Advocacy Pillar Development in a Division of Pediatric Emergency Medicine Using a Strategic Planning Process

Advocacy is a cornerstone of emergency medicine as emergency physicians care for all patients regardless of insurance status, socioeconomic demographics, or other social determinants of health. As they have experience providing care to diverse populations, emergency physicians are uniquely positioned to address systemic health inequities and public health crises, such as mental health access and the opioid epidemic. Within academic emergency medicine, establishing an academic pillar for advocacy legitimizes this work, fosters research and mentorship, and ensures its sustainability in the field. Despite being a critical aspect of emergency medicine, limited formalized pathways exist to pursue an advocacy-focused career, including within pediatric emergency medicine. Addressing systemic health care gaps through a team-based approach is essential to improving health outcomes for patients and communities. This conceptual article describes the strategic development and integration of an Advocacy Pillar within a Division of Emergency Medicine at a freestanding, urban, academic children's hospital, designed to complement existing strategic pillars such as clinical operations, fast track/urgent care, education, safety/quality, scholarly activity/research, and workforce growth. With support from Division leadership, staff were invited to codify an Advocacy Pillar within the Division. A multidisciplinary team began by creating divisional advocacy mission, vision, objectives, and goals. Five objectives were created, and then an assessment of the strengths, weaknesses, opportunities, and threats (SWOT analysis) was conducted on each objective. Action items were subsequently generated to accomplish each objective. The team used a Delphi process to rank action items by importance and feasibility to help prioritize initiatives and strategic goals. The results of this Advocacy Pillar Strategic Planning Process were included in the Division's 5-year Strategic Plan. Advocacy work within the Division is now better supported and integrated throughout the domains of scholarship, service, and education. The Division has implemented structural changes that enhance advocacy for its staff, including new roles for staff (a Director and Associate Director of Advocacy and Health Policy, named nursing advocacy lead, Advocacy Steering Committee, and administrative support), financial incentives for engaging in high impact advocacy work that aligns with academic promotion, an annual advocacy award, and an advocacy-focused faculty development series and fellowship curriculum. We hope that these efforts can act as a framework for other groups that wish to formalize and amplify advocacy in their own settings.