Tackling waits and engaging people across the system are intrinsically linked. We must find ways to ensure the millions of people who are waiting for care get the support they need, without placing unsustainable pressure on busy staff. We know that successfully reducing waits depend on more than just one or two big ideas, is rarely done by a single team or a single department, and requires an understanding of flow along a pathway. So it’s important to engage people to work collaboratively to address these issues.

In the most recent Q Lab we explored how to improve collaboration to reduce delays in elective pathways. This is one of many ways we’re supporting members to reduce waits. This blog is the first in a series where we’ll explore learning from our most recent Q Lab.

Read on to discover what our five test teams learned about engaging stakeholders with this challenge.

1. Identify the ‘hidden’ stakeholders in the pathway

Reviewing a whole patient pathway can identify unexpected stakeholders. During the Lab, teams found “hidden” stakeholders who played an important role but hadn’t been considered before. They were often people close to the detail, who really understood things or could help solve a specific bottleneck. These stakeholders were frequently administrative and diagnostic staff.

No matter how many conversations I’ve had with people, the stakeholder list of people that are relevant to solving this problem is always one more than we thought it was. […] . The …people that need to be onboard to make a change happen has really surprised me.

The scheduler, the invisible person that does scheduling … what a goldmine full of information! I’ve spent a couple of afternoons sitting with them in our office watching what they do, how they do it, and all their frustrations.

Using improvement tools like user journey mapping can help you surface these roles.

2. Don’t wait for perfect evidence

Early stakeholder engagement can feel challenging. During the Lab, some teams really felt the pressure to provide evidence that their approach was effective, which wasn’t possible from the start. They delayed reaching out to some of their key stakeholders until they had the data available.

Waiting for the “right” time for stakeholder engagement can disadvantage the work and delay getting support and buy-in to progress.

If we knew what we know now when we started, we could have started engagement with commissioners earlier and indicated that we may be successful and if so, we need to start thinking about commissioning intentions.

Teams who engaged relevant stakeholders from the start had stronger support for their projects. They found this helped increase the collective ownership of the project, as key stakeholders were involved in the project decisions.

Start stakeholder engagement as early as possible, so all relevant stakeholders can buy into your work.

3. Prioritise listening and shared ownership of tackling waits

You need to provide stakeholders with a common goal to invest in, to encourage ongoing support for the work.
Rather than approaching stakeholders with ready-made solutions (and evidence), you can engage people with a shared ambition, and try to understand and solve the problem together. One team discovered that listening and understanding their stakeholders without offering solutions was particularly important.

We tried to create a common problem. No one was coming into it thinking they’re being told, “this is how you’re going to solve this”. It’s just listening. It’s just sitting back and just letting them tell you how they’re individually wanting to solve this problem.

For another team, approaching their stakeholders with a solution was met with resistance. Stakeholders pushed back when they felt they were being told what to do, despite the team sharing some promising evidence.

Even though that is not our intention, our idea was perceived as criticism of the status quo. Nothing puts a consultant off like telling them a solution to their problem, without involving them in the process.

Engaging stakeholders across the system takes time, can rarely be rushed, and requires patience. People will come on board when they are ready.

While the pace may seem slow, using frameworks like the diffusion of innovations model can help you maintain confidence in the process, and identify what may influence different groups to adopt your idea.

4. Respond to stakeholders’ needs and priorities

Different stakeholders have different needs and priorities. You should respond to those without jumping into what you need from them. For example, frontline and clinical staff may have different priorities to leadership and management.
If you use appropriate language for the different stakeholder groups, it will help you gather support more quickly. The Lab teams found that “reducing delays” had limited engagement among frontline staff. Not everyone was naturally motivated by reducing delays.

Teams found there was a heaviness to the topic, which connected to issues around workload pressures and burnout. But one team shared how shifting the language from “reducing delays” to “improving care” better connected to staff motivations and purpose.

We went from the message being “It’s taking too long, as x number of days.” We changed that into “this is the number of patients that are dying because they’re waiting too long.”

Given the current strains on the health and care system, it was important for other stakeholders to be provided with data about effectiveness and cost implications.

Tailoring your messages to the needs, priorities, and common language shared by different stakeholder groups will help you secure support for your project more quickly.

5. Celebrate collective improvement

The test teams shared that seeing the positive results of their work made a difference to the enthusiasm of the wider team. They found there was more appetite for continuously investing time and energy into progressing the projects.
Seeing the results helped people from different groups feel involved and positive about the pathway’s improvement and innovation.

When you see one person near you doing something that makes a difference, and then you see your little bit making a difference, and then you see the bigger picture all adding up – the enthusiasm is infectious! The results are infectious and the overall improvement grows and grows and grows.

While a lack of data shouldn’t hold you back from engaging stakeholders, it is important to share data when available. When able to see the results of their work, teams found it re-energised them.

This is the first time we’ve had really good consistent improvement and benefits that we can see. You know, we can see evidence of the work that’s been done.

And seeing tangible results of work can be a source of motivation for staff across all levels. Echoing Jim Mackey, the power of learning from data and tracking progress “helps people feel like they’ve achieved something, builds confidence and gathers momentum”.

Make sure you create space to celebrate the results of your work with those involved throughout the project.

Read more about the Lab projects through the co-researcher notes:

• Aneurin Bevan: addressing issues in the cancer pathway for head and neck cancer patients.
• University College London Hospitals: taking an equity lens to understanding and reducing young people’s rheumatology clinic non-attendance.
• Stockport NHS Foundation Trust: addressing practical challenges in setting up a clinic, focusing on referral pathways, scheduling, and space allocation.
• South Doc Services: understanding and supporting existing waiting times while also redesigning the patient pathway to alleviate the strain on secondary services.

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We’ve drawn information for this blog from individual interviews, presentations and discussions at our Lab workshops between July 2023 and March 2024. As some reflections on stakeholder engagement felt sensitive to participants, we are sharing them anonymously.