Stakeholder Engagement A Practical Guide for the NHS

					          A Practical Guide for the NHS

              Stakeholder Engagement
This guide explains the value of working with stakeholders and, using case
      studies from the ISIP Local Health Communities Demonstrator
 Programme, shows how consulting, listening and involving stakeholders
     has been key to the delivery of successful service transformation.
            Why Engaging Stakeholders In Service Transformation Matters

What do we mean by Stakeholder Engagement?                                                 Principles of Patient and Public Involvement

     Stakeholders can be defined as any person or group of people who have an                 Identify and understand your stakeholders
      interest in, or will be affected by, any planned changes in an organisation or
      Local health Community. They can be internal or external to that                         Define who needs to be involved, who needs to be
      organisation or Local Health Community, and they can comprise staff,                      informed and who is likely to be affected by the
      patients, trade unions, MPs and members of the public                                     issues under consideration
                                                                                               Make sure all stakeholders are appropriately
     Stakeholder Engagement is a process by which an organisation / Local                      involved and ensure that your involvement activity
      Health Community learns about the perceptions, issues and expectations of
      its stakeholders, and uses these views to assist in managing, supporting and              is relevant to your stakeholders’ interests
      influencing any planned changes / improvements in service delivery                       Consider who is likely to be affected by the
                                                                                                implications of the matter in hand.
     Stakeholder engagement is all about building relationships with people who
      you affect through your work, or who could make an impact on your success.
      It is the foundation of effective organisational responsibility, and refers to the                     Ref. The NHS Centre for Involvement
      formal management of the human dimensions of change.

Why Stakeholder Engagement is important for successful service transformation?

‘We must recognise that change is difficult, and as we have seen over recent months, can provoke powerful reactions
from stakeholders. One of the clear findings from Sir Ian’s work was that the NHS needs to be much better at engaging
with stakeholders, including; the public and their representatives, patients and carers, clinicians and staff, MPs and a
whole range of other stakeholders. The NHS needs to do more to ensure that stakeholders are actively engaged in
developing proposals for change and also explaining the reasons behind any decisions that are made’.
                                                                                                          David Nicholson CEO Letter February 2007
There are tremendous benefits to be realised from improving stakeholder engagement in service transformation:
      It can increase the likelihood of the service transformation succeeding and minimises the risk of failure
      It provides access to a wide range of views, expertise, values and beliefs, which can be integrated into the service transformation
      Views can be incorporated into developing the case for change and in articulating both clinical and patient benefits.
                           Demonstrator Experience:
 Calderdale and Huddersfield Rheumatology Service
The approach to                                   Power and Influence Stakeholder Map
stakeholder engagement
adopted by the Calderdale
                                                    Keep Satisfied                            Manage Closely
and Huddersfield
Rheumatology project team      High      Our Patients       Risk Management      HRI – Senior            Choose & Book
was to first identify key                  Clinical          Organisational      Management               Pain Services
stakeholders.                            Governance           Development        Rheumatology                ‘Leeds’
                                          Pathology         OPACCS / Medical     Team CRH                 Kirklees PCT
Once identified the team                  Pharmacy               & Elderly       Therapy Services        Calderdale PCT
undertook a thorough                    NRAS, ARMA,                              Medical Records
analysis.                               Arthritis Care
The stakeholder mapping                                Monitor                                 Keep Informed
and analysis aimed to:                             (Minimum Effort)
•Identify and group the
                                       Leeds University         Yorkshire              Kirklees &            ‘IMT’
individual stakeholders                Huddersfield         Ambulance Trust           Calderdale           Radiology
•Assess stakeholder                    University          Professional Bodies         Councils’        Human Resources
interests in relation to the   Low
                                                                The Press             ‘Transport’            A&E
work programme                                                                           ‘R&D’               SHA
•Understand how these                                                               Orthopaedics
                                                                                  Portering / Estates
interest might impact upon
the programme or project.
This created a power /                 Low                                                                           High

influence stakeholder map.
         Communicating with Stakeholders
Use the stakeholder map to identify the most appropriate means of keeping
stakeholders informed of developments within the Programme.

The four groups                                  Keep Satisfied                                        Manage Closely
identified within the
stakeholder map         High         Exploit existing management meetings and                 Frequent personal briefings and Q&A’s
(Monitor, Keep                      committees (CG, ETD) to explain project and
Informed, Keep                                                                          Proactive risk and issue awareness – first points of
                                          respond to queries and concerns
Satisfied, and                                                                                       contact for news (+ve/-ve)
                                 Presentations at any local health community events
Manage Closely)                                                                           Workshops to develop involvement and exploit
                                    (primary & secondary care, and third sector)
provided the basis                                                                         knowledge and skill available, and tie-in key
for the team’s                                                                                           stakeholders
communication                      Regular item on Organisational Team Briefing
                                                                                           Presentation to key Groups - Trust Boards &
strategy.                                                                                           Professional Committees
The team agreed

what would be
appropriate means                                   Monitor                                             Keep Informed
of communicating                                (Minimum Effort)
with each of the                   No Specifically targeted communication effort.              Hospital Newsletter, Posters, Flyers,
four groups.                                                                                          Department Website
This was captured                 This sector is the recipient of general information
on the same                        such as: local media ‘press’ releases, local PCT                    Contact Phone line
template used for                information distributed to households, public health                 Project e-mail address
the stakeholder                               information campaigns etc.
The Figure shows                   Monitor communication traffic from this sector
the completed           Low               for items requiring a response
version.                         Low                                                                                            High
      Demonstrator Experience: Liverpool PCT
                           Scheduled Care Programme
Deliberative events
 Aim to involve people in the big decisions that will affect their lives. They are used to talk about issues where members
  of the public may not have a great deal of knowledge or information
 These events give people the chance to exchange ideas on important issues with each other and with people working
  in those services
 Deliberative events allow people a voice, whilst giving them all the facts they need to reach a fully informed opinion.
  Having equipped people with this information, people are then asked how they think things can change for the better.

                                             THE BIG HEALTH DEBATE
   ‘Together we can deliver the world class services the people of Liverpool need and expect.’
Began in the Summer of 2006 and lasted almost 12 months. A variety of methods were used to gain the views of the
people of Liverpool which included a city-wide survey, visits to community groups, focus groups, multidisciplinary
workshops for health and social care staff, road shows for health professionals and a deliberative event (Big Health
Debate Live).

Big Health Debate Live                                The results of the Big Health Debate have informed the Outside of
                                                      Hospital Strategy which was published in July 2007
It was a one day workshop, which involved a
                                                      ‘we will speak with local people and other stakeholders and
mixture of table top discussion and polling.
                                                      listen to what they have to say about our proposals. We will be
Participants included a cross section of the
                                                      honest about what we can and cannot deliver and the reasons
population of Liverpool and health care
                                                      why’ Liverpool PCT.
professionals. Table facilitators led the
                                                                          Build on existing knowledge
discussions and a research company analysed
the notes and tape recordings of the                  Rather than repeat the process we were able to use the outcomes
conversations to produce a report on the day.         from the Big Health Debate to inform some of the visioning of future
                                                      services and care models within the Scheduled Care Programme.
        Demonstrator Experience: Croydon PCT
                      End of Life Care – The Big Question
      “Name one thing that would improve your quality of life right now?”
• Croydon PCT wanted to obtain a snapshot of the views of patients                          Staff Feedback
  with End of Life Care needs and their carers on the service they have
  been experiencing.                                                         “Simple process to organise, it allowed direct
                                                                             access to the target population”
• They designed The Big Question Week which was suggested by
  Croydon Voluntary Action as an approach to hear the direct voice of a      “Limits the burden placed on health and
  population that standard PPI forums cannot easily reach                    social care staff”

• The Big Question Week was an opportunity to hear directly from             “Gave us the opportunity to target a wider
  people who are using health and social care services. It involved          sector of the target population “
  requesting selected health and social care professionals to ask the
  same question to one patient and one carer who fit the target group        “Limits the amount of resource required to
  and then to report the responses back. In this case the target group       analyse and feedback results”
  was patients who were aware they were receiving End of Life Care
  and their informal carers (partners, siblings, friends, relatives, etc).   “Patients and carers informed us of issues
                                                                             that they hadn’t discussed with us before”
• The aim was for 50 nurses to ask the question to about 100 patients
 and/or carers. It was agreed to send out a daily email alert to staff to
 remind them to ask the question. However due to e-mail problems
 reminders were delayed and as a result some people forgot and
 fewer people were consulted.
              Key Messages

Coordinate the              Plan enough time for
communication activity      effective stakeholder
across projects to          engagement.
monitor the accuracy of     One size doesn’t fit all. You
the key messages,           need to employ a variety of
improve efficiency and      techniques to understand
avoid mixed messages        the range of stakeholder
being given to different    views.

People give their own       Be prepared to listen. Don’t
views and identify what     assume you know what
the potential issues are    people want and what their
for them. Collect and       aspirations are, as they can
analyse the full range of   be very different to what you
views and group them        perceive them to be.
into themes to get the
big picture.
         Where to go for more information
External references:
Liverpool PCT :
The NHS centre for Involvement:
NHS Integrated Service Improvement Programme:

Named contacts:
Mark Brandreth, Director of Stakeholder Engagement, Liverpool PCT,
Dr Richard Reece, Consultant Rheumatologist, Huddersfield Royal Infirmary,
Stephen Hunt, Patient Public Involvement Manager, Croydon PCT,