Although advocacy can be defined in a number of ways, essentially, it is the process of undertaking active interventions with the explicit goal of influencing government.1
The American College of Surgeons (ACS) interacts with decision-makers on behalf of surgeons on two levels: case-based and systemic advocacy. Case-based advocacy occurs when the ACS assists individual Fellows or small groups of Fellows to address specific issues that may be reconciled with decision-makers at the local, state, or federal level. The second, and by far the more common approach taken on behalf of Fellows, is systemic, sometimes known as cause-based advocacy, which takes knowledge from individual cases or issues and combines it to form collective advocacy for systemic changes through legislation or regulations.2 The ACS Division of Advocacy and Health Policy (DAHP) works with Fellows to develop policy positions that inform the division’s collective advocacy. Case and systemic advocacy produce positive policy changes on an individual and/or structural level.
Passive versus active advocacy
The DAHP provides opportunities for Fellows to participate in advocacy through a passive or an active approach. Passive advocacy occurs when the organization or representative for the individual or cause speaks on behalf of another person or group.3 Busy surgeons need to have a strong passive advocacy mechanism in place that protects their ability to provide care to their patients. The ACS DAHP provides passive advocacy as a member benefit to surgeons, building policy that can bring about positive systemic change for surgeons, surgical practices, and surgical patients.
Active advocacy, on the other hand, occurs when people, in this case surgeons, speak for themselves. The ACS provides the tools and resources to help surgeons advocate individually, such as when a Fellow uses SurgeonsVoice to write a letter or schedule a meeting with a member of Congress.
The advocacy framework as established earlier in this article relies on an external or internal mechanism. External advocacy occurs when advocates work outside of a system, whereas internal advocacy refers to advocacy that works within established systems.2 An example of external advocacy is a protest. The ACS focuses primarily on internal advocacy—working to improve the system over time and with incremental change.
Policy is many times developed by actors in a particular advocacy framework. As these frameworks often arise from like-minded parties that exist in the current system, are motivated by the same problems, and, in the end, share a very similar perspective, the policy solutions can fall short of capturing all sides of a problem. However, successful advocacy depends on multiple voices and perspectives rallying around a clearly defined solution. Advocacy is an imperfect process; indeed, it is very fluid and fraught with the unexpected, but the ACS DAHP strategizes ways to promote and enact policy changes developed by its experts and Fellows to implement positive systemic change for surgeons. Strategic advocacy requires a process that captures the policy perspectives of multiple parties and capitalizes on opportunities to achieve a unified desired outcome.
Work the process
A multitude of political process theories exist, but, essentially, most advocacy efforts fall into one of two categories: reactive or proactive. Reacting to the policy positioning of others usually leads to a weak outcome for the individual or group with the alternate perspective. Policy groups or individuals without a specific agenda often find themselves in a reactive stance. It is far better to proactively create policy change. For the purpose of highlighting strategic advocacy process development, this article focuses on proactive advocacy.
Understand, troubleshoot, and solidify policy solutions
Policy teams work to ensure they have developed clear solutions that will lead to positive change. Although they try to account for all perspectives, systemic advocacy makes it difficult to ensure a full understanding of all, especially counter, perspectives. Advocates need to think through the reactions of other entities before they propose solutions to decision-makers. Anything that can be done before pitching the proposal to legislators will help strengthen the likelihood of a good outcome. One of the first questions a decision-maker may ask is whether anyone opposes this concept. Many times, a legislative solution is not going to move through the process if any controversy is associated with it. It is well worth thinking through the opposition’s views before trouble hits.
For advocacy teams to succeed, they must be able to understand the policy well enough to sell the solutions to a multitude of perspectives and broker compromise as necessary.
Additionally, advocates need to ensure that their messaging is clear, easy to understand, and shown to be mutually beneficial to all stakeholders. For advocacy teams to succeed, they must be able to understand the policy well enough to sell the solutions to a multitude of perspectives and broker compromise as necessary. Solidifying and refining solutions to ensure clarity can save loads of trouble down the road.
Define your strategic plan
Timing is everything
As the adage states, there is a time and a place for everything. Most policy comes with a set of steps or several solutions.4 With regard to place, some of those solutions may best be resolved at different levels of government: local, state, and federal. Having a basic understanding of what might best be resolved at a local versus federal level will help to focus the target area. It also is possible that some of the solutions can and should be resolved on the private side. Determining the appropriate level of government is the first step in focusing the advocacy strategy.
Likewise, there is an appropriate time to ask for certain solutions. Understanding the broader political landscape is crucial to determining areas of focus within a set of recommended policy solutions. Knowing what other significant issues are the focus for decision-makers will help narrow or target which solutions might be most likely to gain momentum. In fact, it is best to frame the advocacy, if possible, around the topic of the moment.
Decision-makers need to know what the impact will be on the most important issues of the day. They also need to know if it is relevant to what they are discussing as solutions to other challenges. Obviously, this strategy works only if the solution does, in fact, relate back to the underlying and dominant issue. If pitching a policy solution does not seem to resonate in the moment, it is often better to wait for the right circumstance rather than appear insensitive or self-serving, which can hurt the likelihood of success in the future. Patience and tactfulness are essential.
Once the level of government that needs to be involved and the appropriateness of the moment are determined, focusing the policy solutions down to achievable goals is a good action step. Typically, more than one issue can be addressed, but ideally, the scope of discussions should be limited to fewer than 10 topics.
Develop measurable outcomes for each focus area
Knowing what the end goal looks like is essential to any advocacy plan. Is the goal to eliminate a barrier by changing an underlying law? Would gaining more information to further policy development serve as an accomplishment? Whatever it is, a vision is helpful in explaining what achievement looks like to a would-be champion for the policy solution.
Set milestones and steps along the way
With the end result in mind, measurable outcomes are important to determine whether progress is being made. For example, ensuring introduction of legislation in both the U.S. House of Representatives and the Senate might be a good measurable step toward the enactment of a policy solution. Checking on the milestones along the way can build collaboration between advocates and the decision-makers serving as champions for the policy solutions. Setting realistic short-term goals in addition to the long-term objective helps to verify the likelihood of proposed policy achieving success.
Write it down
Make the strategic plan real by writing it down. The plan need not be overly complicated, but all advocates should be able to refer to the policy objective, set short-term and long-term goals, identify who the stakeholders are, and consider other important details along the way.
Advocacy requires action
Taking action on the strategic plan involves using previously established relationships and continuous communication. Advocacy teams ensure certain mechanisms are in place when it is time to move policy into an active state.
A key cornerstone in this design is investment in relationships with decision-makers. Those relationships need to be in place before solutions are proposed and definitely before a crisis arises. Relationship building is a regular part of any advocacy infrastructure. Many books focus on the power of networking, and they are the 101 guides for any lobbyist, but outside of relationship-building, it also is important to use political action committees (PACs), such as the ACS Professional Association SurgeonsPAC, as well as constituent relationship development, such as through SurgeonsVoice. Active advocacy by Fellows can sometimes be the critical turning point to ensure a major milestone is achieved.
Find your champions
Finding strategic champions for the policy solution can determine the success of the outcome. A decision-maker who is the lead advocate on the policy solution and who is internal to the system sometimes is called a champion for that issue. Champions need to be in relevant positions; for example, legislators who are assigned to a committee that has jurisdiction over the particular issue. They also must be willing to work toward success on the issue. Some champions add value by using a loud, clear, and impactful voice. Some are true workhorses and have staff who can build support and ensure milestones are reached. It can be frustrating and halt the achievement of even short-term goals if the champion is ill-suited or lacks the appropriate commitment to the policy change.
A good message, well thought out and framed the right way, will resonate beyond the internal advocates. If the message, the moment, and the policy solution align, the likelihood of success increases exponentially.
Ensuring key communications are activated in a timely and appropriate way also makes a significant difference to the outcome of the strategic plan. Using key communications to amplify the message and ensure it resonates with multiple audiences can help increase the decision-maker’s—and, hopefully, the public’s—will to bring about change. A good message, well thought out and framed the right way, will resonate beyond the internal advocates. If the message, the moment, and the policy solution align, the likelihood of success increases exponentially. Consequently, a strong communications team can help elevate the strategic plan and messaging to ensure the idea is reaching the right audiences. Communications teams also can be a great sound check on the message, ensuring that the message being communicated resonates with the right audiences and that it is clear and on point. They can provide this feedback at intervals as well.
Although most of this work can be done in the passive form of advocacy, as previously stated, at least some active advocacy by the Fellows who are directly affected or in need of systemic advocacy through policy change can have the greatest impact on the decision-makers, the message, and the outcome.
Review the strategic plan at intervals
Process checks along the way can help improve messaging, adjust short- and long-term goals, and ensure that all parties are in alignment. It is important to check back in because in the business of advocacy, you can miss windows of opportunity if you are not regularly reviewing goals and timelines.
Keep at it
Advocacy is an imperfect and fluid process. That said, using an advocacy framework informed by the case and systemic advocacy to develop a strategic plan can go a long way toward improving the likelihood of success.
- Onyx J, Armitage L, Dalton B, Melville R, Casey J, Banks R. Advocacy with gloves on: The “manners” of strategy used by some third sector organizations undertaking advocacy in NSW and Queensland. Volunt Int J Volunt Nonprofit Org. 2010;21(1):41-61.
- Brescia University. The intersection of social work and advocacy. April 30, 2019. Available at: www.brescia.edu/2019/04/social-work-and-advocacy/. Accessed July 16, 2021.
- Dalrymple J, Boylan J. Effective advocacy in social work. SAGE Publications Ltd. Available at: www.sagepub.com/sites/default/files/upm-binaries/58102_Dalrymple_&_Boylan.pdf. Accessed July 16, 2021.
- Morrison E. 5 steps to convert a strategic plan into action. October 6, 2014. Available at: www.linkedin.com/pulse/20141006212125-128014-5-steps-to-convert-a-strategic-plan-into-action/. Accessed July 16, 2021.