Section 3: Recruiting Advocates
As you are investigating possible partners, you also will be starting the process of recruiting. This step encompasses cultivating relationships, communicating the mission and goals of your Community Quality Collaborative, and determining together the potential fit between the advocate and the Community Quality Collaborative. Your goals at this point are to identify the most suitable options among the ones available to you and make the case for their involvement.
What You May Want to Find Out
As with a budding relationship with any potential Community Quality Collaborative stakeholder, it helps to start out by learning as much as you can about the advocates you are interested in. Take the time to get to know them:
- What are their organizational priorities?
- Where does health care fit into these priorities?
- What do they know about the issue of health care quality, and what is their interest in working to improve quality?
- How many paid staff does their organization have?
- What constraints might the advocates face in engaging in health care quality work? (e.g., a fundraising objective, a legislative platform that does not include health care)
- What external factors influence their work? (e.g., legislative calendar, election year, business community if union)
- Do they ever work with other organizations? Which ones and for what purposes?
- What programs, tools, etc., do they provide to the people they serve?
- How do they communicate with their constituents? (e.g., Web site, newsletter, listserv, annual meeting)
- What is their organization's “reach” (i.e., their membership, the people they serve or their constituency)? How many people do they communicate with via their Web site, newsletter, listserv, annual meeting?
- What are their professional interests as individuals?
- What challenges do they face in their day-to-day work?
You can use this information both to gauge whether your initial assessment holds true (i.e., that this person and the organization they represent really will be a good fit with your Community Quality Collaborative) and to assess how your Community Quality Collaborative could benefit from this person's experience and knowledge.
Suggested Messaging: Engaging and Educating
As you cultivate relationships with the consumer advocates, as with any new stakeholder group, it is important to communicate several points so they clearly understand what they are agreeing to do.
1. First, you need to explain why the work of your Community Quality Collaborative concerns them.
Not all advocates are aware of the issues surrounding health care quality. You will need to brief them on the nature and extent of these problems. If possible, try to put the problems in a context that is meaningful to them. Helping them see how access is a key element of quality-and how poor access contributes to poor quality of care-can be particularly useful. To the extent that information on quality can be tailored to their constituents (e.g., by geography, payer, disease, age), all the better. (Resources from HCUPnet http://hcupnet.ahrq.gov/ and NHQR http://www.ahrq.gov/qual/nhqrfact.htm noted earlier might be useful.)
Be careful not to overwhelm the advocates with detailed information. For example, you wouldn't want to start talking about quality measures with someone who is not already well-versed in quality issues. The purpose at this point is to engage more than it is to educate. Explaining the breadth of the quality problems-such as infections and medical errors-and the extent to which these quality deficiencies occur are compelling ways to help the advocates understand why improving quality is an important goal. Using personal consumer stories or patient vignettes about quality care also will resonate with many consumer advocates.
2. Second, it is important to make the connection for them between their organization's priorities and the work of your Community Quality Collaborative.
For example, if one of the priorities of an advocacy organization is to provide education, information, and support to people with diabetes, you can explain how the Community Quality Collaborative will gather and report information that enables consumers to choose a health care team that provides high-quality diabetes care. Additionally, most advocacy organizations will be interested in giving their constituents information about patients' experiences with health care providers and facilities, so if your Community Quality Collaborative will be reporting based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS), point this out to the advocates and explain how this information can assist consumers in making informed health care decisions.
A second key message involves the value to the advocates of participating in the Community Quality Collaborative's initiatives. It is natural for the advocates to want to know what's in it for them. While you may want to tailor what you say to the individual, there are a few points you can make:
- This is an opportunity to be involved in a fast-growing movement to improve health care quality. While the idea of assessing and reporting performance information to spur higher-quality care has been simmering for some time, in many communities it has only recently taken root. Participating in the Community Quality Collaborative puts advocates at the center of a promising initiative with national support.
- Participating advocates can tell their organization's members that their interests are being represented in a forum with diverse and important community stakeholders.
- Involvement in the Community Quality Collaborative enables the advocates to make sure that their colleagues in the Community Quality Collaborative understand the benefits and costs of the initiative from the perspective of the constituency that they represent.
- Participating advocates have access to a national network of advocacy organizations pursuing better quality and increased transparency.
3. Finally, it will be helpful to spend some time talking about advocate roles.
(See Section 4 for a discussion of the roles that advocates can play in the Community Quality Collaborative.) Some advocates may be better suited for certain roles than others, so discussing expectations up front can help minimize frustrations in the future and ensure that you recruit the best people for the tasks at hand. Similarly, Community Quality Collaborative leaders should be as explicit as possible about what will be required of participants in terms of time, resources, and/or staff. As noted earlier, the donation of the advocate's time may be all the organization can afford.
Advice About Communicating With Advocates
Based on several years of experience recruiting advocates around the country, the staff of the National Partnership for Women & Families offers the following tips:
Selecting the Right People
- Get a feel for the politics of the advocacy community. If possible, expand your network beyond the “usual suspects,” and ask questions to learn who is respected and who to avoid.
- Whenever possible, begin the process at a high level in the organization. A senior leader is in the best position to commit the organization to your Community Quality Collaborative.
- Choose advocates who will provide meaningful input, rather than the ones who will not “rock the boat.” However, be careful not to choose people who are likely to be consistent “naysayers.” Your goal is to find the people who will support your mission and will help move your Community Quality Collaborative forward productively.
- Frame the message as a win-win. Talk about how participating in your Community Quality Collaborative will benefit both the advocacy organization as well as the Community Quality Collaborative.
- Be positive-not critical-about the role of health care providers. Many consumer advocates have ongoing collaborations with the physician community.
- While your Community Quality Collaborative's activities may be intended to benefit everyone in the community, advocates are acutely aware that quality problems faced by some populations will not be eliminated quickly or easily. Acknowledge the limitations of a “rising tide” argument and be prepared to point out the ways that the work of your Community Quality Collaborative will impact the advocates' constituents positively.
- Be prepared to explain to the advocates the benefits of a more efficient health care system (e.g., reducing waste, such as duplicate or unnecessary tests). Advocates may be wary of the term efficiency and incorrectly associate the concept with limits on treatment, medications, etc., that could help their constituents.
- Anticipate that some topics, such as patient privacy, will be controversial for some advocates. It is not necessary to avoid those topics, but be prepared to address concerns that advocates are likely to raise, including how patient privacy is protected in your Community Quality Collaborative's transparency agenda.
- Let the advocates know who else will be at the table. Some advocates will be attracted by the opportunity to serve alongside their colleagues at other organizations.
- A presentation template to assist you in communicating with consumer advocates is provided. http://www.ahrq.gov/qual/value/caocvesl.htm | PowerPoint Version [ - 649.5 KB] | PDF Version [ - 359.46 KB]
As you get to know various consumer advocates and move toward recruiting some more intensively, there are several considerations to keep in mind:
- Timing. Don't allow the recruitment of consumer advocates to lag behind that of other member types. Adding them at the end will reinforce any concerns they may have about being peripheral to your Community Quality Collaborative's main objectives. If you do ask advocates to participate in Community Quality Collaborative work after all the other stakeholders are assembled, be sure to emphasize how important advocate involvement is to ensuring that the end results of your Community Quality Collaborative efforts benefit consumers, patients, and the public-at-large.
- Representation. Ideally, the advocates participating in your Community Quality Collaborative will represent a broad swath of the community. This does not mean that you cannot recruit someone associated with a narrow focus (e.g., an uncommon disease), but that you should try to strike a balance so that multiple interests have a voice.
- Resources. Ideally, participating advocates have sufficient resources to support their role as a Community Quality Collaborative stakeholder, whether by participating in meetings or by telling consumers about your Community Quality Collaborative's initiatives. However, making the availability of resources a criterion for participating in the work of your Community Quality Collaborative may eliminate some advocates with significant strengths who can provide other important benefits to your Community Quality Collaborative. Some Community Quality Collaboratives address this issue by establishing a reduced dues rate for consumers and advocacy groups.
- Initial Representation and Future Expansion. It is important to strive to have a good balance among stakeholders in your Community Quality Collaborative, including consumer advocates. Over time, it may make sense to add advocates to your Community Quality Collaborative, or replace those who have to leave. You can use this initial recruiting process as a way to identify and cultivate possible future participants so that you have a pool of relationships to revisit.
- The Messenger. In some communities, advocates may have preconceptions about other stakeholders, or even certain members of your Community Quality Collaborative. You may need to find a “trusted messenger” who can approach the advocates about the idea of participating in your Community Quality Collaborative. Ideally, this "trusted messenger" would be another consumer advocate, a representative from an organization that provides funding for advocacy initiatives, or a stakeholder who has a history of collaborating successfully with advocacy organizations.