.
  4. Convening the stakeholder group and disseminating products.
  5. Assessing the quality and results of the engagement.
The guide breaks down each step into tasks, lists questions to guide your implementation of each task, and identifies key points to consider when determining what will work best for your State. Along the way, we offer links to additional resources to inform many of the tasks. You can use this guide as a starting point and tailor the process of stakeholder engagement to fit your State’s priorities, culture, and environment. Although this guide is focused on stakeholder engagement in child health care, the steps and resources provided may also be applicable to engagement efforts in other areas.
The guide is based on the early experiences of three States in the CHIPRA Quality Demonstration Grant Program that are using funds to engage stakeholders in meaningful ways—Georgia, Idaho, and Massachusetts. It was also informed by two additional CHIPRA quality demonstration States—Utah and Vermont—that assisted Idaho with its implementation via the National Improvement Partnership Network (NIPN). The appendix provides more details about the particular stakeholder engagement initiatives Georgia, Idaho, and Massachusetts are implementing as part of the CHIPRA quality demonstration.

Stakeholder Engagement in Three CHIPRA Quality Demonstration States

  • Georgia is forming both youth and caregiver stakeholder groups. These groups will play an active role in developing curricula for training youth and caregivers to be certified peer specialists (CPS) so they can participate in the child behavioral health workforce. Georgia will use the second half of the grant period for training and certifying youth and caregivers as CPS.
  • Idaho is building an Improvement Partnership (IP), a statewide organization that will support QI efforts for children. Named the Idaho Health and Wellness Collaborative for Children (IHAWCC) Link to Exit Disclaimer, Idaho’s IP will support providers by coordinating QI initiatives, including learning collaboratives and educational events. IHAWCC and its partners belong to NIPN, which gives them access to knowledge and resources from different States across the country.
  • Massachusetts has formed a statewide coalition called the Massachusetts Child Health Quality Coalition (CHQC). This coalition has identified and prioritized gaps in the quality and measurement of children’s health care and has formed task forces to address these gaps.
We developed our five-step approach based on semi-structured, in-person interviews conducted in the spring and summer of 2012 with staff from each State’s CHIPRA quality demonstration and members of the CHIPRA quality demonstration-funded stakeholder groups. We also used information from semiannual progress reports that the States submitted to the Centers for Medicare & Medicaid Services. To ensure that this information was current, we held informal discussions with key staff in the States in the summer of 2013. Finally, we scanned the literature on stakeholder engagement to identify additional resources.

The Important Role of Stakeholders

Involving stakeholders in QI initiatives and activities can bring many benefits to your State, such as:
  • Ensuring that your QI efforts represent a variety of perspectives.
  • Increasing the transparency of QI efforts.
  • Securing buy-in or increasing support from key decisionmakers.
  • Expanding your capacity for current and future QI efforts.2
  • Empowering community members to be involved in QI activities.34
  • Increasing public awareness.
  • Improving coordination of QI efforts.
  • Advancing policy changes at the State level.5
Stakeholder groups also can facilitate networking and collaboration, especially when they include experts and leaders from different QI areas. If you engage a broad range of stakeholders early in the QI initiative, you are more likely to have relevant, timely, and actionable results, thus helping to ensure the initiative’s success.6 By fostering collaboration among stakeholders, your State and other organizations pursuing child health care QI can use available skills and resources more effectively and efficiently.

An Approach to Stakeholder Engagement

We found that States had to make many major decisions when designing a stakeholder engagement process. These generally involved five major steps (Figure 1).
Figure 1. Steps for Engaging Stakeholders in QI Initiatives for Child Health Care
Figure 1 illustrates the five steps involved in engaging stakeholders in quality improvement initiatives. The five steps are (1) define goals, scope, and institutional home; (2) decide whom to engage; (3) build structure; (4) convene and disseminate; and (5) assess engagement. Two-headed arrows indicate the back and forth collaboration and communication involved between each of the first four steps and step 5, assessment.
Although the first four steps may take place in the numeric order shown in Figure 1, your process will vary according to the needs and resources of your State. For example, you may start by deciding whom to engage and let those stakeholders define the goals. Regardless of how you sequence these steps, it is critical to periodically reexamine how well the process is working—described in Step 5: Assess Engagement—and to modify your strategies as needed.
The remainder of this guide details the tasks involved in each step, key points to consider when making decisions, and the advantages and disadvantages of various options.
Current as of July 2014
Internet Citation: Engaging Stakeholders to Improve the Quality of Children’s Health Care: Implementation Guide Number 1. July 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/implementation-guides/implementation-guide1/index.html

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