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Appendix E-3. Sample Leading Practices Survey

Community quality collaboratives are community-based organizations of multiple stakeholders, including health care providers, purchasers (employers, employer coalitions, Medicaid and others), health plans, and consumer advocacy organizations, that are working together to transform health care at the local level. The Agency for Healthcare Research and Quality offers these organizations many tools to assist in their efforts.

Introduction to the Sustainability Pilot Project

The Louisiana Health Care Quality Forum (LHCQF) has been selected as one of two pilot Community Quality Collaborative (Community Quality Collaborative) sites for intensive technical assistance focused on developing and refining strategies for sustainability. This survey is one component in the pilot project to guide the LHCQF through this process.

The end product of this project will be a sustainability plan document and supporting workplan. Once the pilot projects are complete, the tools and results will be shared with all of the other Community Quality Collaboratives in the Learning Network.

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What You Need to Do: Stakeholder Survey

As a key stakeholder, your insight is vital to this strategic process. Please complete the attached survey, reflecting your unique viewpoint and ideas.

Please complete this survey electronically, and return it
via email to:
<insert contact information>
By <insert due date>

Your input will be consolidated with comments from other stakeholders to provide a baseline view of the current state and to shape the activities that will follow. You also may be contacted by phone for additional input or clarification. This information will be presented and reviewed with the LHCQF board at the August retreat.

For this pilot, we are surveying the following stakeholders:

  • Louisiana Health Care Quality Forum Board of Directors
  • Medical Home, Quality Measurement, HIT and Outreach and Education Committee members, subcommittee members and advisors

Please let us know if there are others you believe we should survey for additional viewpoints.

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If you have any questions, please contact:

<Insert Contact Information>

Planning Note: Using an automated, online tool to gather survey feedback saves time and effort.
A number of low cost, easy to use alternatives are available.

Date Completed 
Role in Louisiana Health Care Quality Forum 
Phone Number 

Please answer each question from your unique stakeholder perspective. Please feel free to provide additional comments. When you type information into the response boxes, the template will automatically expand the space as needed.

Please use the following rating scale on questions that ask for a rating:

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Rating Scale

5 = Very Effective
4 = Good
3 = Neutral or Mixed
2 = Fair
1 = Not Effective
0 = Not Applicable

1)  Value PropositionResponses & Comments
a)  On a scale of 1 to 5, how well does this collaborative meet the expectations of your organization?Rating:
b)  On a scale of 1 to 5, how do you perceive the balance between the investment required to participate in the collaborative and the benefits received?Rating:
c)  On a scale of 1 to 5, how does your organization perceive the balance between the investment required to participate in the collaborative and the benefits received?Rating:
d)  How effectively does this collaborative measure and report results?Rating:
e)  How effectively does the organization choose and allocate resources among worthy initiatives?Rating:
f)  What has been the leading challenge or criticism by your organization specific to the value created by this collaborative? 
g)  What do you see as the most significant challenge(s) to the sustainability of this organization? 

2)  Leading PracticesResponses & Comments
In the case studies of successful multi-stakeholder collaboratives, we have identified the following seven leading practices. Please rate how effectively the Louisiana Health Care Quality Forum is applying each of these practices. Please provide comments on any gaps or opportunities.
Responding to Compelling Market Circumstances
h)  Has the collaborative positioned itself to adequately address the compelling circumstances in the Louisiana health care arena that inspired its formation? 
i)  On a scale of 1 to 5, how effectively is the collaborative responding to new changes or circumstances?Rating:
j)  What compelling new opportunities would you like to see the collaborative pursue? 
Providing Effective Leadership
k)  On a scale of 1 to 5, how effective is the leadership at channeling passion into results?Rating:
l)  What future challenges do you see for the leadership of this collaborative? 
m)  Do you believe the collaborative and its leaders are leveraging an effective network of contacts throughout the community and health care industry?Rating:
n)  Do you have any suggestions for how the network could be enhanced? 
Delivering Tangible Value
o)  Do you believe the collaborative has effectively delivered tangible assets of significant value to its stakeholders?Rating:
p)  What high value assets or support has the collaborative delivered since its inception? 
q)  What additional assets or support would you like to see the collaborative deliver in the next 3 years? 
Communicating Proactively
r)  On a scale of 1 to 5, how effectively does the collaborative articulate its mission and value to the community and market?Rating:
s)  How does the collaborative assess community and market expectations? 
Maintaining Balance Among Stakeholders
t)  Do you believe that the collaborative includes the right stakeholders as active participants?Rating:
u)  Do you believe there is an effective balance among stakeholder interests?Rating:
v)  If not, what changes would improve the balance among stakeholders? 
Establishing a Transparent Management Style
w)  Do you believe the collaborative shares the appropriate type and amount of information about its activities with stakeholders, including the general market?Rating:
x)  If not, what additional approaches would you recommend to increase transparency? 
Employing Rigorous Prioritization
y)  Is the collaborative clearly focused on the right things? If not, what areas would you like to see getting more attention? 
z)  Do you believe the collaborative has an effective process for prioritizing projects?Rating:
aa)  Do you believe all stakeholders are clearly aligned on these priorities? If not, please explain. 

3)  ConclusionResponses & Comments
a)  Overall, how would you compare the effectiveness of this collaborative to other multi-stakeholder organizations you have participated in?Rating:
b)  Are there any other key points or challenges you believe are critical to the future sustainability of this collaborative? 
c)  Are there other participants you would recommend that we survey to get the full picture? 

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Page last reviewed January 2009
Internet Citation:   E-3. Sample Leading Practices Survey: Appendix E-3: Designing for Sustainability Stakeholder Survey. January 2009. Agency for Healthcare Research and Quality, Rockville, MD.


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