page.tpl.php
NODE.TPL.PHP

Strategies to Obtain Buy-in

The good news is that if you meaningfully involve stakeholders during the design of your activity (as explored in Roadmap Step 4, Designing the Activity), you will already have a head-start on gaining their buy-in. And when you approach new partners, buy-in should be easier to obtain because you’ve created an activity that is both feasible and relevant.

Buy-in From Staff

Staff input is essential for ensuring that your activity will be adopted and properly implemented.

Strategies for obtaining staff buy-in

Let staff know their input is key

Be sure that staff understands that their input is key and will inform the ongoing design, implementation and evaluation of the effort.

Consult everyone who will be affected

Think about which staff members are likely to be impacted by your equity activity and consult with all of them. For example, it may not just be providers but also the reception staff or medical assistants.

Minimize time burdens

When seeking staff participation in the design process, be sure to be respectful of their time and solicit information in the least burdensome way. For example, you could ask for their ideas at regularly scheduled staff meetings.

Report back to everyone who gave input

And this is a step that’s often left out: it’s important to report back to everyone who gave input and let them know how their opinions were considered, what revisions were ultimately adopted, and why.

Finding Answers Spotlight

Olive View-UCLA is one of Finding Answers’ grantees who grappled with the issue of obtaining staff buy-in. The team at Olive View held a meeting with front-line staff. They explained exactly how the project would affect staff workload and clinic operations. They discussed why the project was worth additional time and effort, and described the steps they’d taken to minimize burden and show respect for staff time. They also solicited feedback about how best to incorporate the intervention into clinic flow and adjusted the program to address staff concerns.

This direct approach was helpful in increasing uptake of the activity and securing buy-in from front-line workers.

Different Strategies for Different Staff Groups

StakeholderArea of Influence/ConcernBuilding the Case
LeadershipReturn on investmentPresent data on potential positive financial impact
ProvidersOffice visit efficiencyShow how activity will enhance the care team and coordinate care
Front-line staffClinic flowBe honest about potential impact and solicit input for improvement
EveryonePatient outcomesExplain your process and how activity should affect outcomes

Within an organization, different staff may be motivated for different reasons. Organization leadership, providers, and front line workers may have very different motivations. Finding Answers identified several themes through our grantee projects.

Leadership

We found that leadership was often most responsive to interventions with the potential for a positive return on investment and those that leveraged existing resources. If you can, present data that demonstrate cost savings or a cost-neutral outcome. Either can be a strong argument in support of your equity activity.

This data can come from pilot projects at your organization or from similar equity activities that took place at other institutions.

(As part of the Finding Answers program, we are collecting cost data from our 33 grantee projects and we’re happy to share this data with organizations wishing to adopt similar equity activities. Feel free to let us know if you’d like to learn more about this.)

It’s important to note that a return on investment is not necessarily measured in revenue. Leaders may choose to spend money on an equity activity because it helps to meet the organization’s mission and value objectives. These benefits are often achieved via improved quality of care, enhanced perception of the organization by patients and the community, or simply by meeting the moral imperative to address disparities.

Investing in equity can also help your organization comply with regulatory requirements and become eligible for federal dollars.

Finally, financial benefit may be accrued indirectly. If your organization is at the cutting edge of disparities reduction, funders may be more likely to support you.

As a reminder, Finding Answers offers a tool called “Making the Case for Equity,” summarizing arguments for investing in equity.

Providers

On to providers: we’ve found through work with our grantees that providers are often concerned with maximizing efficiency during the office visit. Considering strategies that enhance the care team and promote care management outside the clinic can help address these concerns.

For example, you might be able to shift some responsibilities from physicians to nurses, or to increase the involvement of the pharmacist in patient care.

Front-line Staff

With the introduction of a new equity activity, front line staff may be wary of impacting patient flow and room availability. As in our Olive View example, openly acknowledge staff concerns, take steps to minimize the burden, and continually gather feedback.

Everyone

Everyone cares about taking care of patients, so be sure to explain how the equity activity will help patients. Describe to staff how you conducted the root cause analysis and priority matrix, and why you designed this particular activity for your setting. Some staff will have been involved in these processes directly while others may be less familiar. Keeping everyone informed as much as possible is the key to securing buy-in across the organization.

Getting Buy-in From Patients

So now we’ve covered the people in your organization. Let’s move on to buy-in from patients.

Not all interventions require buy-in from patients – for example, an intervention that sends electronic reminders to providers does not need patient buy-in. But for many ambulatory QI activities, the success of the project relies on the patient’s active role in managing his or her condition.

There are several steps you can take to inspire active participation in the equity activity as it rolls out.

Carefully Consider Recruitment Strategies

Think carefully about recruitment strategies. For example, the Southside Diabetes Project, another group at the University of Chicago, works in practices and in communities in South Side of Chicago to reduce disparities in diabetes. Staff at the project found that having providers recommend patients for diabetes classes to be a very successful recruitment strategy. The patients were often honored and excited to be “nominated” by their doctor.

The way potential participants are approached can make a difference as well.

Be aware that individuals may decide to participate based on other patients’ decisions.

For example, one of our grantees from the University of Southern California approached patients in large waiting rooms. They noted that if one person declined the offer to learn more about the study, others tended to do the same. They were more successful when patients were approached in individual clinic rooms. On the other hand, if you have a recruiter that is charismatic and highly motivating, a group setting may be ideal.

Speak to What Motivates Patients

It’s important to help patients recognize the value of the program for them—while it may be obvious to you, the designer, new participants need to have the benefits emphasized in a way that feels relevant.

When you communicate with patients about the program, prioritize their perspective. Find out what motivates them and emphasize how the equity activity will help them meet their personal goals.

For example, one of our grantees at Yale University screened mothers for depression during visits to the pediatrician. They encouraged mothers to undergo treatment for the well-being of their children. This messaging was really successful because it appealed to the mothers’ primary concern.

Giving patients a choice in how the program will work for them also encourages buy-in. At the University of Southern California, our grantee had social workers guide patients with depression to choose the treatment they preferred; medication, therapy or both. They found that patients were more likely to enter care and receive more of the recommended treatment protocol when given this choice.

Getting buy-in from the community

Finally, let’s talk about getting buy-in from the community. Some of your equity activities may involve building partnerships with community leaders and organizations. Getting community buy-in to your equity activity is a critical part of this process.

Our partners at the University of Chicago Hospitals’ Southside Diabetes Project have had a lot of experience cultivating community partnerships. Here are some of their recommendations, based on years of forging successful relationships with community groups on the South side of Chicago:

  • You need to give before you get. Usually, it’s pretty painless: for example, a professional giving a lecture to an organization, can mean a lot. The ‘giving’ is about being reciprocal and a team player.

  • Be interested in other people’s agendas: don’t just advance your agenda, be honestly interested in their goals and aims.

    • Example: staff at the project once helped a local community group recruit facepainters -- not because they were experts in facepainting, but because it was a genuine need for the group’s community event.

  • Meet with everyone you want to know, one-on-one, before you meet together as a group. This builds trust and relationships. Your potential partners get a better sense of who you are. And, it helps people understand how you can serve their interests, as well.

  • Meet them where they are.

    • Literally: go meet people at their office or location; don’t make them come to you, and:

    • Metaphorically: work to understand their needs, and strive to forge a mutually-beneficial relationship.

  • Be a constant presence, long-term.

    • Become a part of their team in the long haul – Don’t just drop in for short term projects.

    • Instead, whenever possible, contribute to and participate in their organization – serve on committees, assist with planning, etc.

  • Be a champion for resource distribution. Help to deploy your resources whenever possible to help their organization.

    • Utilize what you have, and they do not. Be creative with ways you can help.

(There are a wealth of resources for effectively building partnerships with community organizations and leaders. As part of its community scan, CHCS will help you identify opportunities in your community.)

Test it out: roleplay practice

We’ve discussed tips for getting buy-in from patients, organizational leadership, providers, front-line staff, and community leaders. Now we’ll try a role play activity to practice getting buy-in from these various stakeholders.

Finding Answers facilitators will play the part of different types of stakeholders. Your job will be to “sell” us on the equity activity that you designed using the FAIR toolkit for homework. You want to get our buy-in for the equity project.

Roleplay, playing one of the following stakeholders:

  • Provider
  • Finance Director
  • Front-line staff who will implement your activity
  • Head of your CAB

Be sure to prepare specific asks: what are you hoping to get from the designated party? The more targeted your request, the more likely you are to get a pledge to action. To the extent possible, make your requests specific to your clinic’s situation.

The main points are collected in a product we call “Securing Buy-In” that’s posted in Moodle under Webinar 5. This product summarizes approaches to getting buy-in from the various stakeholders we’ve discussed today. We think you’ll find it useful as you implement your equity activity.