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  • Sophia Webber and Erin McGaffigan, Collective Insi

COVID-19 is Changing Everything. Where are the Stakeholders?

Updated: Jul 2


In the midst of the COVID-19 pandemic, the need for stakeholder engagement is more evident than ever. We have closed our nursing facilities to visitors and we have nearly eliminated in-person community socialization. Caregivers, paid and nonpaid, also are required to provide more care with even less resources. These are examples of major policy decisions intended to save lives, but undoubtedly will have long-term, rippling effects.


With all this change going on around us, we expect stakeholder engagement to be a ‘must’ for finding solutions and paving the way to our new normal. Instead, meetings with stakeholders are more often sidelined while meetings among a few decision makers are held virtually. We must acknowledge and address the exclusion of those most vulnerable to COVID-19 in decision making and the impact this has on our COVID-19 response.


Do you know of a fabulous engagement strategy happening to inform a COVID-19 response? If so, share it with us at collectinsight.com.


COVID-19 Must Be a Catalyst, Not a Barrier, for Engagement


COVID-19 deaths among long-term care facility residents currently make up 43% of the total share of COVID-19 deaths in the U.S. (KFF 2020). Moreover, adults with intellectual or developmental disabilities contract Coronavirus at 4 times the rate of the general population and are 2 times more likely to die from the illness (Shapiro 2020). These disparities are compounded for Latinx and Black older adults and adults with disabilities, who also endure the racial health disparities causing disproportionate COVID-19 deaths in their communities (Jordan and Oppel 2020) While trying to protect those most vulnerable, we have made, as a society, assumptions and decisions about what is in the best interest of others. What we do not know yet is the impact of making these insulated decisions without fully vetting their repercussions.


COVID-19 must be a reason to expand engagement, not pause it. Without engagement of stakeholders, policies can miss their mark or be completely dismissed due to a lack of buy-in. Older adults and people with disabilities, especially people of color, are in fact those with the most at stake. Person-centered, high quality care and support in a world of COVID-19 cannot be executed effectively without their input.


Unfortunately, the crisis amplifying the need for engagement also presents the greatest challenge to it. In settings focused on vulnerable populations, limited resources are redirected towards new safety measures, thus deprioritizing engagement. Lack of PPE availability, combined with reorganization and/or furloughing of many critical staff (Fadel 2020), exacerbates the crisis. However, the redirection of resources away from engagement relies on a false dichotomy. The voices of those being left out are in fact required for an effective COVID-19 response.


Applying the “PAE Attention” Framework During COVID-19


Using the “PAE Attention” Framework, we have assisted decision makers to expand and improve stakeholder engagement activities across multiple settings and populations. Through this Framework, everyone is reminded that effective engagement requires sensitivity to three very important factor groups: the People, the Approach, and the Environment. The PAE Attention Framework continues to be important, and some may argue even more important, during the COVID-19 pandemic. Let’s take a look.




The People Factor

The people who you engage (or choose not to engage) will matter when it comes to making decisions. More often than not, the term ‘expert’ is used sparingly to include only those with initials behind their names. In reality, those most at risk for COVID-19 have a lot to say about what puts them at risk and what they are willing to do to minimize risk. Therefore, we must actively work to include and elevate the voices of stakeholders who are often left out of the decision making process, including Black, Indigenous, and People of Color (BIPOC). Engagement strategies can open our eyes to obstacles that stand in the way of safety of stakeholders, such as understanding why and how to use masks and to social distance. This information is invaluable when making policy decisions that will work.


The people doing the engagement will also matter. When developing new strategies to engage stakeholders during a pandemic, those responsible for these efforts need to be innovators and flexible (like we said, this is our new ‘normal’). They need to understand that expertise can come from lived experience. They also need to have outreach, facilitation, and communication skills that transcend traditional, in-person engagement tactics. Finally, they need to be willing to challenge their biases, recognize their privileges, and commit to dismantling systems of oppression in their work.


The Approach Factor

Like people, the approach matters. Engagement in the midst of COVID-19 must look different. Although many states have lifted their restrictions on in-person events, it remains our responsibility to provide engagement strategies that do not put people’s lives at risk. Organizations must look to the engagement spaces they have already created and ask how they can make them COVID-19 accessible to those they are excluding. One example is the People First of Washington Zoom videoconferences, which are held for individuals with disabilities to discuss the barriers they face accessing care and support during COVID-19 and to voice their concerns for future state funding cuts (Shapiro 2020).


COVID-19 has taught us many things, including that most in-person meetings are not essential. Virtual engagement is now our engagement ‘go to’ for the foreseeable future—so, we must make it work for everyone. This means finding platforms that can be used by the old and the young as well as by those who face hearing, seeing, mobility, and thinking obstacles. We also need to recognize weaknesses with the platforms chosen, advocate for design improvements, and prop these tools up with creative, ad hoc strategies to level the engagement playing field for everyone.


Even in times of crisis, accessibility cannot be sacrificed in favor of speed. An unofficial pause in the adoption of 508 compliance not only limits access to information, but also exacerbates the disparity that already exists when it comes to contracting and surviving COVID-19. Simple website navigation, including less cluttered pages that are accessible through screen readers, is critical to encourage participation among individuals who have disabilities and/or lower technological literacy rates.


Similarly, many organizations have generated exciting engagement material, such as webinars; however, many are created with the assumption that older adults and people with disabilities will not be (or should not be) the audience. Finding post-call transcripts, supportive materials, and phone numbers or emails for future questions or comments can be rare. Although these missteps may be a symptom of speedy adaptations due to COVID-19, they act as signals of participation discouragement for older adults and people with disabilities. This is especially true for BIPOC given such materials rarely reflect their languages, cultures, and colors.



The Environment

The influence of environment on engagement outcomes is not lost on us during a global pandemic. This current environment has shed light on humans’ ability to adapt and prioritize, which should tell us that the traditional reasons for avoiding stakeholder engagement (e.g., time or resources) are all relative. As decisions makers, it is important to reinforce a culture where ‘customers’ are seen as experts and where consistent, transparent, two-way information sharing is not just suggested, but required. Leaders should include stakeholder engagement expectations in their strategic conversations and quality metrics applied during our COVID-19 era as well as budget staff time to these efforts. While crises are never sought out, they often provide windows of opportunity for learning and systems change that previously went unnoticed. This often includes new funding sources to innovate and assist in crisis response, of which many encourage, if not require, stakeholder engagement.


Start Somewhere. Here are Some Ideas.


You may be asking what you can do now to get stakeholders engaged in your COVID-19 response. It is never too late, and here are some ideas:

· Run to, not away from, the infusion of accessibility into your existing initiatives, but also use this time of “new normal” to reprioritize engagement and to make newly developed activities virtually accessible to your stakeholders.

· Appoint a person (or people) in your organization who can develop a COVID-19 Stakeholder Engagement Strategy. Give them the ability to prioritize this work even amidst the chaos of a pandemic.

· Take time to ask stakeholders what they need to make engagement successful. Ask them what their concerns are Re COVID-19, and their solutions,

· Create accessible engagement through technology. The Nisonger Center of The Ohio State University has compiled resources for offering accessible and socially distanced mechanisms for engagement-- view the list here.

· Do more than add translated subtitles— explore the National Center for Cultural Competency’s website for resources to inform cultural and linguistic competency in your engagement.

· Incorporate anti-racism into all your initiatives; read anti-racism resources, seek out anti-racism training, and identify where BIPOC voices are missing in your engagement. This process is difficult and ongoing, but absolutely critical-- explore the Washington Area Women’s Foundation website for a jumping off point.

· Create an environment conducive to engagement- request that your leaders and staff identify ways to engage stakeholders in their COVID- 19 response and incentivize this work through staff evaluations and quality metrics.

· Get credit for what you do and consistently improve! Create a public communication loop to seek input from stakeholders and communicate how this input informs change.


Do you have suggestions on how we can improve our stakeholder engagement work? If so, share it with us at collectinsight.com



References


Fadel, Leila, Will Stone, Meg Anderson, and Robert Benincasa. “As Hospitals Lose

Revenue, More Than A Million Health Care Workers Lose Jobs.” NPR. NPR, May 8,

2020. https://www.npr.org/2020/05/08/852435761/as-hospitals-lose-revenue-

thousandsof-health-care-workers-face-furloughs-layoff.


Goode, Tawara N., Mathew McC N. McCullough, Octavio N. Martinez, and Dr. Yanira N.

Cruz. “Ensuring Linguistic Competence in Person-Centered Practices and System.”

NCAPPS (Webinar). National Center on Advancing Person-centered Practices and

Systems, May 20, 2020. https://ncapps.acl.gov/webinars.html.


Jordan, Miriam, and Richard A. Oppel. “For Latinos and Covid-19, Doctors Are Seeing an

'Alarming' Disparity.” The New York Times. The New York Times, May 7, 2020.

https://nytimes/com/2020/05/07/us/coronavirus-latinos-disaparity.html.

“Learn to Zoom! in Clear Language.” Nisonger Center. The Ohio State University, April

24, 2020. https://nisonger.osu.edu/learn-to-zoom/.


Shapiro, Joseph. “COVID-19 Infections And Deaths Are Higher Among Those With

Intellectual Disabilities.” NPR. NPR, June 9, 2020.

https://www.npr.org/2020/06/09/872401607/covid-19-infections-and-deaths-are-higher-

among-those-with-intellectual-disabili


“State Data and Policy Actions to Address Coronavirus.” KFF, June 2, 2020.

https://www.kff.org/health-costs/issue-brief/state-data-and-policy-actions-to-address-

coronavirus/?utm_source=web&utm_m

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