Building Consensus

At the conclusion of this module, participants will be able to:

• Assess stakeholder interest.
• Apply techniques for the establishment of project communication and feedback.
• Identify members of the project team. 
• State the role of a quality improvement (QI) Committee.
• Differentiate between the role of a QI committee and research committee. 

Stakeholder engagement- Without buy-in from stakeholders, practice improvement projects may become very stagnant, and the results may have limited potential for dissemination. Buy-in could be visualized as the wind behind the sails of the practice improvement ship. Everything may be in order and ready for implementation and results, but the investigator will have a hard time moving the project forward without support. Depending on the practice, stakeholders may include clients, staff, leadership, community representatives, organizational boards, and investors. Suggested steps for initiating stakeholder involvement include:

• Identifying stakeholders
• Stakeholder interest assessment
  1. What matters to each type of stakeholder?
  2. What is in it for them? 
  3. Are there any anticipated downsides?
• Establishing modalities for communication/feedback
  1. How will proposed projects be presented?
  2. What timeline is needed?
  3. Who will coordinate this effort?

Members of the project team- The project team size and roles will vary depending on setting and scope of the project. There will always be a project champion, sometimes referred to as a primary or principal investigator (PI).  Although this is more of a research term, it is still applicable when referring to the lead person of the QI project. Projects that result from academic ventures (such as doctoral projects) will often have a mentor, or content expert and a committee that includes a project chair. 

1. Review criteria for project-type 
2. Define project team for the specific project
3. Establish communication pathways for the team

Academic or professional project committees

• QI committees are frequently created in academic settings as a necessity for various accrediting bodies. Similarly, QI committees are a value addition in industry and community organizations
• Research committees are common in academic settings and support students as well as faculty with their scholarship endeavors. Additionally, many healthcare organizations have incorporated research committees as they realize the value of creating new knowledge. A research committee may also be referred to as an internal review board (IRB). IRB is required for original research, and many institutions require all projects to go through IRB for determination designation, even if the investigator feels the project is not truly research.
• While these committees are important for project commencement and completion, they are not considered part of the project team.

Feedback- Regardless of the type of project, it is essential that the project champion or investigator develop an open mindset for the receipt of feedback. Similarly, to the concept of the problem, feedback is sometimes thought of as negative, or criticism. Even poorly delivered feedback can be utilized. Feedback gives us insight into the thoughts and feelings of the audience; an audience that changes with each person who is exposed to the future results. Once the information is disseminated in a final work, there is no longer opportunity to shape the delivery for optimal understanding of the background, details, or implications of a project. 

• Practical application of feedback- Savvy project champions/investigators adapt to receive any feedback with a creative eye. For example, a reviewer may make a recommendation to the plan, and even if the recommendation cannot be literally integrated into the design, clarifications may be needed to help the reviewer understand the rationale. 

• Navigating conflicting feedback-What happens when feedback does not match? 
  1. Compare the differences in feedback.
  2. Determine if there are clear rules (i.e., APA feedback).
  3. If a clear rule is not present, gain additional reviewer clarification-if possible.
  4. If clarification cannot be obtained, seek guidance from the project team.
  5. Review the conflicting feedback and make an informed decision with established rationale.
  6. Integrate any potential clarifications that would support expression of rational into the project communication or final report.

Suggested readings

A Systematic Review of Stakeholder Engagement in Comparative Effectiveness and Patient-Centered Outcomes Research https://link.springer.com/article/10.1007/s11606-014-2878-x

Managing CSR Stakeholder Engagement: A New Conceptual Framework https://link.springer.com/article/10.1007/s10551-013-1913-x

Patient and Stakeholder Engagement in the PCORI Pilot Projects: Description and Lessons Learned https://link.springer.com/article/10.1007/s11606-015-3450-z

Stakeholder participation in comparative effectiveness research: defining a framework for effective engagement https://www.futuremedicine.com/doi/abs/10.2217/cer.12.7

Reference 

Agency for Healthcare Research and Quality. (2001). Translating research into practice (TRIP II). Retrieved from http://archive.ahrq.gov/research/findings/factsheets/translating/tripfac/trip2fac.pdf 

Zaccagnini, M. & White, K. (2017). The Doctor of Nursing practice essentials: A new model for advanced practice nursing. Burlington, MA: Jones and Bartlett