Using Stakeholder Mapping to Build Commitment to QI

Marsha Hughes-Rease

MSOD, MSN, RN

Magnet^®, Pathway to Excellence^®

With 30+ years of experience in Health care and over 10 years of consulting experience, Marsha Hughes-Rease brings a wealth of knowledge about organization effectiveness, culture change management, and group process to her consulting practice.

With 30+ years of experience in Health care and over 10 years of consulting experience, Marsha Hughes-Rease brings a wealth of knowledge about organizational effectiveness, culture change management, and group process to her consulting practice. She integrates this knowledge with her consulting expertise to help Health care organizations operationalize the Magnet^® Model to achieve a professional practice environment focused on achieving empirical outcomes in a changing Health care environment.

Marsha has consulted with Health care administrators, nurse leaders, and clinical nurses in 30+ Health care organizations that have earned ANCC Magnet Recognition, or who are on the Magnet or Pathway to Excellence® journey. Using an intentional and inclusive consulting approach, she focuses on engaging clinical nurses, nurse managers, and other key stakeholders to accelerate the achievement of Magnet Recognition or Pathway to Excellence. She collaborates with senior nurse leaders and the chief nurse executive to identify and take strategic actions to create organizational alignment and commitment to the organization's mission and vision.

Marsha’s consulting specialty areas include providing an organizational assessment and gap analysis for Magnet Recognition or Pathway to Excellence, identification of concrete actions to close the gaps, facilitating the development and implementation of a professional practice model, facilitating the development and implementation of a shared decision-making model compatible with the organization's governance structure, review of written documents for Magnet Recognition submission, readiness preparation for a Magnet Recognition site visit, and customized training. Marsha regularly facilitates the two day Journey to Magnet Excellence^® workshop. She has also co-designed and facilitates the one day workshop, Empirical Outcomes: Exceeding Magnet Expectations, which provides participants with an integration of practical tools to excel as change leaders.

Summary of Services

Helps determine readiness to submit a Magnet or Pathway to Excellence application based on a gap analysis.
Conducts a self-assessment that familiarizes participants with the Sources of Evidence in the Magnet Model while simultaneously gathering quantitative data to use as part of the gap analysis report.
Conducts a self-assessment that familiarizes participants with the Pathway to Excellence Elements of Performance while engaging them in action planning to address perceived gaps.
Conducts comprehensive on-site readiness assessments in preparation for Magnet site visits, a process which includes helping clinical nurses learn a communication technique that reflects self-confidence and competence, and articulates the value of nursing at the unit level.
Provides transformational leadership development specifically facilitating peer coaching techniques to address complex issues
Uses creative strategic planning techniques to increase staff nurse engagement, alignment with nursing strategic goals, and effective execution at the unit level.
Customizes education and just-in-time training on transformational leadership, structural empowerment, and change management
Works with senior leaders to design strategic interventions to address performance gaps.
Works with nurse executives to address challenges at all levels that may potentially derail the Magnet Recognition or Pathway to Excellence designation process.

Education

BSN, University of Kentucky, Lexington, KY
MSN, Nursing Administration, George Mason University, Fairfax, VA
MS, Organizational Development, Johns Hopkins University, Baltimore, MD

Certifications

American Nurses Credentialing Center – Certificate Holder in Fundamentals of Magnet^®
Fielding Graduate University, Santa Barbara, CA – Graduate Certificate, Leadership Coaching
Graduate Certificate, Skilled Facilitator, Johns Hopkins University, Baltimore, MD

Professional Memberships

American College of Healthcare Executives
American Nurses Association
American Organization of Nurse Executives
American Society of Training and Development
Institute of Coaching
International Coaching Federation
International Leaders Association
Plexus Institute
Sigma Theta Tau International

Special Acknowledgements

Published numerous articles and book chapters including a chapter on Transformational Leadership in the award-winning text, Nursing Management Principles and Practice(2011, Oncology Nursing Society)
Served as adjunct faculty member at George Mason University College of Nursing, is a faculty member at Duke Corporate Education, and is a certified Executive Coach.

Interprofessional collaboration is becoming increasingly important in a value-based purchase system. No one Health care provider can ensure that the patient receives the highest quality of care without collaborating with other providers. The Canadian Interprofessional Health Collaborative (CIHC) defines interprofessional collaboration as "the process of developing and maintaining effective interprofessional working relationships with learners, practitioners, patients/clients/families, and communities to support optimal health outcomes." According to CIHC, "Elements of collaboration include respect, trust, shared decision making, and partnerships."

Magnet®-designated hospitals are expected to employ clinical nurses who assume leadership roles in collaborative activities to improve the quality of care as reflected in Source of Evidence EP12 in the 2014 Magnet® Application Manual. A robust governance structure for decision making at the unit level provides an excellent forum to fulfill this requirement. When initiating a quality project at the unit level, it’s common for many key interprofessional stakeholders to be overlooked. (A stakeholder is a person or group that is involved in or affected by a course of action.) The later they are brought into the change process, the more likely there will be resistance to the change.

One way to facilitate interprofessional collaboration and accelerate the change process is to identify your stakeholders at the very beginning and develop action steps to ensure their commitment to achieving the goal. Here are some tips and a tool to help you map stakeholder commitment and develop action strategies to ensure collaboration.

Tips for Stakeholder Commitment Mapping

Brainstorm which stakeholders should be included as part of the change initiative or could be impacted by the change initiative.
Looking at Figure 1, place each individual or group in the stakeholder column.
Identify the current commitment of the individual or group to the change initiative using Figure 1 (For an explanation of the meanings of the letters or words at the top of each column, see Figure 2.) In this example, the current commitment of the physician group to interprofessional rounding is perceived to be zero since the majority of them may not even know about the initiative. Looking at the direction of the arrow, the desired commitment is to make them part of the group for making the change happen.
Draw an arrow from the column representing the current commitment of the stakeholder to the desired commitment needed for each individual or group.
Develop action strategies to move the individual or group from its current level of commitment to your desired level of commitment. If you know that you already have some members of a group who support the change initiative, enlist their help in developing strategies to target their colleagues.
Determine the critical mass of individuals or groups that you believe is needed to align with the change agenda to ensure success.

You are probably looking at this mapping process and thinking, "This will take too long!" However, I would encourage you to think about how long it may take to reach your goal if you fail to get all the key players on board. Sometimes you have to go slow in order to go fast. In other words, it is to your advantage to take the time to engage stakeholders, tackle the tough issues early on, and then speed through implementation.

My consulting colleagues and I recognize how important the unit governance structures and processes can be to ensuring improved quality outcomes. This is just one tool we can introduce to help your units and departments accelerate change in your hospital and ambulatory care settings.

This article was originally published in June 2015.

*Use of ANA Consultation Services does not guarantee you will achieve an ANCC credential. ANA consultants and staff cannot influence the actions of ANCC program staff nor decisions of the Commission on Magnet® Recognition, Commission on Pathway to Excellence®, or Commission on Accreditation in Practice Transition Programs and the Commission for Nursing Continuing Professional Development..