Date Presented 4/22/2018
We describe the development and implementation of a stakeholder engagement framework within a federally funded study evaluating postacute care. Strategies for using this framework to enhance clinical quality improvement initiatives and future research efforts are discussed.
Primary Author and Speaker: Jenny Martinez
Additional Authors and Speakers: Natalie Leland
Contributing Authors: Jeremy Furniss, Addie Middleton, Kendra Hanley, Eunjoo Pacifici, Theresa Murphy, Holly Holyk, David Karchem
BACKGROUND AND PURPOSE: The implementation of value-based payment models in postacute care (PAC; IMPACT Act, 2014) demands that occupational therapy practitioners demonstrate their distinct value and ensure high-quality care through quality improvement (QI) initiatives (Lamb & Metzler, 2014; Leland et al., 2015). Addressing the needs of key stakeholders is critical to effective QI that optimizes the impact, relevance, and implementability of efforts to improve care (Frank et al., 2014). In this study, we developed and implemented a stakeholder engagement framework tailored to rehabilitation QI. The framework parallels well-known conceptualizations of QI, facilitating its use in occupational therapy QI efforts. Importantly, it addresses a gap in the profession’s knowledge and builds capacity for rehabilitation-specific stakeholder engagement.
METHOD: For this qualitative study, we conducted a review of the peer-reviewed literature to examine knowledge about stakeholder engagement in clinical research. Our findings were systematically evaluated for common themes to develop a framework tailored to PAC rehabilitation. Implementing this framework, we identified and engaged relevant stakeholder groups (e.g., patients, practitioners, policymakers) from the PAC community to collaborate on the identification and evaluation of evidence-based, patient-centered practices for hip fracture rehabilitation. Next, we used our lessons learned and analysis of stakeholder perspectives to develop and refine a framework for PAC stakeholder engagement in QI initiatives.
RESULTS: We identified eight themes related to effective stakeholder engagement from the investigation of the literature. We translated these themes to a PAC context and organized them under four common elements of QI programming: (1) stakeholder identification; (2) project conception, design, and implementation and dissemination of findings; (3) data collection; and (4) development of a culture of equality and mutual respect. Next, we implemented our emergent framework in a study investigating PAC hip fracture rehabilitation. Our implementation of this framework led to the identification of multiple facilitators of and barriers to stakeholder engagement in QI initiatives. Lessons learned include the importance of strategically selecting stakeholder partners, engaging stakeholders early on, fostering overarching collaborations that go beyond the current project, constructing a project infrastructure that prioritizes strong relationships and communication, and building resilience within the project team to navigate the successes and setbacks inherent in authentic stakeholder engagement. These lessons informed the development of a revised framework that builds on existing, well-accepted models for QI and embeds stakeholder engagement throughout the entirety of rehabilitation QI initiatives.
CONCLUSION: The resulting framework guides the establishment of a sustainable, active community in rehabilitation QI initiatives and can be easily implemented alongside accepted best practices for QI. Although multiple barriers to stakeholder engagement were identified, our rehabilitation QI research was significantly enhanced by stakeholder engagement and has led to collaborative identification of occupational therapy’s distinct contributions to hip fracture rehabilitation in PAC.
IMPACT STATEMENT: QI initiatives that thoughtfully respond to stakeholder priorities and are easily implementable in a rapidly changing reimbursement and policy landscape are essential for occupational therapy to thrive. The proposed stakeholder engagement framework offers a clear strategy for strengthening existing quality improvement, advocacy, and policy efforts designed to demonstrate the profession’s distinct value and ensure that rehabilitative care meets client priorities.
References
Frank, L., Basch, E., & Selby, J. V. (2014). The PCORI perspective on patient-centered outcomes research.JAMA, 312, 1513–1514. https://doi.org/10.1001/jama.2014.11100
Improving Medicare Post Acute Care Transformation (IMPACT) Act of 2014, 113 USC H.R. 4494.
Lamb, A. J., & Metzler, C. A. (2014). Health Policy Perspectives—Defining the value of occupational therapy: A health policy lens on research and practice. American Journal of Occupational Therapy, 68, 9–14. https://doi.org/10.5014/ajot.2014.681001
Leland, N. E., Crum, K., Phipps, S., Roberts, P., & Gage, B. (2015). Advancing the value and quality of occupational therapy in health service delivery. American Journal of Occupational Therapy, 69, 6901090010. https://doi.org/10.5014/ajot.2015.691001
