Securing Buy-in

Buy-in is a pledge to support and take part in the intervention. It’s an important part of establishing and sustaining equity programs.

Your organization is more likely to succeed in its initiatives if you have the concrete support of all of the stakeholders involved.

Roadmap Step 1 focused on creating a culture of equity throughout your organization. With a strong culture of equity, staff across the organization recognize disparities and take responsibility for addressing them – a general commitment and willingness to prioritize equity.

But what will stakeholders think about your plans for the specific equity program that you’ve designed?

That’s where buy-in becomes important. Buy-in from everyone in the organization—from leadership to staff to patients—is critical to the success of your disparities reduction activities. If buy-in is not present from the beginning, it will be difficult to implement and sustain your efforts.

What is buy-in?

Buy-in is the commitment of interested or affected parties to a plan. Ideally, this commitment is demonstrated through action, rather than passive acceptance.

Buy-in can be difficult to recognize, but it generally takes the form of a concrete pledge to support the project and to help it succeed.

For organization leadership, this might mean freeing up resources, such as staffing and meeting time – or it could mean giving the equity team the freedom and flexibility to test new ideas. This demonstration of trust in the equity team is a strong indication of buy-in.

Patient buy-in might mean that a patient is willing to showing up for an extra office visit with a certified diabetes educator, or even paying a co-pay.

Community buy-in could mean that a community leader is willing to help get the word out about the program at local gathering places, such as churches or recreation centers.

So who will you need to get buy-in from for your equity activity? Think about the activity you’ve designed, or others you’ve been considering for the future.

Why is buy-in important?

Staff Buy-in: Staff input is an important factor in ensuring that your activity will be adopted and properly implemented. Any new activity or intervention will affect staff, so it’s important to consider who might be affected, either directly or indirectly. Likewise, it’s essential to determine whose support and assistance you need to ensure the success of your program.

Patient Buy-in: Patient buy-in will help foster participation in your program, which can help ensure that it will be successful. Furthermore, if patients buy in to your program, it will influence whether they are eventually willing to pay for services related to this initiative. Willingness to pay will significantly impact the financial feasibility and sustainability of the activity.

Community Buy-in: Why is buy-in from the community important?

  • It will build trust. By building a partnership with community organizations, your health center can become a trusted resource in the community. This, in turn, will bring new participants and partners to your clinic for future equity efforts.
  • It will get the word out. Community stakeholders will be more likely to publicize the program if they are convinced that it’s a worthwhile endeavor.
  • It can help foster patient interest. The number of patients requesting to be involved can in turn increase your organization’s commitment to the initiative. With increased demand may come an increased willingness to support and sustain the effort. (Read more about Sustainability here.)


Buy-in and sustainability

Community and patient buy-in have an important relationship with the sustainability of your program. Sustainability is an important component any successful quality improvement activity that helps reduce disparities.

  • Community buy-in can help foster patient interest and buy-in: the number of patients requesting to be involved can in turn increase your organization’s commitment to the initiative. With increased demand may come an increased willingness to support and sustain the effort.

(You can read more about sustainability on the Roadmap Sustainability page.)

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

Speaking Directly

The direct approach was helpful for Olive View-UCLA, one of Finding Answers’ grantees, that 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.

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. Don’t forget to involve staff from all levels of the organization: for example, will reception staff or medical assistants need to play a role?

Minimize time burdens
When seeking staff participation in the design process, 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
This step is often left out: it’s important to report back to everyone who gave input. Let them know how their opinions were considered, what revisions were ultimately adopted, and why.



Different strategies for different staff groups

stakeholder interest chart

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.

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.

These data can come from pilot projects at your organization or from similar equity activities that took place at other institutions. You may find helpful examples in the FAIR Database.

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 aligns with the organization’s mission and values. Sufficient return on investment is often achieved via improved quality of care, enhanced perception of the organization by patients and the community, or 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.

Finding Answers offers a resource called “Making the Case for Equity” that summarizes arguments for investing in equity. This product may help make the argument to support equity.

Providers are often concerned with maximizing efficiency during the office visit. Consider strategies that enhance the care team and promote care management outside the clinic.

For example, you might be able to shift some responsibilities from physicians to the broader care team, or to increase the involvement of the pharmacist in patient care. Additionally, there are some programs that have explored incentive-based interventions and whether they impact REL disparities.

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 the Olive View example, openly acknowledge staff concerns, take steps to minimize the burden, and continually gather feedback.

Everyone cares about patient outcomes, 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 key to securing buy-in across the organization.

Getting buy-in from patients

Small Details Matter

One of our grantees, the University of Southern California, approached patients in large waiting rooms. Research staff 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.

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 South Side Diabetes Project works in practices and communities in the South Side of Chicago to reduce disparities in diabetes care and outcomes. Staff at the project found that having providers recommend patients for diabetes classes was a very successful recruitment strategy. The patients were often honored and excited to be “nominated” by their doctor.

The way you approach potential participants can also make a difference. Be aware that individuals may decide to participate based on other patients’ decisions.

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 of the program, 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.


Context is Important

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 successful because it appealed to the mothers’ primary concern.


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 South Side Diabetes Project have cultivated many community partnerships as a core component of their project. Here are some of their recommendations, based on years of relationship-building with community groups on the South Side of Chicago:

  • Give before you get. ‘Giving’ is about being reciprocal and a team player. Giving may be easier than you think: for example, a free lecture from a medical professional can mean a lot to community organizations. Giving isn’t just something that happens after people agree to work on your project – ideally it comes first. Become known in the community – because of your giving – before going to organizations to talk about ways in which they can help advance your agenda.
  • Be interested in other people’s agendas. Take interest in the goals and aims of your partners. You may have an agenda to advance, but so do they.
    For example: the diabetes project staff 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 event, and the project staff knew students who could help.
  • Meet with everyone you want to know, one-on-one, before you meet together as a group.  Individual conversations build personal relationships, and with those relationships come trust. Your potential partners get a better sense of who you are, and it helps people understand how you can serve their interests, too.
  • Meet partners where they are. This tip is important—in two ways!
    Literally: Meet partners at their office or location; don’t always make them come to you.
    Metaphorically: Work to understand the needs of your partners, and strive to forge a mutually-beneficial relationship.
  • Be a constant presence. Join a partner’s team for the long term – don’t just drop in for the projects that help your agenda. For example, volunteer to serve on their committees.
  • Be a champion for resource distribution. Help deploy your resources whenever possible. Share what you have, and they need—whether that’s space, volunteers, or material resources. Even small donations or loans can make a big difference in a partnership.