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.
Highlights
Engaging stakeholders from varied organizational levels is essential to successful healthcare quality improvement
Though conceptualized in varied ways, engagement features prominently across the five categories of theoretical approaches to implementation science described by Nilsen [22]: classic theories, process models, determinant frameworks, implementation theories, and evaluation frameworks
Engagement was described as active participation from willing and committed stakeholders, the levels of which ranged from information sharing to more extensive involvement such as collaboration or full decision-making
Summary
Engaging stakeholders from varied organizational levels is essential to successful healthcare quality improvement. Stakeholder engagement has been described as essential and even “critical” [1,2,3] for moving knowledge into action within healthcare [4, 5]. Efforts to transform large systems are more successful when healthcare professionals are engaged, resulting in improvements to clinical outcomes and patient safety [6,7,8,9], quality of care [8, 10, 11], and financial performance [8]. Employee engagement has been measured in efforts to understand how a large-scale improvement program influenced the vigor, dedication, and absorption [29] of hospital-based ward teams [30]
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