How do stakeholders from multiple hierarchical levels of a large provincial health system define engagement? A qualitative study

Abstract

BackgroundEngaging stakeholders from varied organizational levels is essential to successful healthcare quality improvement. However, engagement has been hard to achieve and to measure across diverse stakeholders. Further, current implementation science models provide little clarity about what engagement means, despite its importance.The aim of this study was to understand how stakeholders of healthcare improvement initiatives defined engagement.MethodsParticipants (n = 86) in this qualitative thematic study were purposively sampled for individual interviews. Participants included leaders, core members, frontline clinicians, support personnel, and other stakeholders of Strategic Clinical Networks in Alberta Health Services, a Canadian provincial health system with over 108,000 employees. We used an iterative thematic approach to analyze participants’ responses to the question, “How do you define engagement?”ResultsRegardless of their organizational role, participants defined engagement through three interrelated themes. First, engagement was active participation from willing and committed stakeholders, with levels that ranged from information sharing to full decision-making. Second, engagement centered on a shared decision-making process about meaningful change for everyone “around the table,” those who are most impacted. Third, engagement was two-way interactions that began early in the change process, where exchanges were respectful and all stakeholders felt heard and understood.ConclusionsThis study highlights the commonalities of how stakeholders in a large healthcare system defined engagement—a shared understanding and terminology—to guide and improve stakeholder engagement. Overall, engagement was an active and committed decision-making about a meaningful problem through respectful interactions and dialog where everyone’s voice is considered. Our results may be used in conjunction with current implementation models to provide clarity about what engagement means and how to engage various stakeholders.

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“…This challenge is elucidated by O'Meara et al in their study on community and facility level engagement in planning and budgeting in Kenya where there were differences in priorities identified by community members, facility staff, and the national level MoH. Scholars even argue that the definition of engagement is murky . Norris et al attempt to debunk the murky concept of engagement and identify three modalities including active participation coupled with information sharing and shared decision making; a shared decision making process; and two‐way interactions with mutual respect throughout the process where all stakeholders feel heard and understood .…”

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