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Moving to Impact: Creating Policy Alignment

      With over 2,700 fellows, the American Academy of Nursing's intellectual capital is vast. Adding the expertise of the honorary fellows yields infinite networks that create a depth and breadth of knowledge which encompasses nearly all healthcare issues and much beyond that scope as well. This is the true strength of the association. At the same time, that broad scope begs the question: can we do it all? This challenge is particularly relevant when it comes to policy matters. The world of policy is saturated with equally expert views that may be consistent, similar, or contrary to that of the Academy. When there are multiple stakeholders vying for airtime with policymakers, how can the Academy be a thoughtful and influential contributor? Can we and should we engage in all conversations? How does our work become actualized?
      For nearly a year, the Board of Directors has been considering this very question. We know many in our fellowship have as well. What is the voice of the Academy, and to that end, where, when, and how can we maximize our impact? There was no singular moment that called upon us to ask this question. Perhaps it was the dynamics at the national level or our natural curiosity as scholars to critically ask, “so what?” Whatever the reason, the challenge was real and we as a Board wanted to thoughtfully evaluate how to take the already incredible work and elevate it.
      Now, and for some time, the organization has been in transition. With the opportunity to bring on a new CEO, the Search Committee and Board of Directors were able to seek input from our members on the future direction of the Academy. We heard a resounding call for us to focus on our policy work. It was not just the need to produce more, but also the interest to see impact on national priorities. Policy work is a constant process that is linked to the political cycle. The issues may not change, but the policymakers may, as does the way things are phrased and advanced. This requires the Academy be nimble and strategic. However, it is not simply a matter of being the first organization to respond, or the number of policy briefs and press releases we write that measure our success.
      In a recent Harvard Business Review article (2018), the President of the American Enterprise Institute (AEI) grappled with this same question.
      Brooks, A.C. (2018, March-April). “AEI's President on Measuring the Impact of Ideas.” Harvard Business Review. Retrieved from: https://hbr.org/2018/03/aeis-president-on-measuring-the-impact-of-ideas.
      1Brooks, A.C. (2018, March-April). “AEI's President on Measuring the Impact of Ideas.” Harvard Business Review. Retrieved from: https://hbr.org/2018/03/aeis-president-on-measuring-the-impact-of-ideas.
      Arthur C. Brooks noted,“nonprofits struggling to measure effectiveness will frequently turn to whatever is easiest to see—usually inputs such as how much they've received in contributions or outputs such as how busy they have been. This is obviously inadequate, because what we're really interested in isn't inputs or outputs but impact.” (¶ 16).
      Reading the AEI's process and considerations demonstrated that first, the Academy was not alone in its quest for impact. Secondly, it reinforced the need for our association to assess where change would be beneficial. What Brooks discussed and what we know is that no single metric truly measures impact. For example, if a policy is changed, there are multiple stakeholders, influences, and politics that were ultimately contributing factors. AEI decided, “We had to find ways of measuring how much leaders wanted and sought our work” (¶20).
      During our last meeting in February, the Board started to assess this statement. In the past, we would review the action plans of the Expert Panels (EPs) and, in the most recent year, develop policy priorities. This year, we utilized a slightly different tactic. Still considering the feedback of the EPs, we looked at the national policy landscape and the political overlay to determine what would be the policy priorities of the organization. What we discovered was that this was not an easy process. We heard from our EPs policies that are priorities but at the same time we kept asking, “What do policy leaders want from the Academy?” We considered multiple frames to align our priorities more with the legislative cycle and the topics currently being considered by the Administration.
      We walked away with a clear solution, although not a clear and immediate decision. The Board decided, and as President-Elect Eileen Sullivan-Marx noted the old adage, “we have to go slow to go fast.” We recognized the moment in time for our organization had come to not add more, but focus. To do this, we must strengthen partnerships, be open to a new way of operation— informed by those in influential policy positions— and frame our work so that it resonates. Each of our fellows was inducted to the Academy for their sustainable impact. It is now time to consider the organization's sustainable impact.
      This will not be a task accomplished quickly or necessarily easily. Difficult decisions will need to be made as a non-profit organization with limited resources. However, the Board is incredibly excited about the future as we have a tremendous foundation. That foundation is built upon the association's previous work, its passionate and dedicated fellows as well as the networks of individuals who see the value in partnering with the Academy.
      Reflecting on 2018, the Academy took steps in this direction. For example, in the past year, the organization weighed in on some of the most important healthcare discussions such as opioids use, gun violence, and children separated at the border. On each of these issues the Academy was able to provide our cumulative knowledge, cultivated over years of research and clinical practice. We know that through partnerships and timing, the Academy bonded with a community of partners striving toward the same goals.
      Transitions are a natural cycle in all aspects of our lives. The Board of Directors recognizes that so too, the Academy is prime to continue its momentum during our time of transition. The most empowering piece of our transition will be member engagement. This is not just the work of the Board, this is the work of all of us. Together, working hand-in-hand, we move to impact. We move to policy alignment and ultimately, a larger stake in changing the health and wellness of all communities.