research topics on stakeholder management

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• Published: 11 July 2018

How to engage stakeholders in research: design principles to support improvement

• Annette Boaz   ORCID: orcid.org/0000-0003-0557-1294 1 ,
• Stephen Hanney 2 ,
• Robert Borst 3 ,
• Alison O’Shea 1 &
• Maarten Kok 4  

Health Research Policy and Systems volume  16 , Article number:  60 ( 2018 ) Cite this article

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Closing the gap between research production and research use is a key challenge for the health research system. Stakeholder engagement is being increasingly promoted across the board by health research funding organisations, and indeed by many researchers themselves, as an important pathway to achieving impact. This opinion piece draws on a study of stakeholder engagement in research and a systematic literature search conducted as part of the study.

This paper provides a short conceptualisation of stakeholder engagement, followed by ‘design principles’ that we put forward based on a combination of existing literature and new empirical insights from our recently completed longitudinal study of stakeholder engagement. The design principles for stakeholder engagement are organised into three groups, namely organisational, values and practices. The organisational principles are to clarify the objectives of stakeholder engagement; embed stakeholder engagement in a framework or model of research use; identify the necessary resources for stakeholder engagement; put in place plans for organisational learning and rewarding of effective stakeholder engagement; and to recognise that some stakeholders have the potential to play a key role. The principles relating to values are to foster shared commitment to the values and objectives of stakeholder engagement in the project team; share understanding that stakeholder engagement is often about more than individuals; encourage individual stakeholders and their organisations to value engagement; recognise potential tension between productivity and inclusion; and to generate a shared commitment to sustained and continuous stakeholder engagement. Finally, in terms of practices, the principles suggest that it is important to plan stakeholder engagement activity as part of the research programme of work; build flexibility within the research process to accommodate engagement and the outcomes of engagement; consider how input from stakeholders can be gathered systematically to meet objectives; consider how input from stakeholders can be collated, analysed and used; and to recognise that identification and involvement of stakeholders is an iterative and ongoing process.

It is anticipated that the principles will be useful in planning stakeholder engagement activity within research programmes and in monitoring and evaluating stakeholder engagement. A next step will be to address the remaining gap in the stakeholder engagement literature concerned with how we assess the impact of stakeholder engagement on research use.

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Closing the gap between research production and research use is a key challenge for the health research system. Stakeholder engagement is being increasingly promoted across the board by health research funding organisations, and indeed by many researchers themselves, as an important pathway to achieving impact [ 1 ]. The literature is diverse, with a rapidly expanding but still relatively small number of papers specifically referring to ‘stakeholder engagement’, and a larger number of publications discussing issues that at least partly overlap with stakeholder engagement. Several of the papers explicitly analysing stakeholder engagement come from the field of environmental research (e.g. Jolibert and Wesselink [ 2 ], Phillipson et al. [ 3 ]). However, stakeholder engagement is also gaining traction in the health field. A recent supplement in this journal consolidated learning relating to tools and approaches to stakeholder engagement within the United Kingdom Department for International Development’s Future Health Systems research consortium [ 4 ]. In particular, in health, there is an important stream of analysis from North America. A review for the United States Agency for Healthcare Research and Quality drew on papers from a range of fields [ 5 ].

This opinion piece provides a short conceptualisation of stakeholder engagement, followed by ‘design principles’ that we put forward based on a combination of existing literature and new empirical insights from our recently completed longitudinal study of stakeholder engagement in research. We have drawn on a systematic literature search conducted to inform the wider study and in particular to conceptualise stakeholder engagement (Additional file  1 ).

Literature review

Conceptualising stakeholder engagement: what does the literature say.

Stakeholders have been defined as “ individuals, organizations or communities that have a direct interest in the process and outcomes of a project, research or policy endeavor ” ([ 6 ], p. 5). In seeking to conceptualise stakeholders, Concannon et al. [ 7 ] developed the 7Ps Framework to identify stakeholders in Patient-Centered Outcomes Research and Comparative Effectiveness Research in the United States of America. The 7Ps are patients and the public, providers, purchasers, payers, public policy-makers and policy advocates working in the non-governmental sector, product makers, and principal investigators. The seven categories signal an overlap with the large literature on patient and public involvement (PPI) in research. However, our focus here is on multi-stakeholder engagement, where diverse groups of stakeholders take part in the research process. Deverka et al. [ 6 ] define engagement as “ an iterative process of actively soliciting the knowledge, experience, judgment and values of individuals selected to represent a broad range of direct interest in a particular issue, for the dual purposes of: creating a shared understanding; making relevant, transparent and effective decisions ” ([ 6 ], p. 5).

Roles, activities and phases of stakeholder engagement: What does the literature say?

There are additional issues about the definition of stakeholder engagement when the nature of the engagement activities is considered. For example, there are issues about how far co-creation/participatory action research approaches can be considered to be stakeholder engagement or something so far beyond the usual stakeholder engagement that they are really in a different category [ 8 ]. Similarly, there is a large and currently distinct literature on PPI in research [ 9 ], including the development of reporting guidelines such as GRIPP2 [ 10 ]. There are a number of parallels in the issues discussed in these literatures as well as some interesting differences (particularly in terms of power inequalities). However, herein, we conceptualise PPI as a subset of stakeholder engagement in-line with most of the literature, including Concannon et al. [ 7 ].

Most of the stakeholder engagement literature highlights the broad range of activities in which stakeholders can engage depending on their own skills and attributes and the capacity and wishes of the researchers conducting specific studies. At the broadest level of a research system, or research funding body, Lomas [ 11 ] claimed there were many activities in which stakeholders could be engaged in a ‘linkage and exchange’ approach for health services research. These were setting priorities, funding programmes, assessing applications, conducting research and communicating findings. The importance of engaging a wide range of stakeholders in priority-setting has often been emphasised. The pioneering study by Kogan and Henkel [ 12 ] analysed both the importance of engaging policy-makers in setting research agendas to meet their needs, and the obstacles to making the process work well. These obstacles included issues around how far the assessment of needs-based research should focus on the relevance and practical impact of the research as well as its scientific merit. Many of the more recent studies explicitly examining stakeholder engagement also set out a range of activities in which stakeholders may be involved. These are often related to phases of the research processes. Concannon et al. [ 7 ] provide a list of roles related to stages and used the identified roles in a subsequent review [ 13 ].

Knowledge translation (KT) is one of many terms used to describe efforts to ensure research evidence is used to inform decision-making [ 14 ]. Although the importance of engaging stakeholders in KT is recognised, it has been acknowledged that stakeholder engagement is often overlooked in favour of more conventional dissemination strategies [ 15 ]. Integrated KT has been developed as an approach to collaborative research in which researchers work with stakeholders who identify a problem and have the influence and sometimes authority to implement the knowledge generated through research [ 16 , 17 ]. Grimshaw et al. [ 14 ] argue that different groups of stakeholders are likely to be engaged depending on the type of research that is being translated.

Assessing the impact of stakeholder engagement: What does the literature say?

A final consideration about the nature of the body of literature specifically on stakeholder engagement is that not only is it still quite limited in total, but there are also notable areas where authors claim it is particularly sparse. In particular, Hinchcliff et al. [ 18 ] examined the literature on multi-stakeholder health services research collaborations in an attempt to address the question of whether it was worth investing in them. They identified very few studies (Harvey et al’s. [ 19 ] 2011 evaluation of a Collaboration for Leadership in Applied Health Research and Care being one exception) and concluded that their generalisability was questionable. They therefore suggested that “ The lack of reliable evidence compels implementers to rely largely on trial and error, risking variable success ” ([ 18 ], p. 124).

The nature of engagement activity is less contentious than the arguments about its potential impact. Research impacts on non-academic audiences are defined by the United Kingdom Higher Education Funding Council as: “ benefits to one or more areas of the economy, society, culture, public policy and services, health, production, environment, international development or quality of life, whether locally, regionally, nationally or internationally ” [ 20 ]. Various studies have attempted to assess a range of impacts of research (especially health research) and/or attempted to identify facilitators and barriers of research use in policy-making. There are also a growing number of reviews of such studies [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. While these are not explicitly studies of stakeholder engagement, many of them have identified some form of collaboration between researchers and users as one of the factors most likely to lead to the research making an impact. However, this wider range of literature does not go into detail in terms of analysing the nature of the processes of stakeholder engagement that leads to impact.

Studies specifically focusing on the impact of stakeholder engagement are less common, although it is a growing area of interest [ 28 , 29 ]. Jolibert and Wesselink [ 2 ] found a few examples of impact, but suggested ways to increase impact through what they describe as sustained interactions. Concannon et al. concluded that approximately 20% of their study participants “ reported that stakeholder engagement improved the relevance of research, increased stakeholder trust... enhanced mutual learning by stakeholders, and researchers about each other, or improved research adoption ” ([ 13 ], p. 1697), whereas 6% reported improved transparency and 9% increased understanding of research processes. Also, while Forsythe et al. referred to a lack of evidence about impact, they also observed that “ Commonly reported contributions included changes to project methods, outcomes or goals; improvement of measurement tools; and interpretation of qualitative data ” ([ 30 ], p. 13). In the United States, the Center for Medical Technology Policy website makes a strong statement about the impact of stakeholder engagement: “ Including the perspectives of all key stakeholders has powerful benefits, enhancing both the short- and long-term relevance of clinical research efforts ” [ 31 ].

Assessing the impact of stakeholder engagement: a new study

Given the diversity of stakeholder engagement and the thin evidence base for its impact, our study set out to identify a set of indicators that might be used to identify stakeholder engagement with potential for impact. We identified a study called the European study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) and then conducted our own study, Stakeholder Engagement in EQUIPT (SEE-Impact) as a prospective study of stakeholder engagement running alongside. EQUIPT, a major European Commission (EC) – funded project, aimed to achieve impact through extensive stakeholder engagement. Both studies are briefly described in Box 1.

The results of the EQUIPT study have now been published [ 32 , 33 ] and a full account of the main methods from SEE-Impact have been submitted for publication. Papers on the full findings are being finalised. Herein, our aim is to address the statement in our original funding proposal in 2013 that it should be possible to identify aspects of the stakeholder engagement (and perhaps other features of the processes) that might be viewed as intermediate indicators of the eventual impact achieved.

Our analysis of the complex and nuanced process of stakeholder engagement has resulted not in a list of indicators, but in a set of design principles. We hope that these design principles will help to inform the future development of stakeholder engagement as a mechanism for promoting research impact. These principles, rooted in both the existing literature and in the findings from our prospective study of stakeholder engagement, are intended to inform the planning and delivery of stakeholder engagement activities. It is anticipated that they will also provide a structure for building a narrative account of stakeholder engagement as part of an evaluation of an individual project or programme. They might also provide a starting point for the development of future indicators.

Design principles for stakeholder engagement in research

The project team (comprising members of the SEE-Impact research team and collaborators from EQUIPT) met for a 2 day analysis workshop. One aim of the workshop was to begin to build a consensus among the team on what seemed to be the key design principles emerging from the SEE-Impact data and the on-going literature review. SEE-Impact data included observational data, interviews and document analysis. The research team continued to develop the principles through an ongoing period of deliberation, informed by the impact study and the literature. As part of this process, the principles were categorised into three groups, namely organisational, values and practices.

In this section, we first present empirical evidence from the SEE-Impact study that informed our development of the design principles. We then briefly summarise published evidence for each group of design principles in order to situate them in the wider literature.

Design principles and empirical evidence from the stakeholder engagement in EQUIPT for impact (SEE-impact) study

The stakeholder engagement study (SEE-Impact) and the project being studied (EQUIPT) are described in Box 1. In terms of the organisational level principles, the EQUIPT project objectives for stakeholder engagement were clear, as set out in the proposal, protocol and project documents [ 34 ]. The key aims of stakeholder engagement activity were to access the knowledge and skills (described in the protocol as co-creation innovation in the working space) and to increase influence and impact (described in the protocol as dissemination innovation in the transfer space through stakeholder engagement).

In terms of values, the commitment to stakeholder engagement was more clearly demonstrated by some of the EQUIPT project team members than others. For some team members, previous successful experience of an interactive form of working with stakeholders had built a commitment to this particular way of working. It also provided experience of practical elements of working with stakeholders, but perhaps most importantly lived experience of the practical benefits of engagement. For other members of the team, too, working with stakeholders fitted closely with their ethos and values. For example, the Hungarian team talked about their pragmatic approach to research and the need to conduct useful and usable research, with stakeholder engagement being a key component. However, a small group within the wider project team did not seem committed to ensuring stakeholder engagement remained a core element of the project. They favoured a particular, individualised approach to stakeholders and, over time, partially reshaped the stakeholder engagement activities to something more akin to research participation (that is, taking part in a research study as a means of generating specific data as determined by researchers, rather than as co-producers of research). Finally, not all stakeholders identified by the project team were interested in engaging with the project. In particular, the lack of policy priority given to smoking cessation (the focus of the return on investment (ROI) tool) made engagement of policy stakeholders in the Netherlands very difficult to achieve.

In terms of practices, while the EQUIPT project protocol did set out how the stakeholder engagement would operate [ 34 ], there was not as much flexibility as the investigators would have liked in terms of the project plan and this had an impact on the nature of the stakeholder engagement activities. In particular, time intensive methods of engagement originally proposed in the protocol (particularly the large number of face-to-face meetings) began to look unrealistic to members of the team. The lack of flexibility came in part from the funder. The EC told the project team at an early point that there was no scope for negotiation around the project end date. Thus, initial delays in the project put a strain on the project timetable and deliverables. Members of the team proposed a shift from face-to-face meetings with stakeholders to Skype meetings in an effort to ‘catch up’. The technical team producing the new version of the ROI tool for roll out in Europe added to a sense of urgency in ‘speeding up’ the stakeholder engagement work with their need for data to feed into their work. Nevertheless, despite the practical difficulties, in EQUIPT, a significant amount of consideration had been given to stakeholder engagement, including planning how the input provided by stakeholders might be gathered, collated, analysed and used. Vokó et al. highlight that it is important to “ fully analyse several aspects of stakeholder engagement in research ” ([ 32 ], p. 15) and note that there is a tendency to ignore the value of early stakeholder engagement when it comes to development and transferability in the work of economic evaluation. EQUIPT’s careful consideration and the methods adopted facilitated a much more rigorous approach to stakeholder engagement than is often experienced.

Design principles and supporting literature

The design principles for stakeholder engagement are organised into three groups, namely organisational, values and practices, albeit with some inevitable overlaps. We look at each category in turn, alongside a consideration of some of the relevant literature.

Organisational

Clarify the objectives of stakeholder engagement

Embed stakeholder engagement in a framework or model of research use

Identify the necessary resources for stakeholder engagement

Put in place plans for organisational learning and rewarding of effective stakeholder engagement

Recognise that some stakeholders have the potential to play a key role

Some examples from the literature

It is desirable to have a conceptual framework that situates stakeholder engagement as part of a plan for promoting research use in practice. Deverka et al. [ 6 ] proposed an ‘analytic-deliberative’ conceptual model for stakeholder engagement which “ illustrates the inputs, methods and outputs relevant to CER [comparative effectiveness research]. The model differentiates methods at each stage of the project; depicts the relationship between components; and identifies outcome measures for evaluation of the process ” ([ 6 ], p. 1). Furthermore, having a clear evaluation plan is considered critical. Concannon et al. recommended conducting “ evaluative research on the impact of stakeholder engagement on the relevance, transparency and adoption of research ” ([ 13 ], p. 1698). Esmail et al. argue that evaluations of stakeholder engagement should be “ designed a priori as an embedded component of the research process ” ([ 35 ], p. 142). They suggest that, where possible, evaluations should use predefined, validated tools. Jolibert and Wesselink [ 2 ] point out that linking stakeholders’ contributions with specific research objectives is important in order to establish when and how to engage and with whom. They argue that, at the recruitment stage, stakeholders should be made aware of, for example, their role/s, what they could contribute, costs in terms of time and effort, and benefits. Concannon et al. also conclude that funding is needed “ to account for the costs of implementing meaningful engagement activities ” ([ 7 ], p. 989).

In a Canadian study looking at stakeholder involvement in KT as a means of leading to more evidence-informed healthcare, Holmes et al. [ 36 ] identify a range of complexities which, they argue, need to be taken into account by funding schemes in order to meet funders’ and stakeholders’ expected ROI. Stakeholder involvement in research and implementing its findings is complex and time consuming, and the authors recommend an advocacy role where funders support a range of activities to address barriers to effective KT. These include carrying out an assessment of stakeholders’ KT needs “ to identify gaps and opportunities and avoid duplication of efforts ” ([ 36 ], p. 6). Kramer et al. [ 37 ] looked at the involvement of intermediary organisations as research partners on three interventions across four sectors, namely manufacturing, transportation, service and electrical utilities sectors. The authors describe the difficulties, benefits and challenges from the perspectives of both researchers and research partners and stress the importance of allowing the design of the protocol to be collaborative and flexible. Researchers need to honour, trust and respect their partners’ knowledge and expertise, and take into account their needs and priorities. Failure to meet these criteria will significantly dampen stakeholders’ enthusiasm. They also point out the importance of having a model of collaborative research with clear guidelines of how to conduct partnership research projects in order to further facilitate the use of research by practitioners. There would be an invested interest in “ the research question, design and findings, and this would prove to be very valuable as a knowledge transfer strategy ” ([ 37 ], p. 330).

The main literature on stakeholder analysis of policy-making is also useful for highlighting that some stakeholders have more potential to play a key role in the policy deliberations than others. For example, as part of their review of stakeholder analysis of health policy-making, Brugha and Varvasovszky [ 38 ] described an example in which the Hungarian Ministries of Finance and Industry were non-mobilised, high-influence, low-interest stakeholders in debates about public health interventions, but might, in some circumstances, become mobilised high-interest actors.

Foster shared commitment to the values and objectives of stakeholder engagement in the project team

Share understanding that stakeholder engagement is often about more than individuals

Encourage individual stakeholders and their organisations to value engagement

Recognise potential tension between productivity and inclusion

Generate a shared commitment to sustained and continuous stakeholder engagement

Concannon et al. [ 7 ] stress that researchers and stakeholders should be committed to the processes from the outset. Hinchcliff et al. [ 18 ] argue that it is important to define expectations and roles and provide time. Hering et al.’s [ 39 ] global study of water science and technology used stakeholder involvement in the objectives and approaches of the research for the co-production of knowledge as part of transdisciplinary research. Key aspects of particular value to the research included early identification and involvement of stakeholders, continuous engagement with stakeholders, and availability to stakeholders of supporting materials and in multiple languages. Mallery et al. recommend continuing to build trust with stakeholders “ throughout the engagement process ” ([ 5 ], p. 27).

Plan stakeholder engagement activity as part of the research programme of work

Build flexibility within the research process to accommodate engagement and the outcomes of engagement

Consider how input from stakeholders can be gathered systematically to meet objectives

Consider how input from stakeholders can be collated, analysed and used

Recognise identification and involvement of stakeholders is an iterative and ongoing process

Forsythe et al. [ 30 ] highlight the importance of careful and strategic selection of stakeholders. As part of evidence and experience-based guidance to researchers and practice personnel about forming and carrying out effective research partnerships, Ovretveit et al. [ 40 ] developed a guide to categorise and describe types of partnerships or approaches to collaborative working. The guide sets out a framework for the roles and tasks, and the allocation of responsibilities for each partner involved. Roles and tasks are assigned to three main categories, namely questions, design and data, reporting and dissemination, and implementation and integration into organisation or policy. Concannon et al. [ 13 ] suggest the need to develop (and validate) stakeholder engagement tools to support engagement work. Forsythe et al. also stress the importance of “ establishing ‘parameters and expectations for roles’, giving stakeholders guidance, and allowing time for stakeholders to ‘get comfortable with their roles’ as important tasks ” ([ 30 ], p. 19).

The review of methods of stakeholder engagement conducted by Mallery et al. [ 5 ] identified a range of innovative methods and stressed the potential for engaging stakeholders at different points in the research process. The five methods highlighted for consideration were online collaborative forums, product development challenge contests, online communities, grassroots community organising and collaborative research. Jolibert and Wesselink [ 2 ] explored levels and types of stakeholder engagement in 38 EC-funded biodiversity research projects and the impacts of collaborative research on policy, society and science. They looked at how and when stakeholders were involved and the roles played, and argue that greater engagement throughout the whole of the research process, rather than, for example, at the dissemination stage, tends to lead to improved assessment of environmental change and effective policy proposals. Jolibert and Wesselink suggest, following Huberman’s [ 41 ] work in education, that it is desirable to have ‘sustained interactivity’ between researchers and users. Concannon et al. suggest that “ General principles can be drawn from community-based participatory research, which underscores that engagement is a relationship-building process ” ([ 7 ], p. 988). They found that, if bi-directional relationships are sustained over time, stakeholders can serve as ambassadors for high-integrity evidence even where the findings are contrary to generally accepted beliefs. Hinchcliff et al. point to the importance of “ building respect and trust through ongoing interaction ” ([ 18 ], p. 125). Forsythe et al. flag up the importance of continuous involvement and using in-person contact to build relationships [ 30 ]. They also stress the value in having a flexible approach that can adapt to the practical needs of stakeholders. A recent supplement of this journal edited by Paina et al. [ 4 ] also highlighted the importance of flexibility in making space for stakeholder engagement in research processes.

Based on the literature and the application of initial principles to our study, we have developed the elaborated design principles presented in Box 2.

Conclusions

There is a growing interest in stakeholder engagement as a potentially promising approach to promoting research impact. There is also a developing literature mapping out who potential stakeholders might be (the ‘who’), considering approaches to stakeholder engagement (the ‘how’) and identifying rationales for stakeholder engagement (the ‘why’). In this paper, evidence from the literature around these dimensions has been combined with the findings from our study of stakeholder engagement in an EC-funded project to develop a set of design principles to inform future stakeholder engagement in research. The design principles encompass organisational factors, values and practices. We hope that the principles will be useful in planning stakeholder engagement activity within research programmes and in monitoring and evaluating stakeholder engagement. Active engagement of stakeholders may well shift our understanding of what research use looks like [ 39 ]. A next step will be to address the remaining gap in the stakeholder engagement literature concerned with how we assess the impact of stakeholder engagement on research use.

Box 1: Studying stakeholder engagement in tobacco control policy

EQUIPT: the European-study on Quantifying Utility of Investment in Protection from Tobacco

The EQUIPT study set out to work with stakeholders to develop a tool to help government officials, policy-makers and healthcare providers across Europe examine the cost effectiveness and impact of anti-smoking initiatives. The tool was developed as part of a €2 million European Commission grant. An earlier version had already been piloted with local authorities around the United Kingdom, with users able to draw on specific circumstances, statistics and data to predict the impact of tobacco control in their particular regions. The successful stakeholder engagement in the United Kingdom work encouraged the research team to fully integrate stakeholder engagement into the European study. In this study, the following stakeholders were identified: National and European stakeholders consisting of policy-makers, academics, health authorities, insurance companies, advocacy groups, ministries of finance, national committees, clinicians and health technology assessment (HTA) professionals, and experts on smoking cessation and HTA. Ninety three stakeholders took part. They were engaged in a variety of ways, including through one-to-one interviews, Skype meetings and events. Much of the engagement activity focused on the development of the return of investment tool for application in different countries.

SEE-Impact: Stakeholder Engagement in EQUIPT for Impact

SEE-IMPACT was a 3-year prospective study awarded £157,000 from the United Kingdom’s Medical Research Council funding as part of their joint Methodology Programme with the National Institute for Health Research, earmarked to boost understanding of the impact of health-related studies on society and the economy. The study compared and contrasted the way the EQUIPT decision support tool was taken up in a further four European countries – Germany, Hungary, the Netherlands and Spain. The SEE-Impact study focused in particular on the ways in which stakeholders were engaged throughout the EQUIPT study. The study used a range of methods including interviews, surveys, observations and reviews of documents to develop a detailed understanding of how stakeholder engagement might work as a mechanism for promoting impact. An initial literature review on stakeholder engagement was used to distil a set of propositions for testing. Further details about the project can be found on the website of the MRC (now under United Kingdom Research and Innovation).

Box 2 Design principles for stakeholder engagement

1) Clarify the objectives of stakeholder engagement

The objectives might be one or more of accessing knowledge and skills; supporting interpretation of the results and drafting recommendations; supporting future influence and impact on policy and practice; increasing recruitment/enabling research; supporting transferability. The objectives need to be shared then among all parties.

2) Embed stakeholder engagement in a framework or model of research use

There are a number of models and frameworks designed to show how stakeholders might be engaged in a way that helps increase the chances of research being used in policy and practice, for example, the linkage and exchange model [ 9 ]

3) Identify the necessary resources for stakeholder engagement

Resources to consider are budget, time, skills and competences to manage engagement

4) Put in place plans for organisational learning and rewarding of effective stakeholder engagement, for example, through appropriate evaluation of stakeholder engagement

5) Recognise that some stakeholders have the potential to play a key role

Identify those stakeholders who are particularly interested in being engaged and those who are likely to be influential. Depending on the objective of stakeholder engagement, they may provide the most useful input, and are most likely to play a key role in using the results; their engagement should be especially encouraged

6) Foster shared commitment to the values and objectives of stakeholder engagement in the project team

Ideally, make sure the commitment is there from the outset [ 6 ]

7) Share understanding that stakeholder engagement is often about more than individuals

Consideration needs to be given to stakeholders’ roles where they act as representatives – their power and influence within organisations and networks they represent and how these change over time

8) Encourage individual stakeholders and their organisations to value engagement

Support and build capacity for stakeholders and their organisations to engage

9) Recognise potential tension between productivity and inclusion

Engagement may lead to greater relevance and impact, but may have implications for productivity in meeting project objectives (for example, in a timely fashion). Engaging stakeholders, taking into account their needs and inputs and adjusting elements of the research project based on their feedback takes time and can slow down the research process

10) Generate a shared commitment to sustained and continuous stakeholder engagement

Project teams and stakeholders see the value of links between research producers and research users to build ongoing collaborations in order to meet the objectives

11) Plan stakeholder engagement activity as part of the research programme of work

This should be built into the project protocol or plan (see Pokhrel et al. [ 34 ])

12) Build flexibility within the research process to accommodate engagement and the outcomes of engagement

It will also be important to build in mechanisms to allow researchers to have the independence to articulate what is out of scope

13) Consider how input from stakeholders can be gathered systematically to meet objectives

The importance of some face-to-face contact and interactions should be considered

14) Consider how input from stakeholders can be collated, analysed and used

This important aspect of stakeholder engagement needs to be considered earlier than often happens

15) Recognising identification and involvement of stakeholders is an iterative and ongoing process

Ongoing interaction will be fostered by taking the time and creating the structures to build trustful relationships ([ 6 , 12 ])

Abbreviations

European Commission

European-study on Quantifying Utility of Investment in Protection from Tobacco

Knowledge translation

Patient and public involvement

Return on investment

Stakeholder Engagement in EQUIPT for Impact

Kok M, Gyapong J, Wolffers I, Ofori-Adjei D, Ruitenberg J. Which health research gets used and why? An empirical analysis of 30 cases. Health Res Policy Syst. 2016;14:36. https://doi.org/10.1186/s12961-016-0107-2 .

Article   PubMed   PubMed Central   Google Scholar  

Jolibert C, Wesselink A. Research impacts and impact on research in biodiversity conservation: The influence of stakeholder engagement. Environ Sci Policy. 2012;20:100–11.

Article   Google Scholar  

Phillipson J, Lowe P, Proctor A, Ruto E. Stakeholder engagement and knowledge exchange in environmental research. J Environ Manag. 2012;95:56–65. https://doi.org/10.1016/j.jenvman.2011.10.005 .

Paina L, Ekirapa-Kiracho E, Ghaffar A, Bennett S. Engaging stakeholders in implementation research: tools, approaches, and lessons learned from application. Health Res Policy Syst. 2017;15(Suppl 2):104.

Google Scholar  

Mallery C, Ganachari D, Fernandez J, Smeeding L, Robinson S, Moon M, Lavallee D, Siegel J. Innovative Methods in Stakeholder Engagement: An Environmental Scan. Prepared by the American Institutes for Research under contract No. HHSA 290 2010 0005 C. AHRQ Publication NO. 12-EHC097-EF. Rockville: Agency for Healthcare Research and Quality; 2012.

Deverka PA, Lavallee DC, Desai PJ, Esmail LC, Ramsey SD, Veenstra DL, et al. Stakeholder participation in comparative effectiveness research: defining a framework for effective engagement. J Comp Eff Res. 2012;1(2):181–94.

Concannon TW, Meissner P, Grunbaum JA, McElwee N, Guise JM, Santa J, Conway PH, Daudelin D, Morrato EH, Leslie LK. A new taxonomy for stakeholder engagement in patient centered outcomes research. J Gen Intern Med. 2012;27:985–91. https://doi.org/10.1007/s11606-012-2037-1 .

Greenhalgh T, Jackson C, Shaw S, Janaiman T. Achieving research impact through cocreation in community-based health services: literature review and case study. Milbank Q. 2016;94(2):392–429.

Boaz A, McKevitt C, Biri D. Rethinking the relationship between science and society: has there been a shift in attitudes to patient and public involvement and public engagement in science in the United Kingdom? Health Expect. 2016;19(3):592–601. https://doi.org/10.1111/hex.12295 .

Article   PubMed   Google Scholar  

Staniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, et al. GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. BMJ. 2017;358:j3453.

Article   PubMed   PubMed Central   CAS   Google Scholar  

Lomas J. Using ‘linkage and exchange’ to move research into policy at a Canadian foundation. Health Aff. 2000;19(3):236–40. https://doi.org/10.1377/hlthaff.19.3.236 .

Article   CAS   Google Scholar  

Kogan M, Henkel M. Government and Research: The Rothschild Experiment in a Government Department. London: Heinemann Educational Books; 1983. (2nd edition. Dortrecht: Springer; 2006).

Concannon TW, Fuster M, Saunders T, Patel K, Wong JB, Leslie LK, Lau J. A systematic review of stakeholder engagement in comparative effectiveness and patient-centered outcomes research. J Gen Intern Med. 2014;29:1692–701. https://doi.org/10.1007/s11606-014-2878-x .

Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci. 2012;7:50. https://doi.org/10.1186/1748-5908-7-50 .

Bowen S, Graham ID. Integrated knowledge translation. In: Straus SE, Tetroe J, Graham ID, editors. Knowledge Translation in Health Care: Moving from Evidence to Practice. Chichester: John Wiley & Sons Ltd; 2013. https://doi.org/10.1002/9781118413555.ch02 .

Chapter   Google Scholar  

McCutcheon C, Graham ID, Kothari A. Defining integrated knowledge translation and moving forward: a response to recent commentaries. Int J Health Policy Manage. 2017;6(5):299–300.

Gagliardi AR, Berta W, Kothari A, Boyko J, Urquhart R. Integrated knowledge translation (IKT) in health care: a scoping review. Implement Sci. 2016;11:38. https://doi.org/10.1186/s13012-016-0399-1 .

Hinchcliff R, Greenfield D, Braithwaite J. Is it worth engaging in multi-stakeholder health services research collaborations? Reflections on key benefits, challenges and enabling mechanisms. Int J Qual Health Care. 2014;26:124–8. https://doi.org/10.1093/intqhc/mzu009 .

Harvey G, Fitzgerald L, Fielden S, McBride A, Waterman H, Bamford D, Kislov R, Boaden R. The NIHR collaboration for leadership in applied health research and care (CLAHRC) for greater Manchester: combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy. Implement Sci. 2011;6(1):96. https://doi.org/10.1186/1748-5908-6-96.

Higher Education Funding Council for England (HEFCE). 2014 REF: Assessment Framework and Guidance on Submissions. Panel A Criteria. London: HEFCE; 2012.

Innvær S, Vist G, Trommald M, Oxman A. Health policy-makers’ perceptions of their use of evidence: a systematic review. J Health Serv Res Policy. 2002;7:239–44. https://doi.org/10.1258/135581902320432778 .

Hanney SR, Gonzalez-Block MA, Buxton MJ, Kogan M. The utilisation of health research in policy-making: concepts, examples and methods of assessment. Health Res Policy Syst. 2003;1:2. https://doi.org/10.1186/1478-4505-1-2 .

Lavis J, Davies H, Oxman A, Denis JL, Golden-Biddle K, Ferlie E. Towards systematic reviews that inform health care management and policymaking. J Health Serv Res Policy. 2005;10 Suppl 1:35–48. https://doi.org/10.1258/1355819054308549 .

Boaz A, Fitzpatrick S, Shaw B. Assessing the impact of research on policy: a literature review. Sci Public Policy. 2009;36:255–70. https://doi.org/10.3152/030234209X436545 .

Banzi R, Moja L, Pistotti V, Facchini A, Liberati A. Conceptual frameworks and empirical approaches used to assess the impact of health research: an overview of reviews. Health Res Policy Syst. 2011;9:26. https://doi.org/10.1186/1478-4505-9-26 .

Oliver K, Innvar S, Lorenc T, Woodman J, Thomas J. A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res. 2014;14:2. https://doi.org/10.1186/1472-6963-14-2 .

Hanney S, Greenhalgh T, Blatch-Jones A, Glover M, Raftery J. The impact on healthcare, policy and practice from 36 multi-project research programmes: findings from two reviews. Health Res Policy Syst. 2017;15:26. https://doi.org/10.1186/s12961-017-0191-y .

Nyström ME, Karltun J, Keller C, Andersson Gäre B. Collaborative and partnership research for improvement of health and social services: researcher’s experiences from 20 projects. Health Res Policy Syst. 2018;16:46. https://doi.org/10.1186/s12961-018-0322-0.

Pollock A, Campbell P, Struthers C, Synnot A, Nunn J, Hill S, Goodare H, Watts C, Morley R. Stakeholder involvement in systematic reviews: a protocol for a systematic review of methods, outcomes and effects. Res Involv Engage. 2017;3:9. https://doi.org/10.1186/s40900-017-0060-4 .

Forsythe LP, Ellis LE, Edmundson L, Sabharwal R, Rein A, Konopka K, Frank L. Patient and stakeholder engagement in the PCORI pilot projects: description and lessons learned. J Gen Intern Med. 2016;31:13–21. https://doi.org/10.1007/s11606-015-3450-z .

Center for Medical Technology Policy. Stakeholder Engagement. http://www.cmtpnet.org/our-work/stakeholder-engagement/ . Accessed 31 Aug 2017.

Vokó Z, Cheung KL, Józwiak-Hagymásy J, Wolfenstetter S, Jones T, Muñoz C, Evers S, Hiligsmann M, de Vries H, Pokhrel S. On behalf of the EQUIPT study. Similarities and differences between stakeholders’ opinions on using health technology assessment (HTA) information across five European countries: results from the EQUIPT survey group. Health Res Policy Syst. 2016;14:38. https://doi.org/10.1186/s12961-016-0110-7.

Evers SMAA, Hiligsmann M, Vokó Z, Pokhrel S, Jones T, et al. Understanding the stakeholders’ intention to use economic decision-support tools: a cross-sectional study with the tobacco return on investment tool. Health Policy. 2016;120(1):46–54.

Pokhrel S, Evers S, Leidl R, Trapero-Bertran M, Kalo Z, De Vries H, et al. EQUIPT: protocol of a comparative effectiveness research study evaluating cross-context transferability of economic evidence on tobacco control. BMJ Open. 2014;4(11) https://doi.org/10.1136/bmjopen-2014-%20006945 .

Esmail L, Moore E, Rein A. Evaluating patient and stakeholder engagement in research: moving from theory to practice. J Comp Eff Res. 2015;4(2):133–45. https://doi.org/10.2217/cer.14.79 .

Holmes B, Scarrow G, Schellenberger M. Translating evidence into practice: the role of health researcher funders. Implement Sci. 2012;7:39.

Kramer D, Wells R, Bigelow P, Carlan N, Cole D, Hepburn CG. Dancing the two-step: collaborating with intermediary organizations as research partners to help implement workplace health and safety interventions. Work. 2010;36(3):321–32. https://doi.org/10.3233/WOR-2010-1033 .

Brugha R, Varvasovszky Z. Stakeholder analysis: a review. Health Policy Plan. 2000;15:239–46.

Article   PubMed   CAS   Google Scholar  

Hering J, Hoffmann S, Meierhofer R, Schmid M, Peter A. Assessing the societal benefits of applied research and expert Consulting in Water Science and Technology. Gaia. 2012;21(2):95–101. https://doi.org/10.14512/gaia.21.2.6 .

Ovretveit J, Hempel S, Magnabosco JL, Mittman BS, Rubenstein LV, Ganz DA. Guidance for research-practice partnerships (R-PPs) and collaborative research. J Health Organ Manage. 2014;28(1):115–26. https://doi.org/10.1108/JHOM-08-2013-0164 .

Huberman M. Research utilization: the state of the art. Knowl Policy. 1994;7(4):13–33.

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Acknowledgements

The authors would like to acknowledge the contribution of the EQUIPT team, in particular, the Principal Investigator Subhash Pokhrel.

The SEE-Impact study (Stakeholder Engagement in EQUIPT for Impact), received funding from the United Kingdom Medical Research Council to explore the engagement of stakeholders in the EQUIPT project.

The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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Stephen Hanney

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AB and SH conceived of the study. All authors contributed to the design, data collection and analysis. An initial draft of the paper was produced by AB, with all authors contributing significantly to its development and revision. The final version has been approved by all authors.

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Ethical approval for the study entitled ‘Stakeholder Engagement in EQUIPT for Impact (SEE-IMPACT)’ was gained from the Research Ethics Committee, the Faculty of Health, Social Care and Education, St George’s University of London and Kingston University, on 18th March 2014.

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SEE-Impact study literature search. (DOCX 17 kb)

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Boaz, A., Hanney, S., Borst, R. et al. How to engage stakeholders in research: design principles to support improvement. Health Res Policy Sys 16 , 60 (2018). https://doi.org/10.1186/s12961-018-0337-6

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Corporate Governance

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Article publication date: 20 September 2018

Issue publication date: 4 February 2019

The stakeholder theory is a prominent management approach that has primarily been adopted in the past few years. Despite the increase in the theory’s use, a limited number of studies have discussed ways to develop, execute and measure the results of using this strategic approach with stakeholders. This study aims to address this gap in the literature by conducting a systematic review of the stakeholder management process.

Design/methodology/approach

Five databases were selected to search articles published from 1985 to 2015. The keywords used were stakeholder management, stakeholder relationship and stakeholder engagement. Starting from 2,457 articles identified using a keyword search, 33 key journal articles were systematically reviewed using both bibliometric and qualitative methods for analysis.

The results highlight that stakeholder management is increasingly embedded in corporate activities, and that the coming of the internet, social networking and Big Data have put more pressure on companies to develop new tools and techniques to manage stakeholders online. In conclusion, synthesizing the findings and developed framework allows the understanding of different streams of research and identifies future steps for research.

Originality/value

While literature reviews are a widespread practice in business studies, only a few more recent reviews use the systematic review methodology that aggregates knowledge using clearly defined processes and criteria. This is the first review on stakeholder management in which the structure is existing knowledge on strategy development, execution and the measurement of performance.

• Stakeholder management
• Systematic review
• Stakeholder engagement
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Pedrini, M. and Ferri, L.M. (2019), "Stakeholder management: a systematic literature review", Corporate Governance , Vol. 19 No. 1, pp. 44-59. https://doi.org/10.1108/CG-08-2017-0172

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Ten simple rules on how to develop a stakeholder engagement plan

Contributed equally to this work with: Susanne Hollmann, Babette Regierer, Jaele Bechis

* E-mail: [email protected] (SH); [email protected] (BR)

Affiliations SB Science Management UG (haftungsbeschränkt), Berlin, Germany, University of Potsdam, Faculty of Science, Potsdam, Germany

Affiliations University of Potsdam, Faculty of Science, Potsdam, Germany, Leibniz Institute of Vegetable and Ornamental Crops (IGZ) e.V., Großbeeren, Germany

Affiliation Université de Lorraine, Université de Strasbourg, CNRS, BETA, Nancy, France

¶ ‡ LT and DD’E also contributed equally to this work.

Affiliation Rete Europea dell’Innovazione—REDINN, Pomezia, Italy

Affiliation Institute for Biomedical Technologies, National Research Council, Bari, Italy

• Susanne Hollmann, 
• Babette Regierer, 
• Jaele Bechis, 
• Lesley Tobin, 
• Domenica D’Elia

Published: October 13, 2022

• https://doi.org/10.1371/journal.pcbi.1010520
• Reader Comments

To make research responsible and research outcomes meaningful, it is necessary to communicate our research and to involve as many relevant stakeholders as possible, especially in application-oriented—including information and communications technology (ICT)—research. Nowadays, stakeholder engagement is of fundamental importance to project success and achieving the expected impact and is often mandatory in a third-party funding context. Ultimately, research and development can only be successful if people react positively to the results and benefits generated by a project. For the wider acceptance of research outcomes, it is therefore essential that the public is made aware of and has an opportunity to discuss the results of research undertaken through two-way communication (interpersonal communication) with researchers. Responsible Research and Innovation (RRI), an approach that anticipates and assesses potential implications and societal expectations regarding research and innovation, aims to foster inclusive and sustainable research and innovation. Research and innovation processes need to become more responsive and adaptive to these grand challenges. This implies, among other things, the introduction of broader foresight and impact assessments for new technologies beyond their anticipated market benefits and risks. Therefore, this article provides a structured workflow that explains “ how to develop a stakeholder engagement plan ” step by step.

Citation: Hollmann S, Regierer B, Bechis J, Tobin L, D’Elia D (2022) Ten simple rules on how to develop a stakeholder engagement plan. PLoS Comput Biol 18(10): e1010520. https://doi.org/10.1371/journal.pcbi.1010520

Copyright: © 2022 Hollmann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This publication is based on outputs of the COST Action CHARME supported by COST - European Cooperation in Science and Technology ( https://www.cost.eu ) funding agreement CA15110, results of the project OXIPRO funded by the European Union's Horizon 2020 research and innovation programme ( https://ec.europa.eu ) under Grant Agreement No. 101000607 and SB Science Management UG ( www.sb-sciencemanagement.com ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Scientific knowledge is one of the pillars of the modern economy [ 1 ]. As underlined by the European Commission (EC) [ 2 ], science strongly contributes to innovation creation and valorisation [ 3 ]. Innovation, as the dissemination, reuse, and valorisation of knowledge, plays a major role in employment and economic growth. While the time lag between research and its financial economic exploitation may be long and characterised by high uncertainty, “the economic impact of science is indisputable” [ 4 ].

For these reasons, funding bodies playing a major role in research funding, such as the EC, have always been interested in the optimal spending on scientific research [ 5 ] and continue to orient policies for making research outcomes more meaningful, and research more responsible. This applies to basic scientific research as well as to applied science. Citing Needham, Freeman says that “There is really only science with long term promise of application and science with short term promise of application” [ 6 ].

Meaningful and responsible research requires the alignment of public-funded research with societal values and needs to influence the project’s trajectory and increase the societal impact. Research and technological advances only make sense if they are useful, usable, and embraced by consumers. This requires the public to be made aware of new scientific developments and to have the opportunity to communicate and interact with researchers. Therefore, early engagement with stakeholders is of paramount importance [ 7 – 9 ].

Responsible Research and Innovation (RRI) emphasises the importance of two-way communication between researchers and stakeholders. It is a “transparent, interactive process by which societal actors and innovators become mutually responsive to each other with a view on the (ethical) acceptability, sustainability and societal desirability of the innovation process and its marketable products” [ 7 ]. “RRI should be understood as a strategy of stakeholders to become mutually responsive to each other and anticipate research and innovation outcomes underpinning the ‘grand challenges’ of our time for which they share responsibility” [ 10 ] and as such lead to desirable societal benefits [ 11 , 12 ].

In this context, engagement with multiple stakeholders ( Fig 1 ) is of utmost importance in modern research for catalysing scientific knowledge use [ 13 , 14 ] especially through information and communications technology (ICT).

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• PNG larger image
• TIFF original image

Definition of a stakeholder [ 6 ].

https://doi.org/10.1371/journal.pcbi.1010520.g001

In addition, allowing stakeholders to interact with the project in its initial stage can result in tailored products, services and solutions [ 15 , 16 ]. This engagement allows the researchers to adjust project strategies from the beginning, avoiding futile, money-wasting, and time-consuming activities. Therefore, since 2014, the EC has called for engagement with stakeholders as a prerequisite to receiving funding.

To discuss the research results, two-way communication requires engaging stakeholders, which may not be an easy task. The added value, however, is that it allows both the communicator and the recipient to freely express their views, ideas, and feelings. This mutual exchange of information creates a democratic environment in the setting that is beneficial for both parties. For the project team, it is an opportunity to receive relatable feedback and, if needed, to react accordingly. For stakeholders, it represents a way to participate in the whole research project and, in this way, guide the research towards its specific objectives and real needs.

Due to the heterogeneity of stakeholders, the implementation of different approaches is necessary to reach every single actor and ensure appropriate coordination.

With this paper, we provide “10 simple rules on how to develop a stakeholder engagement plan” that help identify and manage stakeholder engagement and, fundamentally, adopt an RRI approach. It is important to note here that the stakeholder engagement plan is not a static document and should be revised and reviewed in tandem with the project implementation.

Rule 1: Identify and formulate the challenges of the project

Before identifying the stakeholders, a careful analysis of the internal and external opportunities and threats or risks to the project should be carried out. This analysis of the project framework conditions is necessary to achieve its expected outcomes and impact and to understand which stakeholder groups should be involved for the success of the project. In doing so, 2 main tools can help to analyse both internal and external challenges to be overcome in order to reach the desired outcomes. The Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis tool [ 17 ] is designed for the identification of both internal and external factors that may influence project outcomes and impact. In particular, the tool focuses on strengths and weaknesses that characterise the project’s success and on opportunities and threats that emanate from the external environment. Because of the complexity of the external environment, the analysis needs to be further developed using the Political, Economic, Social, Technological, Environmental, and Legal (PESTEL) [ 17 ] framework. This second tool focuses on the external elements, namely political, economic, social, technological, environmental, and legal factors that may influence the desired outcomes. The identification of these key external factors is crucial because they might have a relevant influence on your research, while you have only little or no means to control these. With a careful analysis of these factors, it is possible to take action to avoid potential pitfalls and, on the other hand, exploit new opportunities.

By conducting the analysis, elements are identified that provide a clearer view of such factors and conditions that may affect the project outcomes. Knowing them helps to identify and select the conditions that need to be met in order to achieve your objectives, including the stakeholders to be involved.

Rule 2: Identify stakeholders

Once the SWOT and PESTEL analysis results are specified, it is easier to identify actors, i.e., mapping stakeholders, that are likely to be impacted by project outcomes. In this second step, it is necessary to select the actors that need to be involved in facing the defined challenges. To avoid investing time and efforts in a nontargeted (or unfavourable) strategy, it is crucial to ensure that relevant stakeholders are already engaged from the beginning of the research activities.

It is advisable to commence with the specification of the stakeholder reference groups (the stakeholder areas). Stakeholder areas describe the fields that stakeholders represent, i.e., Research, Industry, Policy, and Society. We further divided these stakeholders’ areas into 3 more specific levels: macro-, meso-, and microlevel. The authors of this paper define these levels as follows: macrolevel means all individuals directly affiliated or working in a branch of a stakeholder area such as, e.g., the pharmaceutical industry without any further specification or discrimination. They can be technicians, project managers, engineers, or persons from the management area. Although they belong to the same area, they will not have the same background, needs, interests, or influence on the project. Mesolevel refers to groups representing specific sectors of the macrolevel: one sector covers, for example, all technicians and manufacturing people, the developers, the managers, etc., representing another sector. The microlevel is represented by the single individuals from the above mesolevel.

Keeping in mind the immediate needs of the project, the next stage entails scheming out potential stakeholder needs and the expected impact on the project outcomes as a result of their involvement (feedback).

This analysis enables the evaluation and comparison of the different effects of specific stakeholders on the project as well as how the project can meet diverse stakeholder needs or expectations. The data should be structured in a table designed to record 3 types of key data for each stakeholder; for example, stakeholder needs, project needs, and expected impact.

Rule 3: Implement a roadmap to ensure conformity with data privacy policy

Intellectual property (IP) concerns and data disclosure are examples of issues to be addressed when interacting with actors involved in the project in different ways. While IP refers to the outgoing data management, data disclosure concerns incoming data. Confidentiality of project data is a typical example of data that may raise IP concerns when they are to be shared with stakeholders. In contrast, the management of data generated by stakeholders clearly represents a data disclosure issue.

Therefore, an essential element here is the implementation of specific measures, ensuring conformity with the existing regulations at both national, supranational, and international levels. An example is the General Data Protection Regulation (GDPR) [ 18 ], applicable to all entities collecting data related to persons in the European Union. GDPR is developed around 4 main axes: lawful basis and transparency, data security, accountability and governance, and privacy rights. For example, the data minimisation principle, included in the data security section, states that “You should collect and process only as much data as necessary for the purposes specified.” Because interaction measures differ between stakeholder groups, the information provided to or needed from each stakeholder group might be different. It may be that, for example, information about the age and ethnicity of stakeholders is important for one group but might not be essential for another. Therefore, in order to comply with the data minimisation principle, it is vital to form a clear idea about the specific data emanating from each stakeholder group that is required for the project.

Following the identification of all the IP and data management aspects to be addressed, the next step is to define a robust strategy for complying with the legal framework, e.g., data transfer agreements, consent agreements, etc. As a legal matter and one of the pillars of RRI, from this point, a Data Protection Officer, or the Technology Transfer Office, who also manage ethical issues, must be involved in this process.

Rule 4: Collect stakeholder data (stakeholder register)

All stakeholder information should be collected in a stakeholder register ( Table 1 ). The personal information entered in the Register forms the basis for the stakeholder mapping, whereby all individuals are assigned to a specific area and level. It is important to note that some individuals can belong to different stakeholder groups.

https://doi.org/10.1371/journal.pcbi.1010520.t001

Rule 5: Categorise stakeholders into priority groups

Once the stakeholder register is compiled, stakeholders can be categorised into different priority groups.

Stakeholder classification is necessary for managing their engagement. Stakeholder engagement is a time-consuming activity, and stakeholders differ in terms of the role and the influence they may have on the project’s success. For example, high-priority group members can support or hinder the project, while low-priority groups have a marginal impact on the project outcomes. Therefore, it is essential to prioritise some groups over others.

An effective tool for prioritising stakeholder groups is Mendelow’s matrix [ 19 ]. This system analyses stakeholders according to 2 main characteristics: their interest in the project and their influence on the project outcomes. As a result, 4 different priority groups will emerge: (1) Key stakeholder; (2) Influencer; (3) Interested stakeholder; and (4) Passive stakeholder. The key stakeholders are individuals with high interest and high influence. Influencers are those who have low interest but high influence. The 2 remaining groups are the interested (high interest/low influence) and passive stakeholders (low interest/low influence). Results of stakeholder categorisation are provided in Table 2 .

https://doi.org/10.1371/journal.pcbi.1010520.t002

Once the stakeholders have been categorised into priority groups, the matrix enables the definition of the purpose and the degree of the interaction with each stakeholder group. Special attention must be paid to those individuals who belong to the first 2 groups.

When the purpose is clarified for each stakeholder, stakeholder engagement efforts and activities can be oriented, as shown in Table 3 , where the categorisation output is reported in the first column while the engagement efforts and activities are displayed in the third column.

https://doi.org/10.1371/journal.pcbi.1010520.t003

Rule 6: Devise a stakeholder engagement plan

After creating the stakeholder register, followed by the mapping and prioritisation of the stakeholder groups, the next stage is to devise your stakeholder engagement plan. This plan is designed as a strategic document and timeline that will facilitate the management of stakeholder engagement throughout the lifespan of the project.

As a strategic document, the plan outlines all the specific activities addressed to each stakeholder group that fit the purposes identified in Rule 5. Because the nature of stakeholder involvement is not the same for each priority group, different strategies and media tools must be adopted to reach and engage them. For example, for key stakeholders, solely issuing and targeting them with newsletters will be insufficient and other strategies should be added and implemented to keep them on track, such as round tables and workshops. Conversely, for passive stakeholders, social networks and newsletters are adequate. The greater the stakeholder’s interest and power, the greater the communication flow should be.

Identifying the instruments to be used for implementing the stakeholder engagement plan or strategy is a key point concerning the methodology to be developed. To this end, it is worthwhile listing all the possible dissemination tools considered most suitable for the project’s communication strategy, and then deciding which group(s) can be effectively reached with each tool. Moreover, communication should be two-way; therefore, stakeholders must also be able to communicate with the project representatives and members.

Once the communication strategy has been finalised, it is time to focus on planning activities. Given the different activities necessary for engaging stakeholders, this plan should also be designed along a timeline. Scheduling activities on a timeline will facilitate their timely implementation and allow for appropriate priority to be given to each stakeholder group to be contacted and engaged, in line with the project schedule and deliverable deadlines.

All the activities necessary for implementing the stakeholder engagement plan require time and human as well as other resources. Knowing how much time is required to complete a task or a series of tasks (e.g., preparing a survey or organising a meeting) is pivotal for the plan to be successful. Therefore, in compiling and fixing the schedule of planned activities, the human resources that must be dedicated and the time necessary for each activity should be carefully calibrated. For example, preparing a round table or a workshop requires far more time, resources, and effort than preparing a survey or creating a brochure. For the organisation of a meeting, there are several key considerations to be made. These include topic selection (depending on the high-priority group interests), identification and invitation of keynote speakers, preparation of publicity material (e.g., brochure or flyer), dissemination of the event on selected channels (newspapers, social media, etc.), selection of the event venue, hosting, and facilitation, and in some cases the organisation of social events that are fundamental to prompt interpersonal relationships and stimulate people to work together towards common objectives. Such activities require planning months in advance, with each planning stage executed on time. Finally, since stakeholders are often not members of the project, they may need to be motivated to foster active participation in the organised activities. They may not always be available to participate throughout the planned schedule. Moreover, stakeholders also have individual preferences; for example, some prefer meetings while others like to engage in a one-on-one conversation or through written media; also, security or IP issues might play a role when choosing the optimal interaction tool. Thus, the engagement plan should be adaptable and flexible with built-in alternative strategies if stakeholders prove to be unresponsive.

Rule 7: Identify, select, and test tools for the implementation of Rule 6 and its GDPR conformity

Once the communication strategy has been defined and the most suitable tools to be used identified, it is time to work on the content and format of the chosen communication media. This will require identifying the communication tool that best fits the project’s needs and is the most appealing to the target stakeholder group. During this phase, it is important to define the approach for communication, the content, and the tool(s) to be used. For example, choices may include face-to-face or online meetings, newsletters, surveys, structured interviews, and social network campaigns. Of these choices, structured interviews can prove beneficial in that the questions are planned and created in advance. Accordingly, all candidates are asked the same questions in the same order, making it easier to compare and evaluate their responses objectively and fairly, rendering such structured interviews more legally defensible.

Once the communication media have been compiled, it is worth conducting a meaning and error check for clarity and correctness. A review by peers and colleagues may improve the comprehensibility and accuracy of the media, its formulation, design, and hence the overall efficacy of the communication strategy.

The final step involves testing the GDPR conformity of the communication media, referring to the strategy defined when following Rule 3. The collected interview data and the tools and software utilised for managing the communication activity should be examined for compliance with GDPR guidelines.

Rule 8: Make contact—Engage stakeholders

At this point, the engagement plan can be rolled out to initiate the two-way communication with the stakeholder groups, and this communication should be followed through. For example, when an email is sent to a stakeholder, it is important to pursue this line of contact and ascertain whether a connection has indeed been established, i.e., whether the targeted stakeholder responded positively to the email, subscribed to the project newsletter, or, conversely, if they unsubscribed from your mailing list. Different factors may affect the success of the engagement: For example, unresponsiveness may be an indication that the group has been wrongly prioritised or the person to engage with has been misidentified, or an inadequate media channel has been selected and utilised. Ultimately, it may be that the email sent has landed in their junk folder or was filtered by a spamming programme or firewall. Should these issues arise, it may be necessary to revisit the previous rules ( Fig 2 ) and make the necessary adjustments until a satisfactory result is achieved. The number of responses or newsletter subscriptions will be strong indicators as to whether a trusting relationship has been built with the stakeholders.

If the stakeholder engagement is not successful, it may be necessary to revisit previous rules and, especially, to check contacts, replace unresponsive stakeholders, and change the content and/or the communication flow. The scheme demonstrates the workflow for revision.

https://doi.org/10.1371/journal.pcbi.1010520.g002

Note that it is not yet a central task to include all external stakeholders in the communication flow at the beginning of a project. However, the extensive exploitation of social networks is central to the initiation of the communication process. One starting point is to create posts on media channels where specific interest groups or communities can be targeted, for example, scientific networking tools such as ResearchGate, or professional networking platforms such as LinkedIn. Posting project-related videos on YouTube can also increase visibility, particularly if the video is well designed and the content is developed by experts in the field. In this type of promotion for the project, the appeal of the communication can be enhanced with the use of nonspecialist language and visually attractive material.

Rule 9: Evaluate stakeholder feedback

Considering stakeholder responses is not a passive task, but an assessment activity. Stakeholder feedback should be discussed with partners and, if appropriate, with other stakeholders before it is incorporated into the project strategy leading, e.g., to changes in the project plan. The purpose of stakeholder involvement is to make the research successful and responsible and to balance the needs and requirements of the project with those of the stakeholders.

Once stakeholders are involved, the extent and nature of their response can be assessed. Imagine the scenario where a new app is being developed. In this case, it is reasonable to include potential users in the list of stakeholders. You then apply Rule 8 and invite them to participate in a survey. The survey shows that your app is well received in principle, but users do not feel comfortable using it, which makes it unattractive. Before changing the project plan, it might be advisable to formulate acceptance criteria and consult the stakeholders, as this increases the likelihood that the customers’ expectations—and not the developers’ needs—are met. If necessary, additional requirements can be identified and discussed with stakeholders or a developer before implementation.

If opinions are divergent, reiteration of the evaluation process clarifies positions and perspectives to determine if the requested change should be implemented in the project strategy or not. This evaluation process will also further enhance the two-way communication process. Another way to evaluate stakeholders’ reaction is by using data from some of the tools identified in the communication strategy (Rule 7). Different software exists that allows to retrieve information from stakeholders’ behaviour, such as when they receive the newsletter, respond to questionnaires, or visit the website. GDPR-compliant newsletter tools such as rapidmail, klicktipp, or GetResponse offer an anonymised automatic evaluation of recipient behaviour. This includes information on opens, bounces, clicks on provided links, and unsubscribes. Such software also helps ascertain user tools and demographics, such as whether the message was opened from a desktop, tablet, or phone and in which country, and the gender balance. When performing face-to-face events such as workshops or meetings, afterwards, the administration of a survey on the level of satisfaction or the level of commitment of attendants is of utmost importance to test the effectiveness of the activity and the success of the event for the project objectives. This monitoring is central to the continuous improvement of the communication strategy until it is possible to achieve the desired stakeholder group represented in sufficient numbers and statistically relevant.

Rule 10: Adjust engagement plan

After evaluating stakeholder feedback, it is finally time to adjust the project to best fit its objectives, thereby making research outcomes more meaningful and research more responsible. Once the project plans have been revised, the entire process should be assessed from the start and, if necessary, adjusted where tensions were found ( Fig 3 ). This can either be the case at rule 1 (as shown in Fig 2 ), e.g., if the framework conditions of the project have changed, or at any later stage in the process. The purpose of this process is to continuously improve processes and accelerate the use of a system under development to minimise risks and undesirable developments similar to the OODA loop (Observe-Orient-Decide-Act cycle) [ 20 ], PDCA (plan-do-check-act or plan-do-check-adjust) [ 21 ], and agile software development [ 22 ]. The significance of this should not be underestimated: Early and timely project changes can prevent the loss of time and resources.

Workflow. The scheme demonstrates an optimal workflow for the generation of a stakeholder engagement plan including the preparatory, implementation, and follow-up phase for a complete cycle.

https://doi.org/10.1371/journal.pcbi.1010520.g003

It is also critical to the project’s success that results are continually measured and evaluated if they are still aligned with stakeholder needs based on the project objectives. As mentioned, corrective actions should be implemented as early as possible as this will prevent small issues from becoming larger and irreparable problems. Table 4 provides a nonexhaustive list of questions to help in designing the stakeholder engagement plan.

https://doi.org/10.1371/journal.pcbi.1010520.t004

Conclusions

Nowadays, stakeholder participation in research projects has become a more and more common practice. Usually required by third-party–funded projects, their engagement is of utmost importance to render the research more responsible and research outcomes more meaningful. For example, in solution-oriented research, such as in systems medicine, the effective involvement of stakeholders in the research process is fundamental. Here, one prominent example is personalised medicine, for which the patient is the core reference. What the patients eat, their lifestyle, the type and degree of stress they experience, and the environmental elements to which they are exposed constitute core data to be collected, analysed, and meaningfully correlated to clinical indicators. This is the reason why the involvement of stakeholders is so important. However, dealing with stakeholders is a complex process. Which stakeholders need to be involved in the project? How can they be reached? How can they be engaged? Are they equally relevant for the expected outcomes of the project?

Having an effective stakeholder engagement plan is necessary for successfully identifying, mapping, prioritising, and engaging focal actors who will have the power to positively influence your project trajectory and outcomes. These 10 simple rules will facilitate the development and implementation of a stakeholder engagement plan, monitor the evolution of the importance of the stakeholder groups, and make any necessary adjustments during the lifespan of a project. A robust and effective engagement plan will optimise and maximise the impact of your project.

Acknowledgments

We thank our CHARME community [ 23 ] and OXIPRO partners [ 24 ] for the useful discussions about the topic leading to write this publication. We thank Philip E. Bourne for encouraging us to write this paper.

• View Article
• Google Scholar
• 2. Hilty R, Krujatz S, Bajon B, Frueh A, Kur A, Drexl J, et al. European Commission—Green Paper: Copyright in the Knowledge Economy—Comments by the Max Planck Institute for Intellectual Property, Competition and Tax Law [Internet]. Rochester, NY: Social Science Research Network; 2008 Dec. Report No.: ID 1317730. Available from: https://papers.ssrn.com/abstract=1317730 .
• 6. Freeman RE. Strategic management: A stakeholder approach. Boston, Pitman. 1984
• PubMed/NCBI
• 10. Von Schomberg R. A vision of responsible research and innovation. Responsible Innovation: Managing the Responsible Emergence of Science and Innovation in Society. John Wiley & Sons: Hoboken, NJ, USA; 2013. p. 51–74.
• 13. Freedman P. The Principles of Scientific Research. London: Macdonald & Co. Ltd; 1949.
• 17. SWOT and PESTEL Analysis: An Overview by Jaele Bechis [Internet]. https://doi.org/10.5281/zenodo.6603058 .
• 18. GDPR [Internet]. What is GDPR, the EU’s new data protection law? [cited 2022 Mar 13]. Available from: https://gdpr.eu/what-is-gdpr/ .
• 19. Mendelow A. Stakeholder Mapping. Proceedings of the 2nd International Conference on Information Systems. Plenum Publishers: Cambridge, MA; 1991.
• 21. Lewis WE. PDCA/Test: A Quality Framework for Software Testing. 1st ed. 1998. Auerbach Publications. https://doi.org/10.1201/9780429131769 .
• 23. cost-charme.eu [Internet]. COST Action Harmonising standardisation strategies to increase efficiency and competitiveness of European life-science research (CHARME); c2016-2020 [cited 2020 Apr 7]. Available from: https://www.cost-charme.eu/ .
• 24. oxipro.eu [Internet]. Transition towards environment-friendly consumer products by co-creation of an oxidoreductase foundry. Horizon Europe GA Grant agreement ID: 101000607 [cited 2022 May 27]. Available from: https://www.oxipro.eu/ .

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Stakeholder Management: Proposal for Research—Do Successful Project Managers Employ ‘Interest-Based Negotiation’ to Create Successful Project Outcomes?

• John Heathcote 4 ,
• Colin Butlin 4 &
• Hadi Kazemi 4  
• Conference paper
• First Online: 30 June 2020

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Increasingly the management of stakeholders is reported, by research on the management of projects, as being critical to the successful development of projects. Current research into the management of stakeholders charts a move from: classifying who stakeholders might be, to one of determining whether and how to manage them, to one of recommending ‘engagement’. Stakeholders are seemingly important players in the project’s environment because they are able to both significantly influence the project’s delivery and because they may well be the arbiters of whether the project can be considered successful or not. This latter point indicates the role that stakeholders and those stakeholders that are beneficiaries of the project can have in determining how ‘value’ is interpreted. This research proposal identifies a gap in existing literature; that gap is in the final process of stakeholder management. Aligned to a risk management process, stakeholder management ends with the idea that the stakeholder will be managed . As writers show that ‘engagement’ might be beneficial, then ‘interest-based negotiation’ (IBN) allows for a project manager to engage with these groups through IBN. Anecdotal evidence shows that elements of IBN might be unconscious components of successful project managers’ interactions with stakeholders. This paper proposes a study design that will allow for the hypothesis H1 ‘Successful stakeholder engagement can be correlated with project managers employing elements of interest-based negotiation’ to be tested.

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Aaltonen, K., & Kujala, J. (2010). A project lifecycle perspective on stakeholder influence strategies in global projects. Scandinavian Journal of Management, 26 , 381–397.

Article   Google Scholar  

Achterkamp, M. C., & Vos, J. F. J. (2008). Investigating the use of the stakeholder notion in project management literature, a meta-analysis. International Journal of Project Management, 26 , 749–757.

Association for Project Management. (2006). APM body of knowledge (5th ed.). Princes Risborough: Association for Project Management.

Google Scholar  

Baarveld, M., Smit, M., & Dewulf, G. (2015). Negotiation processes in urban redevelopment projects: Dealing with conflicts by balancing integrative and distributive approaches. Planning Theory & Practice, 16 (3), 363–384.

Bryman, A., & Bell, E. (2003). Business research methods (Vol. 539). Oxford: Oxford University Press.

Easterby-Smith, M., Thorpe, R., & Lowe, A. (1995). Management research: An introduction . London: Sage Publications.

Emery, C. W., & Cooper, D. R. (1991). Business research methods . Burr Ridge, IL: Irwin.

Fisher, R., Ury, W., & Patton, B. (1991). Getting to yes: Negotiating agreement without giving in (2nd ed.). New York: Penguin Books.

Forester, J. (2009). Dealing with Differences: Dramas of Mediating Public Disputesby Oxford University Press.

Karlsen, J. T. (2008). Forming relationships with stakeholders in engineering projects. European Journal of Industrial Engineering, 2 , 35–49.

Liu, S., & Wang, L. (2014). Understanding the impact of risks on performance in internal and outsourced information technology projects: The role of strategic importance. International Journal of Project Management, 32 (8), 1494–1510. Elsevier Ltd.

Mitchell et al. (1997). The Conspicuous lCorporationBusiness, Public Policy, and Representative Democracy University of Michigan Press.

Morris, P. W. (2013). Reconstructing project management . Hoboken: Wiley.

Book   Google Scholar  

Murtoaro, J., & Kujala, J. (2007). Project negotiation analysis. International Journal of Project Management, 25 , 722–733.

Murtoaro, J., Kujala, J., & Artto, K. (2005). Negotiations in project sales and delivery process: An application of negotiation analysis. Espoo, Helsinki University of Technology, Laboratory of Industrial Engineering and Management, Report 2005/3.

Polit, D.F., and Beck, C.T. (2012), Nursing research: Generating and assessing evidence for nursing practice 9. Reference and Research Book News, Vol. 26(3).Philadelphia, PA: Lippincott Williams and Wilkins

Pollack, J. (2007). The changing paradigms of project management. International Journal of Project Management, 25 , 266–274.

Pruitt and Rubin (1986). Pruitt, D. G. and Rubin, J. Z. 1986. Social conflict: Escalation, stalemate, settlement, New York: Random House.

Susskind, L., Mnookin, R. H., Rozdeiczer, L., & Fuller, B. (2005). What we have learned about teaching multi-party negotiation. Negotiation Journal, 21 (3), 395–408.

Thompson, L. (2011). The mind and heart of the negotiator . Upper Side River, NJ: Pearson Education.

Turner, R, (2009). A Model of project complexity: distinguishing dimensions of complexity from severity. In International Research Network of Project Management Conference (IRNOP), 2009-10-11-2009-10-13.

Turner, R., & Zolin, R. (2012). Forecasting success on large projects: Developing reliable scales to predict multiple perspectives by multiple stakeholders over multiple time frames. Project Management Journal, 43 (5), 87–99.

Van Rijswick, M., & Salet, W. (2012). Enabling the contextualization of legal rules in responsive strategies to climate change. Ecology and Society, 17 (2), 18.

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Heathcote, J., Butlin, C., Kazemi, H. (2020). Stakeholder Management: Proposal for Research—Do Successful Project Managers Employ ‘Interest-Based Negotiation’ to Create Successful Project Outcomes?. In: Scott, L., Dastbaz, M., Gorse, C. (eds) Sustainable Ecological Engineering Design. Springer, Cham. https://doi.org/10.1007/978-3-030-44381-8_19

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REVIEW article

Project stakeholder management in the clinical research environment: how to do it right.

• 1 Department of Population Health, New York University Medical Center, New York, NY, USA
• 2 Department of Management, Zicklin School of Business, Baruch College, New York, NY, USA
• 3 District Mental Health Programme, Madurai Medical College, Madurai, India
• 4 Division of Community Psychiatry, M. S. Chellamuthu Trust and Research Foundation, Madurai, India
• 5 University of Virginia Darden School of Business, Charlottesville, VA, USA
• 6 Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, USA
• 7 University of South Carolina, Columbia, SC, USA

This review introduces a conceptual framework for understanding stakeholder management (ShM) in the clinical and community-based research environment. In recent years, an evolution in practice has occurred in many applicants for public and non-governmental funding of public health research in hospital settings. Community health research projects are inherently complex, have sought to involve patients and other stakeholders in the center of the research process. Substantial evidence has now been provided that stakeholder involvement is essential for management effectiveness in clinical research. Feedback from stakeholders has critical value for research managers inasmuch as it alerts them to the social, environmental, and ethical implications of research activities. Additionally, those who are directly affected by program development and clinical research, the patients, their families, and others, almost universally have a strong motivation to be involved in the planning and execution of new program changes. The current overview introduces a conceptual framework for ShM in the clinical research environment and offers practical suggestions for fostering meaningful stakeholder engagement. The fifth edition of PMBOK ® of the Project Management Institute, has served as basis for many of the suggested guidelines that are put forward in this article.

A true architect is not an artist but an optimistic realist. They take a diverse number of stakeholders, extract needs, concerns, and dreams, and then create a beautiful yet tangible solution that is loved by the users and the community at large. We create vessels in which life happens

– Cameron Sinclair ( 26 )

In recent years, a revolution in thinking about organizational management and decision making has taken place. Increasingly, programs have been incorporated into organizations, typically private sector corporations or government agencies, which have sought to involve “stakeholders” in management decision making. Stakeholders are the customers, suppliers, the general public, and any other group, which are likely to be affected by the organization’s ultimate decisions. The process of incorporating the ideas and input from these groups has been termed “stakeholder engagement.” It reflects an increasingly accepted attitude that organizations not only have an ethical obligation to involve the participation of stakeholders in their collective activity but also in so doing their overall organizational effectiveness will be enhanced. While certain generalizations in the application of this philosophy are constant, minor variations also exist, which reflect the specific goals that the organization is pursuing. In this review, the application of stakeholder engagement in clinical research settings, particularly in hospitals or university research centers, is considered.

According to the Institute of Medicine (IOM), the purpose of comparative effectiveness research (CER) is, “to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve healthcare at both the individual and population level” ( 1 ). The Kellogg Commission report defines engagement as follows: “By ‘ engagement ’ we refer to institutions that have redesigned their teaching, research, and extension and service functions to become even more sympathetically and productively involved with their communities, however, community may be defined” ( 2 ). Hospitals and research centers are increasingly taking deliberate steps to include their broader constituencies in project management decision making and to seek their input at an early stage of the research or program implementation process. The term “ community engagement ,” can be defined as, “the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people” [( 3 ), p.3]. It has been noted that traditional models of research which view study subjects or targets of program development as passive audiences may result in research findings that are poorly aligned with the information needs of real-world decision makers ( 4 , 5 ). An additional impetus for this interest has been the Patient Protection and Affordable Care Act of 2010, which was enacted to promote patient engagement. The purpose of the act has been to help patients, clinicians, purchasers, and policy makers make better informed health decisions by “advancing the quality and relevance of evidence about how to prevent, diagnose, treat, monitor, and manage diseases, disorders, and other health conditions.”

The key focus in the process of stakeholder engagement is of course the stakeholder. Freeman ( 6 ): 46 defined stakeholder as, “any group or individual who can affect or is affected by the achievement of the organization’s objectives.” According to the project management institute (PMI), the term stakeholder refers to, “an individual, group, or organization, who may affect, be affected by, or perceive itself to be affected by a decision, activity, or outcome of a project” ( 7 ). In other words, almost any individual or group of individuals with an interest or stake in a consensus-building process thereby the outcome of the project and/or an ability to exert a positive or negative influence by the execution or completion of a project or being affected by the work or its deliverables, outputs, or results.

In clinical research, researchers are often faced with questions about the choices that must be made by patients. Research can also be focused on assisting the process of program development. In either instance, the underlying motivation remains the same: to healthcare delivery, to become aware of dysfunctionalities that may exist in healthcare, and to improve the outcomes of proposed changes. It is essential then that research and program processes are assisted by those who are most directly affected by proposals, i.e., the patients themselves. Central to the process of encouraging stakeholder involvement therefore is a basic assumption that patients have the right to make the best decisions about their own health care.

Stakeholder engagement versus stakeholder management (ShM): in recent years, the term “ stakeholder engagement ” (ShE) has become widely used in applied clinical research and new program development. An important reason for this is that it has been repeatedly shown that critical health issues, which are often known to the patients or research subjects themselves, may not have been addressed in the original research or program proposals ( 8 ). Stakeholder engagement is a bidirectional process. It begins when the researcher communicates and interacts with stakeholders, and ultimately results in informed decision-making concerning the selection, conduct, as well as dissemination of research findings in order to achieve a desired outcome and enhance accountability ( 9 , 10 ). Stakeholder engagement is thus differentiated from one-way communication processes that seek to influence groups to agree with a decision that has already been made.

The obligation to serve all stakeholder interests is often called stakeholder management ( 11 , 12 ). The main distinction between stakeholder management and stakeholder engagement largely rests on the extent to which stakeholders are involved in the decision-making processes. The process of engagement varies across different research programs, but is highly noticeable in complex, multidisciplinary research.

A stakeholder analysis is a process, which provides insights into, and understanding of, the interaction between a project and its stakeholders. In other words, the process of listing, classifying, and assessing the influence of these stakeholders in a project is termed a stakeholder analysis. Stakeholder analysis systematically gathers and analyzes both qualitative and quantitative information thereby to determine whose interest should be taken into account throughout the project. One of the first tasks that a clinical project manager must undertake is to identify how stakeholders can make the greatest impact on the research project or program change, which is being contemplated. The function of stakeholder analysis is to produce an awareness of who will be affected by the project and who can contribute to making the project more successful. The stakeholder analysis, which is usually undertaken at an early stage of planning, is an integral part of risk and reward assessment activities.

It is essential for maximal project effectiveness that managers be committed to the basic philosophy of stakeholder involvement. Project managers must communicate and impart what they see as their goals but also seek to encourage participation by stakeholders so that their perspectives are included in decision making.

The process of identifying, engaging stakeholders must begin well in advance so that dialog is seen to play an important part of project implementation; no decisions should be already made before commencing stakeholder engagement on project-related issues.

Benefits of Stakeholder Engagement

Well managed projects, although long and complex, create long-term economic gain and social values meaning that proper use of taxpayer’s money. When done correctly, stakeholder engagement provides opportunities to further align clinical research practices with societal needs, values, and expectations, helping to drive long-term sustainability and stakeholder interests.

Stakeholder engagement is intended to help administrators fully realize the benefits of applying community and patient interest in hospital programs, and to ensure that research and program changes benefit those who are most directly affected.

The stakeholder focus group is a communication medium through which the opinions of individuals or groups of individuals who are impacted by the research can be elicited. Focus groups can also serve to clarify each stakeholder’s role and responsibilities, as well as promoting an overall understanding of the project requirements. Such processes also provide stakeholders with an environment in which they can express their opinions and feel that they have been heard.

In a series of related manuals the Patient-Centered Outcomes Research Institute (PCORI) ( 13 ) has provided a group of examples of how hospitals and medical clinics can encourage stakeholder involvement, in various research projects or programs whose aim was to improve the quality of medical services.

It can be seen from one of our case studies (see Appendix) that stakeholders can make meaningful contributions to a project when opportunities are structured to encourage their participation. The process of encouraging stakeholder participation is referred to as stakeholder management.

Requirements for Stakeholder Management

Stakeholder management involves the processes of identifying (both internal as well as external) stakeholders; assessing stakeholders’ skills, knowledge, and expertise; determining stakeholders’ requirements; determining stakeholders’ interests and expectations; determining stakeholders’ communication needs; addressing stakeholders’ issues and concerns as they occur; maintaining a positive relationship and communicating with stakeholders throughout the project; identifying stakeholders’ influence-controlling strategies; making sure that stakeholders are involved in the project at the required level throughout the project; and confirming continuous interactions with the stakeholders. In the area of clinical research patients and other stakeholders such as physicians, clinicians, nurses, and others have critical roles to play. Clinical researchers at the outset of research need to ask for patient participation in the development of research questions. Researchers need to find out the exact characteristics of study participants and to define what the nature of the research outcomes should be. In this process, contributions from patients are helpful and often critically important for project success. The process of carrying out research also involves measuring the results of research interventions and monitoring the progress of the research, especially in terms of whether or not it is being directed toward the initial intentions of the research. Finally, patients, who are often very closely connected with the target populations of the research, have a direct perspective on how the targets of the research will respond to the research recommendations, and therefore, can provide useful inputs for insuring its relevancy.

Project Stakeholder Management Processes

The PMI identifies four key processes that are associated with the stakeholder management knowledge area in initiating, planning, executing, and monitoring and controlling process groups ( 7 ) (Table 1 ).

Table 1 . Four project stakeholder management processes and key outputs .

Identify Stakeholders

This entails identifying all people or organizations impacted by the project and documenting relevant information regarding their interests, expectations, involvement, and influence on project success. In the hospital setting, the stakeholders are usually the patients, but can also be healthcare professionals and the families of patients. Examples of stakeholders are given in Table 2 .

Table 2 . The stakeholders can be categorized or classified in many different ways for different purposes .

Throughout the project the following critical tasks should be carried out.

All internal and external stakeholders should be identified. These will usually be the patients but often will include the patients’ family members, healthcare providers, or program administrators.

Stakeholders’ interests, requirements, and expectations should be identified. Obviously, patients are interested in the effects of proposed program changes or research outcomes on their health and well-being, but may have additional interests such as hoping to improve their employment prospects, or expanding their range of capabilities. Clinical researchers and administrators should be alert to these concerns and take appropriate steps to address them. It has been found, for instance, that stakeholder views at the beginning of a program evaluation process may be provisional or may change as a result of additional information. Additionally, stakeholders’ interests may change over time. In one study, the results of pre-workshop and final workshop voting often differed, suggesting that prioritization efforts relying solely on requests for topics from stakeholder groups without in-person discussion may provide different research priorities ( 14 ). Thus, efforts should be made to audit the evolving nature of stakeholders’ expectations and preferences through structured methods.

All stakeholders’ levels of influence should be determined. It is often the case that patients and other beneficiaries of program development have talents and skills that may not be reflected in records of formal education or social standing. Certain personal traits, which patient stakeholders may possess, such as communication skills or life experience, could nevertheless prove invaluable for achieving project goals.

A communication plan for the stakeholders should be determined. Patient stakeholders may not always be familiar with or comfortable in using traditional channels of communication in large organizations. As noted by Lavallee et al. ( 15 ), the increasing availability of mobile technology, social media, internet venues, and electronic devices has multiplied the communication options for many, but carries with it the risk of increasing the quantity of participants while reducing the depth of involvement. Often, the use of focus groups or small informal meetings can be used to increase the quality of communication or to elicit participation from those who might otherwise be reticent about expressing their views. Reviews of methods of communication for engaging stakeholders have concluded that a combination of approaches probably yields the best results. Methods such as voting or using ranking procedures such as the analytic hierarchy process ( 16 ) and other structured techniques are best for establishing research priorities, whereas in-person methods are best for clarifying ideas and generating ideas ( 17 ). Repeated exposure to these experiences be useful for identifying patient stakeholders’ core concerns and for acclimatizing them to organizational communication.

Stakeholders’ expectations and influence over the project should be managed. Reality checks are important for balancing patients’ idealistic expectations and the necessity of dealing with the challenges of getting things done through institutions. Program administrators must identify patient stakeholders’ strengths and channel these for optimal organizational impact.

Depending on their complexity, size, and type, most projects have a diverse number of internal and external stakeholders at different levels of the organization with different authority levels.

Stakeholder identification is a dynamic and sometimes difficult process, and the influence of a stakeholder may not become evident until later stages of a project. And, sometimes projects evolve so that solving unseen problems emerges as a critical task. It is essential to identify as many as stakeholders as possible at the beginning of the project and classify them according to their level of interest, influence, importance, and expectations at the earliest stages of the project as much as possible (Table 3 ). The identification of the relevant stakeholders is not only a core necessity but also poses a significant challenge. For example, under cost constraints, it might not be possible to identify all external stakeholders ( 18 ). On the other hand, stakeholders who are missed out during the identification process might have special requests to be fulfilled. This could potentially delay the project completion or escalate the cost as their requirement needs to be fulfilled. Additionally, as Bryson ( 19 ) pointed out that the failure to attend to the information concerns of stakeholders clearly is a kind of flaw in thinking or action that too often and too predictably leads to poor performance outright failure or even disaster.

Table 3 . Stakeholder management strategy .

As per the PMBOK ® , the “Identify Stakeholders” process has the following inputs, tools and techniques, and outputs:

Project Charter

The project charter gives an overall picture of the project as well as describing some of the stakeholders and their interest in the project along with their requirements.

Procurement Documents

If a project is based on an established contract or the result of a procurement activity, the parties in that contract are key project stakeholders. Other relevant parties such as suppliers, legal parties, and people who will execute the contract should also be considered as part of the project stakeholders list.

Enterprise Environmental Factors

Hospital culture and structure, and other factors may influence the identify stakeholders process.

Organizational Process Assets

To benefit from previous experience those in charge of developing proposals should carefully review the efforts of earlier projects. The stakeholder register template, lessons learned, and the stakeholder registers from previous projects may influence the identify stakeholders process.

Stakeholder Analysis

It is not possible to treat all stakeholders equally in the project, and they are given different priorities with respect to their interests, expectations, and influence on the project. Stakeholder analysis is a process of systematically gathering and analyzing all relevant quantitative and qualitative information about the stakeholders in order to prioritize them and determine whose interests should be taken into consideration throughout the project.

As per PMI, stakeholder analysis is performed by the following steps:

Step 1: all potential project stakeholders and their relevant information, such as their roles, interests, knowledge levels, expectations, and influence levels should be identified.

Step 2: the potential impact or support each stakeholder can contribute should be identified. As per the PMBOK ® , there are several classification models below:

• Power/interest grid: this is based on the level of authority or power and the level of concern or interest that a stakeholder has regarding the project outcome (Figure 1 ).

• Power/influence grid: this is based on the level of authority or power and active influence a stakeholder has.

• Influence/impact grid: this groups stakeholders based on their involvement or influence and their ability to affect changes to planning or execution (impact).

• Salience model: this addresses a stakeholder’s power or ability to impose their will, urgency, or need for immediate attention from the team and legitimate involvement in a project.

Step 3: in order to influence the stakeholders to enhance their support and to mitigate potential negative impacts, the way in which key stakeholders are likely to react or respond in various situations should be assessed.

Figure 1. Stakeholder mapping: the power versus interest grid . The gird shows stakeholders on a two-by-two matrix showing the strategies to be employed to engage and manage them. Power/interest grid model shows the grouping of the stakeholders based on their level of authority (“power”) and their level or concern (“interest”) regarding the project outcomes. Identifying and classifying the stakeholders is pivotal as it helps to develop appropriate strategies to effectively engage and manage all the stakeholders involved in a particular project. This also provides a clear-cut strategy and action-oriented and workable plan to interact with the all the stakeholders in an effective manner so as to minimize the resistance and maximize the support. A project is as successful as the stakeholders think it is. The details of power versus interest grids are found elsewhere ( 25 ).

Stakeholders who have greater power or influence and a strong interest in the project should be managed closely and continuously updated. Stakeholders who have significant power but low interest in the project should be kept informed about the project. Stakeholders who have low power and low interest should be monitored, and stakeholders who have low power and high interest should be kept satisfied.

Expert Judgment

Judgment and expert opinions can be gathered to identify stakeholders, usually from the senior management. These resources can include project team members, project managers from similar projects, subject matter experts, industry groups and consultants, and other units within the hospital or research setting.

Profile analysis meetings with team members and the sponsor will be beneficial for identifying stakeholders and their knowledge, potential roles, importance, impact, interest, and expectations in the project.

Stakeholder Register

This contains all details related to the identified stakeholders including but not limited to

• Stakeholder classification: stakeholders can be classified in many different ways. For example, primary (users of the products, services, or results) or secondary (may not be the direct users, but have some influential relationship), Internal/external, neutral/resistor/supporter/hard to hear, and so on.

• Identification information: name, title, location, organization, role in the project, position, and contact information.

• Assessment information: key requirements and expectations, potential impact, importance, and influence on the project.

A project manager may publish the stakeholder register with other project documentation or keep it in reserve for personal use only (Table 4 ).

Table 4 . A snapshot of a stakeholder register: stakeholder register is a project document, which is an output of identify stakeholders process .

Plan Stakeholder Management

The plan stakeholder management process defines an approach for managing stakeholders throughout the entire project life cycle as per their interest, impact, importance, and influence over the project. It defines the strategies for building close relationships with stakeholders who can benefit the project and for minimizing the influence of stakeholders who may have a negative impact on the project.

This process is iterative and should be reviewed on a regular basis as the required level of engagement of the stakeholders’ changes in the project.

As per the PMBOK ® , the Plan Stakeholder Management process has the following inputs, tools and techniques, and outputs:

Project Management Plan

Components of the project management plan (PMP) such as the human resource management plan, staffing management plan, communications management plan, change management plan, and others are used in developing the stakeholder management plan (SMP).

This contains all details related to the identified stakeholders, including identification information, assessment information, and classification.

All environmental factors within the hospital or clinical research facility, including its culture and history of the organization, are used.

All organizational process assets, especially lessons learned and historical information are used.

Judgment and expert opinions can be gathered from senior management, project team members, identified stakeholders, project managers from similar projects, subject matter experts, industry groups and consultants, other units within the organization, and other people to identify the level of involvement required from each stakeholder at various stages of the project. However, it is possible that expert judgment can be mistaken when possible expert judgment must be balanced with input from the stakeholders themselves.

Meetings with team members and the sponsor will be beneficial for identifying the level of engagement required from each stakeholder.

Analytical Techniques

Various analytical techniques are used for identifying the required level of stakeholder engagement. These techniques take into consideration stakeholder sensitivity to project goals and personal orientations such as being unaware, resistant, neutral, supportive, or providing leadership.

Stakeholder Engagement Assessment Matrix

The stakeholder engagement assessment matrix (SEAM) is used to assess the current and desired state of engagement of a stakeholder for the current phase of the project (Table 5 ).

Table 5 . Stakeholder engagement assessment matrix (SEAM): please note that the current and desired engagement level of key stakeholders expect to change as the project progresses and develops .

The SEAM illustrates that only Stakeholder 4 is engaged in the project at the desired state. The project manager should consider additional communication and further actions to bring all other stakeholders to the supportive and leading states.

Stakeholder engagement is critical to project success; thus, required actions and communication should be planned to minimize the gap between the desired level of engagement and the actual level of engagement.

Stakeholder Management Plan

Stakeholder management plan, which is a subsidiary plan of the PMP that defines the processes, procedures, tools, and techniques to effectively engage stakeholders in project decisions and execution on the analysis of their needs, interests, and potential impact ( 7 ). The SMP can be formal, informal, highly detailed, or broadly framed based on the needs of the project. The SMP typically describes the following:

• information needs of each stakeholder or stakeholder group;

• stakeholder communication requirements;

• format, method, time frame, and frequency for the distribution of required information to the stakeholders;

• person responsible for communicating the information to the stakeholders;

• methods of refining the SMP;

• required engagement level of the stakeholders at various stages of the project;

• stakeholder management strategy that defines an approach to manage stakeholders throughout the entire project life cycle. It defines the strategies to increase the support of the stakeholders who can impact the project positively and minimize the negative impacts or intentions of the stakeholders who can negatively impact the project.

The portion of the plan that contains sensitive information such as stakeholders’ personalities and attitudes, negative impact that stakeholders may cause, or other factors is not usually published and is kept in reserve by the project manager for personal use only.

Project Documents Updates

Project documents such as the project schedule, stakeholder register, and others may be updated.

Manage Stakeholder Engagement

The Manage Stakeholder Engagement process is focused on meeting and exceeding the stakeholders’ expectations by continuously communicating with them, clarifying and resolving their issues, addressing their concerns, and improving the project performance by implementing their change requests.

As per PMI, the project manager is responsible for managing the stakeholders’ expectations. Meeting the stakeholders’ expectations increases the probability of project success by enabling the stakeholders to be active supporters of the project, drastically reducing unresolved stakeholder issues, and limiting disruptions in the project.

As per the PMBOK ® , the Manage Stakeholder Engagement process has the following inputs, tools and techniques, and outputs:

Within the research context, the SMP identifies information needs, communication requirements, required engagement level at various stages of the project, stakeholder management strategy, and other factors to identify and manage stakeholders throughout the entire project life cycle.

Communications Management Plan

The communications management plan is a subsidiary of the PMP. It can be formal, informal, highly detailed, or broadly framed based on the needs of the project. The communications management plan typically describes the following: purpose for communication; Information needs of each stakeholder or stakeholder group; stakeholder communication requirements; format, method, time frame, and frequency for the distribution of required information; person responsible for communicating the information; methods for updating the communications management plan; persons or groups who will receive the information; glossary of common terms; issues/concerns escalation procedures.

A change log is used to document changes that occur during a project. A lot of these changes can impact different stakeholder interests; thus, the change log is reviewed in this process.

Organization communication requirements, issue management procedures, change control procedures, and historical information are used.

Communication Methods

According to the needs of the project, the methods of communication identified for each stakeholder in the communications management plan are utilized during the manage stakeholder engagement process.

Interpersonal Skills

The project manager applies appropriate interpersonal skills or soft skills to manage stakeholder expectations by building trust and resolving conflict.

Management Skills

Management skills such as presentation skills, negotiation skills, writing skills, and public speaking skills used by the project manager can greatly influence how stakeholders feel about the project.

An issue is an obstacle that threatens project progress and can block the team from achieving its goals. An issue log is a written log document to record issues that require a solution. It helps monitor who is responsible for resolving specific issues by a target date. There should be one owner assigned for each issue reported within the project.

Change Requests

Change requests can include a new change to the product or the project, corrective or preventive actions, and other items.

Project Management Plan Updates

The SMP portion of the PMP is updated as new stakeholders’ requirements are identified, existing requirements are changed, or as a result of addressing concerns and resolving issues of the stakeholders.

Project documents that may be updated include, but are not limited to, the following:

• Issue log: this will be updated as resolutions to the current issues are implemented and new issues are identified.

• Stakeholder register: this is updated as stakeholders’ statuses change, new stakeholders are identified, registered stakeholders are no longer involved or impacted by the project, and other factors.

Organizational Process Assets Updates

Lessons learned from managing stakeholders, feedback from stakeholders, project records, causes of issues, and reasons for corrective actions chosen may be updated.

Control Stakeholder Engagement

The control stakeholder engagement is the process of evaluating and monitoring overall stakeholder relationships and ensuring stakeholders’ appropriate engagement in the project by adjusting plans and strategies as required. As the project progresses and its environment changes, this process will maintain or increase the efficiency and effectiveness of stakeholder engagement activities.

As per the PMBOK ® , the Control Stakeholder Engagement process has the following inputs, tools and techniques, and outputs:

Components of the PMP such as the human resource management plan, staffing management plan, communications management plan, change management plan, and others are used in controlling stakeholder engagement.

An issue is an obstacle that threatens project progress and can block the team from achieving its goals. An issue log is a written log document to record issues that require a solution. A modified issue log is developed as a result of identifying new issues and resolving current issues.

Work Performance Data

Work performance data such as resource utilization, deliverables status, schedule progress, percentage of work completed, number of defects, number of change requests, technical performance measures, costs incurred, quality updates, and other factors are used in this process.

Project Documents

Project documents such as issue logs, the stakeholder register, the project schedule, the change log, and others are used in this process.

Information Management Systems

An information management system is an automated system that can serve as a repository for information, a tool to assist with communication, and a system for tracking documents and deliverables. An information management system also supports the project from beginning to end by collecting and distributing information about cost, schedule, and performance for the stakeholders. Several reporting techniques such as spreadsheet analysis, table reporting, presentations, graphics for visual representations, and others may be consolidated from various systems and communicated to the stakeholders.

Judgment and expert opinions can be gathered from senior management, project team members, identified stakeholders, project managers from similar projects, subject matter experts, industry groups and consultants, other units within the organization, and other people to identify new stakeholders, reassess the current stakeholders, and figure out the level of involvement required from each stakeholder at various stages of the project.

Status review meetings with the team, sponsor, and other stakeholders will be beneficial for reviewing information about stakeholder engagement.

Work Performance Information

Work performance information such as deliverables status, change request implementation status, and forecasted estimates to completion are distributed through communication processes.

These are recommended corrective actions for bringing the imminent performance of the project as per the expectations in the PMP and recommended preventive actions for reducing the probability, and impact of future negative project performance will generate a lot of change requests.

Most of the components of the PMP may be updated to reflect changes in the stakeholder management strategy and the approach to effectively control stakeholder engagement in the project.

Project documents such as the issue log, the stakeholder register, and others may be updated.

Lessons learned from managing stakeholders, feedback from stakeholders, project records, causes of issues, reasons for corrective actions chosen, project reports, stakeholder notifications, and other items may be updated.

While the burden of disease is growing rampantly and disproportionately, the challenge to global health outreach efforts is to prioritize those illnesses, which require immediate attention. The global health equity sorts to prioritize on improving health care and achieving equity in health of people around the world. In this context, researchers from high income countries often study the existing diseases and/or emerging challenges in low income countries in order to gain expertise on the health care needs ( 20 ). In this regard, it is essential for overall program effectiveness that representatives of local communities, the stakeholders who will be most impacted by health outreach programs, be invited to provide their insights into which health needs are greatest. The encouragement of ShE and ShM often has a secondary benefit inasmuch as organization’s reputation is subsequently enhanced, which further facilitates organizational effectiveness. The very presence of stakeholders may foster an organizational environment, which encourages relevancy of program objectives to stakeholders’ expectations, a coupling, which in turn contributes to achievement of the project’s goals. Additionally, stakeholders can provide reality checks, which aid in the prioritizing of research objectives, in identifying potentially difficult political issues, and in providing the means to navigate around or to overcome challenges. The experience of stakeholders is thus invaluable for guiding research and achieving program objectives from their early stages in the laboratory to their final clinical application.

Although the process of partnering with stakeholders in clinical research settings is still in its nascent stages, it is anticipated that it will increasingly become accepted and implemented by project managers. In tandem with this process, greater efficiency and transparency will develop in working with stakeholders to meet targets ( 21 ). Part of the function of stakeholder analysis is to promote an understanding of stakeholders and to ensure that their expectations are being met. It is anticipated that project heads will increasingly encourage an awareness (ensuring transparency) of who will be affected by the project and who can contribute to making the project more successful.

Stakeholders have unique perspectives and often possess a number of capabilities which they have acquired from life experience. Program developers can derive the maximum benefit from stakeholders if the proper context is established for drawing out this experience. Alternatively, barriers to effective participation by stakeholders can occur if managers remain unaware of stakeholders’ skills, or if they believe that they do not have appropriate knowledge to contribute.

By increasing the acceptability of programs, stakeholders increase the likelihood of their success. Stakeholders play pivotal roles as healthcare advocates or healthcare ambassadors, partners, and/or agents of change. Although stakeholders differ considerably in their expertise and interests, their involvement is pivotal inasmuch as it can facilitate the successful completion of projects. Stakeholder participation can (a) improve relevance; (b) promote visibility and research transparency; (c) accelerate and translate the research findings to real-world challenges; (d) enhance greater project acceptance as confidence derived in the decisions made during the project’s milestone developments. Similarly, the project’s final outcome can only be considered successful when it is acknowledged by its key stakeholders.

Due to the broad range of ways in which stakeholders can influence program development, it is essential that their behavior be closely monitored, and modulated if necessary. One of the advantages of the described system of viewing the management of stakeholder engagement is that it documents many processes that have taken place. Future efforts to manage this type of engagement can therefore benefit from established experience.

In a nutshell, as Wheeler et al. ( 22 ) pointed out, “a truly stakeholder-responsive approach demands the acceptance of multiple stakeholders and requires that an organization develop a tolerance for ambiguity together with the sensitivities and capabilities needed to inspire trust with diverse and sometimes completing interests.”

A balanced assessment recognizes that certain caveats apply in the establishment of stakeholder engagement and management in clinical and research settings. These relate to the unique nature, demands, resources, and implementation issues which every organization has and how these demands can interact with the unique skills and abilities which stakeholders bring to it.

Many investigators lack clear or a basic understanding and/or training concerning the stakeholder framework as well as terminologies (Figure 2 ).

Figure 2. Project stakeholder management summary .

Often a reactive approach is favored over a proactive one for dealing with stakeholder issues is favored over a proactive one. As suggested by Greenwood, the “glorified depiction of stakeholder engagement gives way to the murky reality that engagement of stakeholders can mean many things to many people” ( 23 ). In this conceptualization, stakeholders may be viewed merely as actors with whom project managers form arms-length transactions rather making a tightly knitted partnership. This limited perspective may result in a failure to assess, understand the social, spiritual, and environmental needs of stakeholders.

Not every project can require or afford to have a full ShE or ShM system in place as outlined in this review. The main barrier here is that stakeholder involvement, and the fostering of attitudes that encourage this process, require a degree of organizational change (i.e., additional paperwork, more meetings, and more communication), which can be expensive. Hence, the benefits of managing a full program of stakeholder engagement, analysis, and management are only applicable to high impact projects. As Cennamo et al. ( 24 ) have noted a stakeholder-committed organization may still act out of self-interest. Thus, while localized programs may recognize and incorporate contributions from stakeholders and the larger community, these activities may continue to serve institutional objectives, which are narrowly focused or even possibly inimical to broader community interests. Additionally, stakeholder preferences are not absolute, but relative, and may also be evolving. Hence, the salience might change frequently across time. Another issue is that there is no generic “one size fits all” strategy for ShM and ShE, rather, the strategy and its execution depend very much on the local stakeholder landscape, as well as the problems that are being addressed. These include the stakeholder assets that are available and the opportunities that exist for their cultivation. Additionally, a barrier to effective participation and the subsequent consensus-building process is that the identified stakeholders may lack appropriate knowledge or skill sets, or believe, correctly or incorrectly, that they do not have appropriate knowledge to contribute and/or the investigators have the knowledge and experience to identify it. Stakeholders might have multiple perspectives and conflicting views, needs, and priorities. These may eventually result in identifying what they perceive to be the “best” or “appropriate” solution in any given situation, although the course of action might completely differ from that of investigators. This, in turn, results in potential “conflicts” and “trade-offs” in terms of project objectives. For example, the conflicting interest among the stakeholders with varied levels of power, importance, interest, and agenda must be managed efficiently. This poses a challenge to novice project managers to experienced investigators. These may potentially limit control mechanisms, and thus impede organizational performance. On the contrary, it is difficult to generate interest and involvement in projects, which are perceived to have little or immediate relevance. Finally and most importantly, while most of the ShE literature emphasizes the positive benefits of stakeholder engagement, it less frequently addresses the potential costs and risks with the adoption of a stakeholder perspective.

Above all, it is impossible to engage with stakeholders and to do stakeholder management in an authentic and effective way without dealing with the multiplicity of ethical issues that arise. These issues arise, first of all, because the stakeholders’ interests can conflict along key ethical dimensions. Therefore, engaging with them must be sensitive to the rights of the parties involved, as well as to the overall harms and benefits, which accrue from managerial action. Second, it is not always apparent when there may be conflicts of interests or hidden advantages or hidden disadvantages among key stakeholders and decision makers. Obviously, these conflicts must be disclosed, and many organizations have specific procedures for handling such conflicts. However, given the nature of the decisions that are to be made, managers must be willing to accept that effective stakeholder management places them squarely in the realm of ethical decision making.

It is not always possible to anticipate all of the ethical issues and conflicts, which may develop in such a multi-stakeholder environment. Therefore, the traditional method of assigning responsibility for solving these problems to an ethics committee does not always work. Clinical project managers must be willing to make choices based on both good ethics (based on PMI’s code of ethics and professional conduct) and on the overall purpose and values of their institution that is best for all stakeholders ( 27 ). While some ethical issues can be anticipated at the start of the project, all should be subjected to discussion among the project stakeholders to find the best possible course of action.

Assuming that the challenges reviewed above can be overcome, additional “higher order” issues will emerge. These will consist of how to best promote the operational adaptability, viability, and implementation of the changes in an acceptable timeframe. Project managers will need to ask if the benefits of managing a full stakeholder analysis are really greater than the costs associated with it. Efforts will also need to be directed toward retrospective analysis, i.e., did real cases go badly because the stakeholder views were not sought out? The difficulty of these questions varies in different clinical settings but it is essential that they be resolved for maximum project effectiveness.

In summary, the concept of promoting stakeholder engagement and management is a relatively recent one in the clinical research arena; hence, there are many lessons to be learnt in the coming years. As this is an iterative process, although the current efforts from funding agencies such as PCORI are necessary but are insufficient to respond to the above challenges. All indications are that attempts to meet these challenges will nevertheless provide significant benefits for project management effectiveness.

From a clinical standpoint, stakeholder engagement and management is pivotal to the development and deployment of community-oriented national and global health initiatives. The ultimate purpose of such engagement is the efficient use of time, money, and resources thereby positively impact existing and/or emerging healthcare challenges.

For the purpose of our review, we have followed the guidelines of PMBOK ® ( 7 ), which provides a common vocabulary to guide the processes. In doing so, our review outlines a systematic model for planning, managing, and implementing stakeholder engagement based on PMBOK ® guidelines. Further, the application of the project management knowledge, skills, tools, and techniques can augment the chances of success, even in complex projects.

This review has drawn on the experience of stakeholder engagement in private organizations and government agencies and has argued that the process is equally viable in hospital program development and in clinical research. It has taken the view that the concept of stakeholder engagement and a proper stakeholder management framework is more than a useful adjunct to pursuing project or program goals and is actually pivotal for enhancing organizational success.

These guidelines have been broken down into a number of component parts. It emphasizes that the stakeholders should first be identified, that their interests and expectations should be understood, and that their level of power and influence should be understood as well. A plan for communicating with stakeholders has been outlined and techniques for encouraging their participation and management have been laid out.

Author Contributions

All authors intellectually contributed to the design, analysis, and interpretation of the results and to drafting the critical review of manuscript. All authors reviewed and approved the final version of the manuscript.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors would like to sincerely thank Professor Philip Kotler, S. C. Johnson & Son Distinguished Professor of International Marketing, Kellogg School of Management, Northwestern University, USA for his time, advice, and his valuable comments on the earlier versions of our manuscript, which enormously improved the quality of the final manuscript. We are also grateful for the comments from the anonymous reviewers. We gratefully acknowledge the National Institutes of Health; National Institute of Mental Health; Duke Endowment; South Carolina Department of Health and Human Services. As of the end of 2012, the Duke Endowment had provided more than $7.25 million in support of the program. Additional funding has come from the South Carolina Department of Health and Human Services, the National Institute of Mental Health (NIMH), and the National Institutes of Health (NIH). NIMH and NIH awarded two grants (one in 2009 and one in 2012) totaling $3.04 million to support evaluation of project outcomes (on quality, economic impact, utilization, and sustainability). In addition to grant funding, user fees and third-party insurance cover some program-related costs; for example, beginning in 2013, BlueCross BlueShield of South Carolina began covering use of telemedicine in mental health. However, the funders had no involvement in study design, data collection, data analysis and interpretation, preparation of the manuscript, or in the decision to submit the manuscript for publication.

1. Sox HC, Greenfield S. Comparative effectiveness research: a report from the institute of medicine. Ann Intern Med (2009) 151 :203–5. doi: 10.7326/0003-4819-151-3-200908040-00125

CrossRef Full Text | Google Scholar

2. Kellogg Commission. Returning to Our Roots: The Engaged Institution . Kellogg Commission on the Future of State and Land-Grant Universities (1999). p. 1–57. Available from: http://www.purdue.edu/vet/engagement/files/documents/kellogg.pdf

Google Scholar

3. Center for Disease Control and Prevention. Principles of Community Engagement . 2nd ed (2011). 193 p. Available from: http://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf

4. Conway PH, Clancy C. Comparative-effectiveness research – implications of the federal coordinating council’s report. N Engl J Med (2009) 2009 (361):328–30. doi:10.1056/NEJMp0905631

5. Tunis SR, Benner J, McClellan M. Comparative effectiveness research: policy context, methods development and research infrastructure. Stat Med (2010) 29 :1963–76. doi:10.1002/sim.3818

6. Edward Freeman R. Strategic Management: A Stakeholder Approach. Pitman Series in Business and Public Policy . 1st ed. Boston: Harper Collins College Div (1984). 275 p.

7. Project Management Institute. A Guide to the Project Management Body of Knowledge (PMBOK ® Guide) . 5th ed. Newtown Square, PA: USA: Project Management Institute (2013). 589 p.

8. Negev M, Davidovitch N, Garb Y, Tal A. Stakeholder participation in health impact assessment: a multicultural approach. Environ Impact Assess Rev (2013) 43 :112–20. doi:10.1016/j.eiar.2013.06.002

9. Deverka PA, Lavallee DC, Desai PJ, Esmail LC, Ramsey SD, Veenstra DL, et al. Stakeholder participation in comparative effectiveness research: defining a framework for effective engagement. J Comp Eff Res (2012) 1 :181–94. doi:10.2217/cer.12.7

PubMed Abstract | CrossRef Full Text | Google Scholar

10. Starks H, Shaw JL, Hiratsuka V, Dillard DA, Robinson R. Engaging stakeholders to develop a depression management decision support tool in a tribal health system. Qual Life Res (2015) 24 (5):1097–105. doi:10.1007/s11136-014-0810-9

11. Bowie NE, Werhane PH. Management Ethics . Malden, MA: Wiley-Blackwell (2004). 168 p.

12. Post JE, Lee E, Preston LE, Sachs S. Redefining the Corporation: Stakeholder Management and Organizational Wealth . 1 ed. Palo Alto, CA: Stanford Business Books (2002). 376 p.

13. Patient-Centered Outcomes Research Institute. PCORI Funded Projects: Sample Engagement Plans from Methods Portfolio (2014). Available from: http://www.pcori.org/sites/default/files/PCORI-Sample-Methods-Engagement-Plans.pdf

14. Krishnan JA, Lindenauer PK, Au DH, Carson SS, Lee TA, McBurnie MA, et al. Stakeholder priorities for comparative effectiveness research in chronic obstructive pulmonary disease, a workshop report. Am J Respir Crit Care Med (2013) 187 :320–6. doi:10.1164/rccm.201206-0994WS

15. Lavallee DC, Wicks P, Cristancho RA, Mullins CD. Stakeholder engagement in patient-centered outcomes research: high-touch or high-tech? Expert Rev Pharmacoecon Outcomes Res (2014) 14 :335–44. doi:10.1586/14737167.2014.901890

16. Vaidya OS, Kumar S. Analytic hierarchy process: an overview of applications. Eur J Oper Res (2006) 169 :1–29. doi:10.1016/j.ejor.2004.04.028

17. Guise J-M, O’Haire C, McPheeters M, Most C, LaBrant L, Lee K, et al. A practice-based tool for engaging stakeholders in future research: a synthesis of current practices. J Clin Epidemiol (2013) 66 :666–74. doi:10.1016/j.jclinepi.2012.12.010

18. Lindgreen A, Kotler P, Vanhamme J, Maon F. A Stakeholder Approach to Corporate Social Responsibility: Pressures, Conflicts, and Reconciliation . Vermont: Gower Publishing Company (2012). 418 p.

19. Bryson JM. What to do when stakeholders matter: stakeholder identification and analysis technique. Public Manag Rev (2004) 6 :21–53. doi:10.1080/14719030410001675722

20. Chu KM, Jayaraman S, Kyamanywa P, Ntakiyiruta G. Building research capacity in Africa: equity and global health collaborations. PLoS Med (2014). 11 (3):e1001612. doi:10.1371/journal.pmed.1001612

21. Concannon TW, Fuster M, Saunders T, Patel K, Wong JB, Leslie LK, et al. A systematic review of stakeholder engagement in comparative effectiveness and patient-centered outcomes research. J Gen Intern Med (2014) 29 :1692–701. doi:10.1007/s11606-014-2878-x

22. Wheeler D, Fabig H, Boele R. Paradoxes and dilemmas for stakeholder responsive fir in the extractive sector: lessons from the case of Shell and the Ogoni. J Bus Ethics (2002) 39 :297–318. doi:10.1023/A:1016542207069

23. Greenwood M. Stakeholder engagement: beyond the myth of corporate responsibility. J Bus Ethics (2007) 74 :315–27. doi:10.1007/s10551-007-9509-y

24. Cennamo C, Berrone P, Gomez-Mejia LR. Does stakeholder management have a dark side? J Bus Ethics (2009) 89 :491–507. doi:10.1007/s10551-008-0012-x

25. Eden C, Ackermann F. Making Strategy: The Journey of Strategic Management . London: Sage Publications Ltd (1998). 528 p.

26. Fromson D. A Conversation with Cameron Sinclair, CEO of Architecture for Humanity . Available from: http://www.theatlantic.com/national/archive/2011/03/a-conversation-with-cameron-sinclair-ceo-of-architecture-for-humanity/72782/

27. Project Management Institute. PMI’s Code of Ethics and Professional Conduct . Available from: http://www.pmi.org/en/About-Us/Ethics/~/media/PDF/Ethics/ap_pmicodeofethics.ashx

Appendix: Examples of Stakeholder Engagement

Statewide telepsychiatry initiative.

In one of our landmark study by the author (MN), the South Carolina Department of Mental Health partnered with the University of South Carolina School of Medicine, Department of Health and Human Services and 18 predominantly rural hospitals from the South Carolina Hospital Association to establish the statewide telepsychiatry initiative. In this public-private-academic partnership, the psychiatrists were available via teleconference 16 h a day, 7 days a week, to assess and treat patients with mental health issues at hospital emergency departments.

The clinicians called the psychiatrist on duty whenever they have a patient who needed a mental health assessment and/or counseling and provide relevant medical records and details. Through a secure video link, the psychiatrists were able to assess the patient and makes recommendations about needed treatment and follow-up, including referrals to community-based resources.

The advantage of such program was that, it drastically reduced emergency department wait times, inpatient admissions, as well as costs; increased attendance at follow-up outpatient appointments; and generated higher level of satisfaction among patients and clinicians. Additional evidence includes post-implementation surveys that gauge the satisfaction of patients and clinicians with the program.

In such an innovative approach, the stakeholder (State Department of Mental Health, University of South Carolina, Department of Neuropsychiatry and Behavioral Science, Hospital, Physicians and Nurses from the South Carolina Hospital Association, and Patients) engagement proved to be feasible, necessary, and beneficial in clinical environment.

Outcome of the Initiatives – Did it Work?

The program has reduced emergency department (ED) wait times, inpatient admissions, and costs; increased attendance at follow-up outpatient appointments; and generated high levels of satisfaction among patients and clinicians.

Shorter ED Wait Times: From March 2009 through 2014, the average waiting time for patients with mental health problems at the 18 participating EDs fell by roughly 50%. Fewer hospitalizations: during the same timeframe, 11% of ED patients assessed by a psychiatrist were hospitalized, half of the 22% admission rate among similarly cared-for patients in South Carolina EDs not offering this program.

Health care utilization: Telepsychiatry consultations resulted in an estimated $1,400 less per mental health patient compared to patients seen in ED’s that did not have telepsychiatry due primarily to the reductions in hospital admissions.

Greater attendance at follow-up appointments: About 46% of patients served by the program attended an outpatient follow-up appointment within 30ădays of the initial ED visit, well above the 16% attendance rate among similar ED patients cared for in South Carolina hospitals not offering the program. Similarly, 54% of patients served by the program attended a follow-up appointment within 90ădays versus 20% among ED patients in hospitals not offering the program.

High satisfaction among patients and staff: More than 80% of patients served by the program reported being satisfied with the process and services received. In addition, 84% of ED physicians and staff believe that the program has improved patient care; 91% report being satisfied with program-related procedures; and 84% express satisfaction with the technology used.

How We Did It: Planning and Development Process Key Steps Included the Following:

Decision to focus on telepsychiatry : The increasing popularity of telemedicine and its potential to bring services to underserved geographic areas made telepsychiatry a logical initial target for these discussions. After reviewing the use of telemedicine in South Carolina and other States, the partners collectively decided to create and implement a telepsychiatry program in hospital EDs.

Securing of funding for demonstration project : In 2007, program leaders contacted the Duke Endowment (a non-profit foundation that supports innovative health care programs) for funding a demonstration project. In 2008, the Duke Endowment agreed to provide a $3.7 million, 3-year grant for this purpose.

Project planning : Four hospitals agreed to participate in the demonstration project, which launched in March 2009. In advance of this date, the partners and participating hospitals worked together to hire and train six psychiatrists, install and test the video equipment in EDs, and set up an EMR system linking the psychiatrists with the EDs.

Program expansion : After the demonstration project went smoothly, program leaders decided in June 2009 to expand the program to three additional sites and have continued to add more sites gradually since that time. From March 2009 through August 2014, more than 20,000 telepsychiatry ED consults have taken place. As of August 2014, 20 hospitals participate, with plans to add 6 more in 2014.

Standardization of training : As the initiative expanded, program leaders standardized the training process for psychiatrists and ED staff, as outlined below:

Psychiatrist training : Participating psychiatrists complete 6ăh of clinical training by viewing videos prepared by University of South Carolina School of Medicine faculty. Supplemented with handouts, the videos cover child and adolescent psychiatry, adult psychiatry, geriatric psychiatry, addiction psychiatry, risk assessment, and legal issues. Newly hired psychiatrists also undergo peer review every 2ăweeks during their first 3ămonths of employment. In addition, during this initial 3-month period, the supervising psychiatrist meets with other hospital physicians to review and discuss consultations performed by newly hired psychiatrists.

ED staff training : ED staffs in participating hospitals watch a video that explains the videoconferencing system and reviews the goals of the program and the training and credentials of the participating psychiatrists. A member of the project leadership team visits each participating ED to discuss questions or concerns that staff might have about the program.

Ongoing meetings to resolve problems, plan expansion : Representatives of the partnering organizations and the participating hospitals meet on a quarterly basis to share program-related experiences, resolve any issues or problems that arise, and discuss and plan for expansion to other EDs. Typically, hospital administrators, providers, researchers, and information technology staff come to these meetings; representatives of non-participating hospitals are also welcome to attend to learn more about the program.

Resources Used and Skills Needed

Staffing : Six full-time psychiatrists and one part-time psychiatrist staff the program, under the supervision of a lead psychiatrist. The program includes several stakeholders namely a director, coordinator, fiscal technician, programmer, and two information resource consultants (subject matter experts; SMEs). Faculty and staff members from the University of South Carolina and Emory University, staff members from the Department of Mental Health and from the South Carolina Office of Research and Statistics also provide support to the program.

Costs : Hard data on the program’s total annual cost are not available. Major program expenses consist of staff salaries and the upfront and ongoing expenses associated with the videoconferencing and EMR technologies.

Keywords: PCORI, PMBOK, PMI, clinical research, code of ethics, professional conduct, project stakeholder management

Citation: Pandi-Perumal SR, Akhter S, Zizi F, Jean-Louis G, Ramasubramanian C, Edward Freeman R and Narasimhan M (2015) Project stakeholder management in the clinical research environment: how to do it right. Front. Psychiatry 6:71. doi: 10.3389/fpsyt.2015.00071

Received: 14 December 2014; Accepted: 27 April 2015; Published: 18 May 2015

Reviewed by:

Copyright: © 2015 Pandi-Perumal, Akhter, Zizi, Jean-Louis, Ramasubramanian, Edward Freeman and Narasimhan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Seithikurippu R. Pandi-Perumal, Department of Population Health, Division of Health and Behavior, New York University Medical Center, Center for Healthful Behavior Change (CHBC), Clinical and Translational Research Institute, 227 East 30th Street (between 2nd and 3rd Avenue), Floor # 6 – 632E, New York, NY 10016, USA, pandiperumal2015@gmail.com

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

The Complete Guide to Stakeholder Management

Updated: December 05, 2023

Published: December 28, 2022

Successful projects have support from stakeholders across the organization. That’s why stakeholder management is essential for any initiative.

Stakeholder management allows you to identify and meet leaders’ needs while keeping communication open.

In this article, you’ll learn what stakeholder management is, why it's important, and how to create a stakeholder management plan.

Table of Contents

What is stakeholder management?

Why is stakeholder management important, benefits of stakeholder management, inside the stakeholder management process, tips for stakeholder management.

Stakeholder management is the process of identifying, assessing, and managing the interests and needs of stakeholders. An effective stakeholder management strategy should be backed by data and paint a clear picture of everyone involved.

Projects fail when the interests and needs of stakeholders are ignored. This leads to a lack of buy-in from key stakeholders, which can jeopardize the success of the project.

When stakeholders feel their needs are being met, they're more likely to support the project. On the other hand, if their needs are not met, they may try to block your initiative. Stakeholder management helps build positive relationships that keep your project running smoothly.

An effective stakeholder management strategy can help you:

• Avoid or resolve conflicts between stakeholders.
• Secure buy-in and support from key stakeholders.
• Communicate effectively with stakeholders.
• Manage expectations of stakeholders.
• Monitor stakeholder engagement throughout the project.

There are many benefits of an effective stakeholder management strategy, including:

• Improved communication. By identifying the interests and needs of stakeholders, you can tailor your communications to their specific needs. This ensures that your messages are received and understood.
• Increased buy-in. According to KPMG, 61% of projects have highly involved sponsors . When stakeholders feel their interests and needs are being considered, they're more likely to support the project.
• Reduced risks. By engaging with stakeholders, you can identify potential risks early and take steps to avoid or mitigate them. This can help reduce the overall risk of the project.
• Improved performance. An effective stakeholder management strategy can help you optimize resources and align project activities with stakeholder interests. This can lead to improved project performance.

While stakeholder management may seem intuitive for some, you can start building trust systematically with a more formal roadmap.

The following six steps can help you understand stakeholder priorities and how you can address these needs.

1. Identify stakeholders.

Stary by identifying all the individuals and groups who can impact your project, both positively and negatively. This includes internal stakeholders (such as team members) and external stakeholders (such as customers or suppliers).

To identify your stakeholders, ask yourself the following questions.

• Who will be impacted by your project?
• Who has an interest in your project?
• Who has the power to influence your project?
• Who wants your project to fail?
• Who wants your project to be successful?

2. Prioritize stakeholders.

After you've identified all your stakeholders, the next step is prioritization. This will help you focus your attention on the stakeholders most important to your project's success.

You should identify where their expectations lie, their level of influence, what information they will want from you, and how often they want reporting from your team. You can use stakeholder mapping to help you prioritize key leaders.

Run a Stakeholder Mapping Exercise

Image Source

The above stakeholder mapping exercise asks you to plot leaders on a two-by-two grid. One axis is labeled power and the other interest.

On the power axis, you rate each stakeholder on their ability to influence the project. On the interest axis, you rate each stakeholder on their level of interest in the project. This will give you a clear picture of which stakeholders are the most important to engage with and how best to do so.

There are several different ways to map stakeholders, including:

• RACI matrix. This is a popular stakeholder mapping method that uses the letters R (responsible), A (accountable), C (consulted), and I (informed) to rate stakeholders on their level of involvement in the project.
• Power/interest grid. This is a simple way to map stakeholders that can be used to prioritize engagement. It is also known as the Salience model.
• Influence/impact matrix. This is a more detailed stakeholder mapping method that can be used to assess the potential impact of each stakeholder on the project.

3. Assess stakeholder needs and interests.

The key to a successful stakeholder management plan is understanding your stakeholders. This will help you assess what they want from the project and how best to engage with them.

At this stage, ask yourself the following questions.

• Do you understand their needs, priorities, and issues?
• Do they have the power to influence the project?
• What financial or emotional interest do they have in the outcome of the project?
• What motivates them?

By understanding the answers to these questions, you can better develop a stakeholder management plan that fits each leader.

4. Define stakeholder motives.

Once you've identified and assessed your stakeholders, you can begin to define their motives. This will help you understand what they want from the project and how best to engage with them.

There are several ways you can define stakeholder motives, including:

• Interviews. You can interview stakeholders to get their views on the project. This can be done in person, over the phone, or via email.
• Surveys. You can send out surveys to stakeholders to get their feedback on the project. This is a quick way to gather data from a large number of stakeholders.
• Focus groups. You can hold focus groups with stakeholders to get their input on the project. This can be used to generate ideas and identify issues.

By understanding stakeholder motives, you can develop an effective stakeholder management plan that meets their needs and interests.

5. Develop a plan for engagement.

The goal of stakeholder engagement is to manage expectations and build relationships. This can be done through several different methods, including:

• Frequent communication. This is the most important aspect of stakeholder engagement . You must regularly communicate with stakeholders to update them on the project and get feedback. This can be done through face-to-face meetings, phone calls, emails, or online tools like a project management software . Each stakeholder may need their own communication strategy.
• Consultation. This involves consulting stakeholders in decision-making. This can be done through meetings, surveys, or focus groups.
• Collaboration. This involves working with stakeholders to complete tasks or achieve objectives. This can be done through co-creation, joint planning, or shared decision-making.

The best way to engage with various leaders will depend on the stakeholder and the project. You should tailor your engagement plan to each individual.

Stakeholder Management Plan Templates

After you’ve identified stakeholders, it’s time to develop management plans for each group.

The below templates can help you create engagement plans and organize your stakeholder communication.

If you’re new to stakeholder management, this template from Asana offers a simple way to stay organized. In this plan, you write down each stakeholder, their level of interest in your project, and how influential they are to your work.

Then, you can check a box to identify their communication preferences. That includes how often they want to hear from your team and how they want you to get in touch.

What we love: With this template, you know which of your leaders prefer a quick Slack versus a formal email at a glance.

Project Management Docs

If you’re looking for a more detailed engagement plan, consider this option from Project Management Docs. With this document, you can fully lay out the vision of your project and which departments your initiative will affect.

What we love: This template includes charts and tables that you can use to determine each stakeholder's level of importance to your project. You can use this document to brainstorm and outline your final draft.

KnowledgeHut

If you’re looking for a complete guide to writing an engagement plan, KnowledgeHut is here to help. This template includes sections that help you identify stakeholders and create a timeline for each person’s involvement. You can also keep track of costs and human resources involvement.

What we love: This template features charts that you can fill out with stakeholder data. If you get stuck, each section comes with helpful questions for self-reflection to guide you along the way.

PM-Training

If you’ve been searching for a simple spreadsheet to manage your stakeholders, look no further. This template from PMTraining offers a straightforward approach to managing stakeholders.

What we love: This template lays out who is involved, what they need to do for your project, and how you plan to keep them engaged. If you’re looking for a quick way to develop a one-page stakeholder management guide, this is it. Plus, everything can be edited in Google Docs.

Formalizing stakeholder management can feel like an overwhelming process. Whether you’re just getting started or have years of experience, the following tips can help you ensure successful stakeholder management.

1. Define the purpose of the project.

According to PMI, 44% of projects fail because of a lack of alignment between business and project objectives.

Before you begin engaging with stakeholders, it is crucial to define the purpose of the project. This will help you identify who you need to engage with and their objectives.

2. Define roles and responsibilities.

At the start of a project, clearly define each stakeholder's roles and responsibilities. This will help ensure that everyone is clear on their involvement in the project.

3. Communicate regularly.

Regular communication is essential for successful stakeholder management. You should update stakeholders on the project regularly and solicit their feedback.

Your strategic objectives should always be clear in stakeholder communication. This allows your team to manage stakeholder expectations and create positive relationships.

4. Be transparent.

It is important to be transparent with stakeholders about the project. This will help build trust and ensure everyone is on the same page.

5. Seek feedback.

Feedback is essential for successful stakeholder management. You should seek feedback from stakeholders at every stage of the project.

Keep track of their suggestions and implement their insights. You can then report back on how you implemented their solutions to further gain their support.

6. Choose the right software.

Today, only one in four teams uses a project management software. Implementing one of these tools can help you keep organized.

That ranges from project management software, like Basecamp or Asana, to collaboration software, like Google Drive or Trello. Choose a tech stack that best fits the needs of your project.

7. Be flexible.

Stakeholder management is not a one-size-fits-all process. You should be flexible and tailor your approach to each individual you work with.

Create an Effective Stakeholder Management Plan

Stakeholders hold the power to influence your project, so engaging leaders while keeping their needs at the forefront will help keep things running smoothly.

Keep these tips in mind as you develop your stakeholder management strategy to stay on track.

Don't forget to share this post!

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Project Stakeholder Management in the Clinical Research Environment: How to Do it Right

Seithikurippu r. pandi-perumal.

1 Department of Population Health, New York University Medical Center, New York, NY, USA

Sohel Akhter

2 Department of Management, Zicklin School of Business, Baruch College, New York, NY, USA

Ferdinard Zizi

Girardin jean-louis, chellamuthu ramasubramanian.

3 District Mental Health Programme, Madurai Medical College, Madurai, India

4 Division of Community Psychiatry, M. S. Chellamuthu Trust and Research Foundation, Madurai, India

R. Edward Freeman

5 University of Virginia Darden School of Business, Charlottesville, VA, USA

Meera Narasimhan

6 Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, USA

7 University of South Carolina, Columbia, SC, USA

This review introduces a conceptual framework for understanding stakeholder management (ShM) in the clinical and community-based research environment. In recent years, an evolution in practice has occurred in many applicants for public and non-governmental funding of public health research in hospital settings. Community health research projects are inherently complex, have sought to involve patients and other stakeholders in the center of the research process. Substantial evidence has now been provided that stakeholder involvement is essential for management effectiveness in clinical research. Feedback from stakeholders has critical value for research managers inasmuch as it alerts them to the social, environmental, and ethical implications of research activities. Additionally, those who are directly affected by program development and clinical research, the patients, their families, and others, almost universally have a strong motivation to be involved in the planning and execution of new program changes. The current overview introduces a conceptual framework for ShM in the clinical research environment and offers practical suggestions for fostering meaningful stakeholder engagement. The fifth edition of PMBOK ® of the Project Management Institute, has served as basis for many of the suggested guidelines that are put forward in this article.

A true architect is not an artist but an optimistic realist. They take a diverse number of stakeholders, extract needs, concerns, and dreams, and then create a beautiful yet tangible solution that is loved by the users and the community at large. We create vessels in which life happens – Cameron Sinclair ( 26 )

In recent years, a revolution in thinking about organizational management and decision making has taken place. Increasingly, programs have been incorporated into organizations, typically private sector corporations or government agencies, which have sought to involve “stakeholders” in management decision making. Stakeholders are the customers, suppliers, the general public, and any other group, which are likely to be affected by the organization’s ultimate decisions. The process of incorporating the ideas and input from these groups has been termed “stakeholder engagement.” It reflects an increasingly accepted attitude that organizations not only have an ethical obligation to involve the participation of stakeholders in their collective activity but also in so doing their overall organizational effectiveness will be enhanced. While certain generalizations in the application of this philosophy are constant, minor variations also exist, which reflect the specific goals that the organization is pursuing. In this review, the application of stakeholder engagement in clinical research settings, particularly in hospitals or university research centers, is considered.

According to the Institute of Medicine (IOM), the purpose of comparative effectiveness research (CER) is, “to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve healthcare at both the individual and population level” ( 1 ). The Kellogg Commission report defines engagement as follows: “By ‘ engagement ’ we refer to institutions that have redesigned their teaching, research, and extension and service functions to become even more sympathetically and productively involved with their communities, however, community may be defined” ( 2 ). Hospitals and research centers are increasingly taking deliberate steps to include their broader constituencies in project management decision making and to seek their input at an early stage of the research or program implementation process. The term “ community engagement ,” can be defined as, “the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people” [( 3 ), p.3]. It has been noted that traditional models of research which view study subjects or targets of program development as passive audiences may result in research findings that are poorly aligned with the information needs of real-world decision makers ( 4 , 5 ). An additional impetus for this interest has been the Patient Protection and Affordable Care Act of 2010, which was enacted to promote patient engagement. The purpose of the act has been to help patients, clinicians, purchasers, and policy makers make better informed health decisions by “advancing the quality and relevance of evidence about how to prevent, diagnose, treat, monitor, and manage diseases, disorders, and other health conditions.”

The key focus in the process of stakeholder engagement is of course the stakeholder. Freeman ( 6 ): 46 defined stakeholder as, “any group or individual who can affect or is affected by the achievement of the organization’s objectives.” According to the project management institute (PMI), the term stakeholder refers to, “an individual, group, or organization, who may affect, be affected by, or perceive itself to be affected by a decision, activity, or outcome of a project” ( 7 ). In other words, almost any individual or group of individuals with an interest or stake in a consensus-building process thereby the outcome of the project and/or an ability to exert a positive or negative influence by the execution or completion of a project or being affected by the work or its deliverables, outputs, or results.

In clinical research, researchers are often faced with questions about the choices that must be made by patients. Research can also be focused on assisting the process of program development. In either instance, the underlying motivation remains the same: to healthcare delivery, to become aware of dysfunctionalities that may exist in healthcare, and to improve the outcomes of proposed changes. It is essential then that research and program processes are assisted by those who are most directly affected by proposals, i.e., the patients themselves. Central to the process of encouraging stakeholder involvement therefore is a basic assumption that patients have the right to make the best decisions about their own health care.

Stakeholder engagement versus stakeholder management (ShM): in recent years, the term “ stakeholder engagement ” (ShE) has become widely used in applied clinical research and new program development. An important reason for this is that it has been repeatedly shown that critical health issues, which are often known to the patients or research subjects themselves, may not have been addressed in the original research or program proposals ( 8 ). Stakeholder engagement is a bidirectional process. It begins when the researcher communicates and interacts with stakeholders, and ultimately results in informed decision-making concerning the selection, conduct, as well as dissemination of research findings in order to achieve a desired outcome and enhance accountability ( 9 , 10 ). Stakeholder engagement is thus differentiated from one-way communication processes that seek to influence groups to agree with a decision that has already been made.

The obligation to serve all stakeholder interests is often called stakeholder management ( 11 , 12 ). The main distinction between stakeholder management and stakeholder engagement largely rests on the extent to which stakeholders are involved in the decision-making processes. The process of engagement varies across different research programs, but is highly noticeable in complex, multidisciplinary research.

A stakeholder analysis is a process, which provides insights into, and understanding of, the interaction between a project and its stakeholders. In other words, the process of listing, classifying, and assessing the influence of these stakeholders in a project is termed a stakeholder analysis. Stakeholder analysis systematically gathers and analyzes both qualitative and quantitative information thereby to determine whose interest should be taken into account throughout the project. One of the first tasks that a clinical project manager must undertake is to identify how stakeholders can make the greatest impact on the research project or program change, which is being contemplated. The function of stakeholder analysis is to produce an awareness of who will be affected by the project and who can contribute to making the project more successful. The stakeholder analysis, which is usually undertaken at an early stage of planning, is an integral part of risk and reward assessment activities.

It is essential for maximal project effectiveness that managers be committed to the basic philosophy of stakeholder involvement. Project managers must communicate and impart what they see as their goals but also seek to encourage participation by stakeholders so that their perspectives are included in decision making.

The process of identifying, engaging stakeholders must begin well in advance so that dialog is seen to play an important part of project implementation; no decisions should be already made before commencing stakeholder engagement on project-related issues.

Benefits of Stakeholder Engagement

Well managed projects, although long and complex, create long-term economic gain and social values meaning that proper use of taxpayer’s money. When done correctly, stakeholder engagement provides opportunities to further align clinical research practices with societal needs, values, and expectations, helping to drive long-term sustainability and stakeholder interests.

Stakeholder engagement is intended to help administrators fully realize the benefits of applying community and patient interest in hospital programs, and to ensure that research and program changes benefit those who are most directly affected.

The stakeholder focus group is a communication medium through which the opinions of individuals or groups of individuals who are impacted by the research can be elicited. Focus groups can also serve to clarify each stakeholder’s role and responsibilities, as well as promoting an overall understanding of the project requirements. Such processes also provide stakeholders with an environment in which they can express their opinions and feel that they have been heard.

In a series of related manuals the Patient-Centered Outcomes Research Institute (PCORI) ( 13 ) has provided a group of examples of how hospitals and medical clinics can encourage stakeholder involvement, in various research projects or programs whose aim was to improve the quality of medical services.

It can be seen from one of our case studies (see Appendix ) that stakeholders can make meaningful contributions to a project when opportunities are structured to encourage their participation. The process of encouraging stakeholder participation is referred to as stakeholder management.

Requirements for Stakeholder Management

Stakeholder management involves the processes of identifying (both internal as well as external) stakeholders; assessing stakeholders’ skills, knowledge, and expertise; determining stakeholders’ requirements; determining stakeholders’ interests and expectations; determining stakeholders’ communication needs; addressing stakeholders’ issues and concerns as they occur; maintaining a positive relationship and communicating with stakeholders throughout the project; identifying stakeholders’ influence-controlling strategies; making sure that stakeholders are involved in the project at the required level throughout the project; and confirming continuous interactions with the stakeholders. In the area of clinical research patients and other stakeholders such as physicians, clinicians, nurses, and others have critical roles to play. Clinical researchers at the outset of research need to ask for patient participation in the development of research questions. Researchers need to find out the exact characteristics of study participants and to define what the nature of the research outcomes should be. In this process, contributions from patients are helpful and often critically important for project success. The process of carrying out research also involves measuring the results of research interventions and monitoring the progress of the research, especially in terms of whether or not it is being directed toward the initial intentions of the research. Finally, patients, who are often very closely connected with the target populations of the research, have a direct perspective on how the targets of the research will respond to the research recommendations, and therefore, can provide useful inputs for insuring its relevancy.

Project Stakeholder Management Processes

The PMI identifies four key processes that are associated with the stakeholder management knowledge area in initiating, planning, executing, and monitoring and controlling process groups ( 7 ) (Table ​ (Table1 1 ).

Four project stakeholder management processes and key outputs .

Identify Stakeholders

This entails identifying all people or organizations impacted by the project and documenting relevant information regarding their interests, expectations, involvement, and influence on project success. In the hospital setting, the stakeholders are usually the patients, but can also be healthcare professionals and the families of patients. Examples of stakeholders are given in Table ​ Table2 2 .

The stakeholders can be categorized or classified in many different ways for different purposes .

For example, primary stakeholders (e.g., users of the products or services) or secondary stakeholders (they may not be the end users, however, have some other relationship) .

Throughout the project the following critical tasks should be carried out.

All internal and external stakeholders should be identified. These will usually be the patients but often will include the patients’ family members, healthcare providers, or program administrators.

Stakeholders’ interests, requirements, and expectations should be identified. Obviously, patients are interested in the effects of proposed program changes or research outcomes on their health and well-being, but may have additional interests such as hoping to improve their employment prospects, or expanding their range of capabilities. Clinical researchers and administrators should be alert to these concerns and take appropriate steps to address them. It has been found, for instance, that stakeholder views at the beginning of a program evaluation process may be provisional or may change as a result of additional information. Additionally, stakeholders’ interests may change over time. In one study, the results of pre-workshop and final workshop voting often differed, suggesting that prioritization efforts relying solely on requests for topics from stakeholder groups without in-person discussion may provide different research priorities ( 14 ). Thus, efforts should be made to audit the evolving nature of stakeholders’ expectations and preferences through structured methods.

All stakeholders’ levels of influence should be determined. It is often the case that patients and other beneficiaries of program development have talents and skills that may not be reflected in records of formal education or social standing. Certain personal traits, which patient stakeholders may possess, such as communication skills or life experience, could nevertheless prove invaluable for achieving project goals.

A communication plan for the stakeholders should be determined. Patient stakeholders may not always be familiar with or comfortable in using traditional channels of communication in large organizations. As noted by Lavallee et al. ( 15 ), the increasing availability of mobile technology, social media, internet venues, and electronic devices has multiplied the communication options for many, but carries with it the risk of increasing the quantity of participants while reducing the depth of involvement. Often, the use of focus groups or small informal meetings can be used to increase the quality of communication or to elicit participation from those who might otherwise be reticent about expressing their views. Reviews of methods of communication for engaging stakeholders have concluded that a combination of approaches probably yields the best results. Methods such as voting or using ranking procedures such as the analytic hierarchy process ( 16 ) and other structured techniques are best for establishing research priorities, whereas in-person methods are best for clarifying ideas and generating ideas ( 17 ). Repeated exposure to these experiences be useful for identifying patient stakeholders’ core concerns and for acclimatizing them to organizational communication.

Stakeholders’ expectations and influence over the project should be managed. Reality checks are important for balancing patients’ idealistic expectations and the necessity of dealing with the challenges of getting things done through institutions. Program administrators must identify patient stakeholders’ strengths and channel these for optimal organizational impact.

Depending on their complexity, size, and type, most projects have a diverse number of internal and external stakeholders at different levels of the organization with different authority levels.

Stakeholder identification is a dynamic and sometimes difficult process, and the influence of a stakeholder may not become evident until later stages of a project. And, sometimes projects evolve so that solving unseen problems emerges as a critical task. It is essential to identify as many as stakeholders as possible at the beginning of the project and classify them according to their level of interest, influence, importance, and expectations at the earliest stages of the project as much as possible (Table ​ (Table3). 3 ). The identification of the relevant stakeholders is not only a core necessity but also poses a significant challenge. For example, under cost constraints, it might not be possible to identify all external stakeholders ( 18 ). On the other hand, stakeholders who are missed out during the identification process might have special requests to be fulfilled. This could potentially delay the project completion or escalate the cost as their requirement needs to be fulfilled. Additionally, as Bryson ( 19 ) pointed out that the failure to attend to the information concerns of stakeholders clearly is a kind of flaw in thinking or action that too often and too predictably leads to poor performance outright failure or even disaster.

Stakeholder management strategy .

Project charter

The project charter gives an overall picture of the project as well as describing some of the stakeholders and their interest in the project along with their requirements.

Procurement documents

If a project is based on an established contract or the result of a procurement activity, the parties in that contract are key project stakeholders. Other relevant parties such as suppliers, legal parties, and people who will execute the contract should also be considered as part of the project stakeholders list.

Enterprise environmental factors

Hospital culture and structure, and other factors may influence the identify stakeholders process.

Organizational process assets

To benefit from previous experience those in charge of developing proposals should carefully review the efforts of earlier projects. The stakeholder register template, lessons learned, and the stakeholder registers from previous projects may influence the identify stakeholders process.

Stakeholder analysis

It is not possible to treat all stakeholders equally in the project, and they are given different priorities with respect to their interests, expectations, and influence on the project. Stakeholder analysis is a process of systematically gathering and analyzing all relevant quantitative and qualitative information about the stakeholders in order to prioritize them and determine whose interests should be taken into consideration throughout the project.

As per PMI, stakeholder analysis is performed by the following steps:

• Step 1: all potential project stakeholders and their relevant information, such as their roles, interests, knowledge levels, expectations, and influence levels should be identified.

Stakeholder mapping: the power versus interest grid . The gird shows stakeholders on a two-by-two matrix showing the strategies to be employed to engage and manage them. Power/interest grid model shows the grouping of the stakeholders based on their level of authority (“power”) and their level or concern (“interest”) regarding the project outcomes. Identifying and classifying the stakeholders is pivotal as it helps to develop appropriate strategies to effectively engage and manage all the stakeholders involved in a particular project. This also provides a clear-cut strategy and action-oriented and workable plan to interact with the all the stakeholders in an effective manner so as to minimize the resistance and maximize the support. A project is as successful as the stakeholders think it is. The details of power versus interest grids are found elsewhere ( 25 ).

• Power/influence grid: this is based on the level of authority or power and active influence a stakeholder has.
• Influence/impact grid: this groups stakeholders based on their involvement or influence and their ability to affect changes to planning or execution (impact).
• Salience model: this addresses a stakeholder’s power or ability to impose their will, urgency, or need for immediate attention from the team and legitimate involvement in a project.
• Step 3: in order to influence the stakeholders to enhance their support and to mitigate potential negative impacts, the way in which key stakeholders are likely to react or respond in various situations should be assessed.

Stakeholders who have greater power or influence and a strong interest in the project should be managed closely and continuously updated. Stakeholders who have significant power but low interest in the project should be kept informed about the project. Stakeholders who have low power and low interest should be monitored, and stakeholders who have low power and high interest should be kept satisfied.

Expert judgment

Judgment and expert opinions can be gathered to identify stakeholders, usually from the senior management. These resources can include project team members, project managers from similar projects, subject matter experts, industry groups and consultants, and other units within the hospital or research setting.

Profile analysis meetings with team members and the sponsor will be beneficial for identifying stakeholders and their knowledge, potential roles, importance, impact, interest, and expectations in the project.

Stakeholder register

This contains all details related to the identified stakeholders including but not limited to

• Stakeholder classification: stakeholders can be classified in many different ways. For example, primary (users of the products, services, or results) or secondary (may not be the direct users, but have some influential relationship), Internal/external, neutral/resistor/supporter/hard to hear, and so on.
• Identification information: name, title, location, organization, role in the project, position, and contact information.
• Assessment information: key requirements and expectations, potential impact, importance, and influence on the project.

A project manager may publish the stakeholder register with other project documentation or keep it in reserve for personal use only (Table ​ (Table4 4 ).

A snapshot of a stakeholder register: stakeholder register is a project document, which is an output of identify stakeholders process .

Stakeholder Register will be an important input to the plan stakeholder management process, as well as several other planning processes, which includes plan communication management. A stakeholder register may contain key information such as the identification, assessment, and classification of project stakeholders. A snap shot of stakeholder analysis to show how the stakeholders and their interest areas mapped onto a matrix. The stakeholder’s position might vary from a supporter (S); moderate supporter (MS); neutral (N); moderate resistor/opponent (MR or MO); and resistor/opponent (R or O). Identifying and analyzing the stakeholders are crucial for a project success .

Plan Stakeholder Management

The plan stakeholder management process defines an approach for managing stakeholders throughout the entire project life cycle as per their interest, impact, importance, and influence over the project. It defines the strategies for building close relationships with stakeholders who can benefit the project and for minimizing the influence of stakeholders who may have a negative impact on the project.

This process is iterative and should be reviewed on a regular basis as the required level of engagement of the stakeholders’ changes in the project.

Project management plan

Components of the project management plan (PMP) such as the human resource management plan, staffing management plan, communications management plan, change management plan, and others are used in developing the stakeholder management plan (SMP).

This contains all details related to the identified stakeholders, including identification information, assessment information, and classification.

All environmental factors within the hospital or clinical research facility, including its culture and history of the organization, are used.

All organizational process assets, especially lessons learned and historical information are used.

Judgment and expert opinions can be gathered from senior management, project team members, identified stakeholders, project managers from similar projects, subject matter experts, industry groups and consultants, other units within the organization, and other people to identify the level of involvement required from each stakeholder at various stages of the project. However, it is possible that expert judgment can be mistaken when possible expert judgment must be balanced with input from the stakeholders themselves.

Meetings with team members and the sponsor will be beneficial for identifying the level of engagement required from each stakeholder.

Analytical techniques

Various analytical techniques are used for identifying the required level of stakeholder engagement. These techniques take into consideration stakeholder sensitivity to project goals and personal orientations such as being unaware, resistant, neutral, supportive, or providing leadership.

Stakeholder engagement assessment matrix

The stakeholder engagement assessment matrix (SEAM) is used to assess the current and desired state of engagement of a stakeholder for the current phase of the project (Table ​ (Table5 5 ).

Stakeholder engagement assessment matrix (SEAM): please note that the current and desired engagement level of key stakeholders expect to change as the project progresses and develops .

C, current state; D, desired state .

The SEAM illustrates that only Stakeholder 4 is engaged in the project at the desired state. The project manager should consider additional communication and further actions to bring all other stakeholders to the supportive and leading states.

Stakeholder engagement is critical to project success; thus, required actions and communication should be planned to minimize the gap between the desired level of engagement and the actual level of engagement.

Stakeholder management plan

Stakeholder management plan, which is a subsidiary plan of the PMP that defines the processes, procedures, tools, and techniques to effectively engage stakeholders in project decisions and execution on the analysis of their needs, interests, and potential impact ( 7 ). The SMP can be formal, informal, highly detailed, or broadly framed based on the needs of the project. The SMP typically describes the following:

• information needs of each stakeholder or stakeholder group;
• stakeholder communication requirements;
• format, method, time frame, and frequency for the distribution of required information to the stakeholders;
• person responsible for communicating the information to the stakeholders;
• methods of refining the SMP;
• required engagement level of the stakeholders at various stages of the project;
• stakeholder management strategy that defines an approach to manage stakeholders throughout the entire project life cycle. It defines the strategies to increase the support of the stakeholders who can impact the project positively and minimize the negative impacts or intentions of the stakeholders who can negatively impact the project.

The portion of the plan that contains sensitive information such as stakeholders’ personalities and attitudes, negative impact that stakeholders may cause, or other factors is not usually published and is kept in reserve by the project manager for personal use only.

Project documents updates

Project documents such as the project schedule, stakeholder register, and others may be updated.

Manage Stakeholder Engagement

The Manage Stakeholder Engagement process is focused on meeting and exceeding the stakeholders’ expectations by continuously communicating with them, clarifying and resolving their issues, addressing their concerns, and improving the project performance by implementing their change requests.

As per PMI, the project manager is responsible for managing the stakeholders’ expectations. Meeting the stakeholders’ expectations increases the probability of project success by enabling the stakeholders to be active supporters of the project, drastically reducing unresolved stakeholder issues, and limiting disruptions in the project.

Within the research context, the SMP identifies information needs, communication requirements, required engagement level at various stages of the project, stakeholder management strategy, and other factors to identify and manage stakeholders throughout the entire project life cycle.

Communications management plan

The communications management plan is a subsidiary of the PMP. It can be formal, informal, highly detailed, or broadly framed based on the needs of the project. The communications management plan typically describes the following: purpose for communication; Information needs of each stakeholder or stakeholder group; stakeholder communication requirements; format, method, time frame, and frequency for the distribution of required information; person responsible for communicating the information; methods for updating the communications management plan; persons or groups who will receive the information; glossary of common terms; issues/concerns escalation procedures.

A change log is used to document changes that occur during a project. A lot of these changes can impact different stakeholder interests; thus, the change log is reviewed in this process.

Organization communication requirements, issue management procedures, change control procedures, and historical information are used.

Communication methods

According to the needs of the project, the methods of communication identified for each stakeholder in the communications management plan are utilized during the manage stakeholder engagement process.

Interpersonal skills

The project manager applies appropriate interpersonal skills or soft skills to manage stakeholder expectations by building trust and resolving conflict.

Management skills

Management skills such as presentation skills, negotiation skills, writing skills, and public speaking skills used by the project manager can greatly influence how stakeholders feel about the project.

An issue is an obstacle that threatens project progress and can block the team from achieving its goals. An issue log is a written log document to record issues that require a solution. It helps monitor who is responsible for resolving specific issues by a target date. There should be one owner assigned for each issue reported within the project.

Change requests

Change requests can include a new change to the product or the project, corrective or preventive actions, and other items.

Project management plan updates

The SMP portion of the PMP is updated as new stakeholders’ requirements are identified, existing requirements are changed, or as a result of addressing concerns and resolving issues of the stakeholders.

Project documents that may be updated include, but are not limited to, the following:

• Issue log: this will be updated as resolutions to the current issues are implemented and new issues are identified.
• Stakeholder register: this is updated as stakeholders’ statuses change, new stakeholders are identified, registered stakeholders are no longer involved or impacted by the project, and other factors.

Organizational process assets updates

Lessons learned from managing stakeholders, feedback from stakeholders, project records, causes of issues, and reasons for corrective actions chosen may be updated.

Control Stakeholder Engagement

The control stakeholder engagement is the process of evaluating and monitoring overall stakeholder relationships and ensuring stakeholders’ appropriate engagement in the project by adjusting plans and strategies as required. As the project progresses and its environment changes, this process will maintain or increase the efficiency and effectiveness of stakeholder engagement activities.

Components of the PMP such as the human resource management plan, staffing management plan, communications management plan, change management plan, and others are used in controlling stakeholder engagement.

An issue is an obstacle that threatens project progress and can block the team from achieving its goals. An issue log is a written log document to record issues that require a solution. A modified issue log is developed as a result of identifying new issues and resolving current issues.

Work performance data

Work performance data such as resource utilization, deliverables status, schedule progress, percentage of work completed, number of defects, number of change requests, technical performance measures, costs incurred, quality updates, and other factors are used in this process.

Project documents

Project documents such as issue logs, the stakeholder register, the project schedule, the change log, and others are used in this process.

Information management systems

An information management system is an automated system that can serve as a repository for information, a tool to assist with communication, and a system for tracking documents and deliverables. An information management system also supports the project from beginning to end by collecting and distributing information about cost, schedule, and performance for the stakeholders. Several reporting techniques such as spreadsheet analysis, table reporting, presentations, graphics for visual representations, and others may be consolidated from various systems and communicated to the stakeholders.

Judgment and expert opinions can be gathered from senior management, project team members, identified stakeholders, project managers from similar projects, subject matter experts, industry groups and consultants, other units within the organization, and other people to identify new stakeholders, reassess the current stakeholders, and figure out the level of involvement required from each stakeholder at various stages of the project.

Status review meetings with the team, sponsor, and other stakeholders will be beneficial for reviewing information about stakeholder engagement.

Work performance information

Work performance information such as deliverables status, change request implementation status, and forecasted estimates to completion are distributed through communication processes.

These are recommended corrective actions for bringing the imminent performance of the project as per the expectations in the PMP and recommended preventive actions for reducing the probability, and impact of future negative project performance will generate a lot of change requests.

Most of the components of the PMP may be updated to reflect changes in the stakeholder management strategy and the approach to effectively control stakeholder engagement in the project.

Project documents such as the issue log, the stakeholder register, and others may be updated.

Lessons learned from managing stakeholders, feedback from stakeholders, project records, causes of issues, reasons for corrective actions chosen, project reports, stakeholder notifications, and other items may be updated.

While the burden of disease is growing rampantly and disproportionately, the challenge to global health outreach efforts is to prioritize those illnesses, which require immediate attention. The global health equity sorts to prioritize on improving health care and achieving equity in health of people around the world. In this context, researchers from high income countries often study the existing diseases and/or emerging challenges in low income countries in order to gain expertise on the health care needs ( 20 ). In this regard, it is essential for overall program effectiveness that representatives of local communities, the stakeholders who will be most impacted by health outreach programs, be invited to provide their insights into which health needs are greatest. The encouragement of ShE and ShM often has a secondary benefit inasmuch as organization’s reputation is subsequently enhanced, which further facilitates organizational effectiveness. The very presence of stakeholders may foster an organizational environment, which encourages relevancy of program objectives to stakeholders’ expectations, a coupling, which in turn contributes to achievement of the project’s goals. Additionally, stakeholders can provide reality checks, which aid in the prioritizing of research objectives, in identifying potentially difficult political issues, and in providing the means to navigate around or to overcome challenges. The experience of stakeholders is thus invaluable for guiding research and achieving program objectives from their early stages in the laboratory to their final clinical application.

Although the process of partnering with stakeholders in clinical research settings is still in its nascent stages, it is anticipated that it will increasingly become accepted and implemented by project managers. In tandem with this process, greater efficiency and transparency will develop in working with stakeholders to meet targets ( 21 ). Part of the function of stakeholder analysis is to promote an understanding of stakeholders and to ensure that their expectations are being met. It is anticipated that project heads will increasingly encourage an awareness (ensuring transparency) of who will be affected by the project and who can contribute to making the project more successful.

Stakeholders have unique perspectives and often possess a number of capabilities which they have acquired from life experience. Program developers can derive the maximum benefit from stakeholders if the proper context is established for drawing out this experience. Alternatively, barriers to effective participation by stakeholders can occur if managers remain unaware of stakeholders’ skills, or if they believe that they do not have appropriate knowledge to contribute.

By increasing the acceptability of programs, stakeholders increase the likelihood of their success. Stakeholders play pivotal roles as healthcare advocates or healthcare ambassadors, partners, and/or agents of change. Although stakeholders differ considerably in their expertise and interests, their involvement is pivotal inasmuch as it can facilitate the successful completion of projects. Stakeholder participation can (a) improve relevance; (b) promote visibility and research transparency; (c) accelerate and translate the research findings to real-world challenges; (d) enhance greater project acceptance as confidence derived in the decisions made during the project’s milestone developments. Similarly, the project’s final outcome can only be considered successful when it is acknowledged by its key stakeholders.

Due to the broad range of ways in which stakeholders can influence program development, it is essential that their behavior be closely monitored, and modulated if necessary. One of the advantages of the described system of viewing the management of stakeholder engagement is that it documents many processes that have taken place. Future efforts to manage this type of engagement can therefore benefit from established experience.

In a nutshell, as Wheeler et al. ( 22 ) pointed out, “a truly stakeholder-responsive approach demands the acceptance of multiple stakeholders and requires that an organization develop a tolerance for ambiguity together with the sensitivities and capabilities needed to inspire trust with diverse and sometimes completing interests.”

A balanced assessment recognizes that certain caveats apply in the establishment of stakeholder engagement and management in clinical and research settings. These relate to the unique nature, demands, resources, and implementation issues which every organization has and how these demands can interact with the unique skills and abilities which stakeholders bring to it.

Many investigators lack clear or a basic understanding and/or training concerning the stakeholder framework as well as terminologies (Figure ​ (Figure2 2 ).

Project stakeholder management summary .

Often a reactive approach is favored over a proactive one for dealing with stakeholder issues is favored over a proactive one. As suggested by Greenwood, the “glorified depiction of stakeholder engagement gives way to the murky reality that engagement of stakeholders can mean many things to many people” ( 23 ). In this conceptualization, stakeholders may be viewed merely as actors with whom project managers form arms-length transactions rather making a tightly knitted partnership. This limited perspective may result in a failure to assess, understand the social, spiritual, and environmental needs of stakeholders.

Not every project can require or afford to have a full ShE or ShM system in place as outlined in this review. The main barrier here is that stakeholder involvement, and the fostering of attitudes that encourage this process, require a degree of organizational change (i.e., additional paperwork, more meetings, and more communication), which can be expensive. Hence, the benefits of managing a full program of stakeholder engagement, analysis, and management are only applicable to high impact projects. As Cennamo et al. ( 24 ) have noted a stakeholder-committed organization may still act out of self-interest. Thus, while localized programs may recognize and incorporate contributions from stakeholders and the larger community, these activities may continue to serve institutional objectives, which are narrowly focused or even possibly inimical to broader community interests. Additionally, stakeholder preferences are not absolute, but relative, and may also be evolving. Hence, the salience might change frequently across time. Another issue is that there is no generic “one size fits all” strategy for ShM and ShE, rather, the strategy and its execution depend very much on the local stakeholder landscape, as well as the problems that are being addressed. These include the stakeholder assets that are available and the opportunities that exist for their cultivation. Additionally, a barrier to effective participation and the subsequent consensus-building process is that the identified stakeholders may lack appropriate knowledge or skill sets, or believe, correctly or incorrectly, that they do not have appropriate knowledge to contribute and/or the investigators have the knowledge and experience to identify it. Stakeholders might have multiple perspectives and conflicting views, needs, and priorities. These may eventually result in identifying what they perceive to be the “best” or “appropriate” solution in any given situation, although the course of action might completely differ from that of investigators. This, in turn, results in potential “conflicts” and “trade-offs” in terms of project objectives. For example, the conflicting interest among the stakeholders with varied levels of power, importance, interest, and agenda must be managed efficiently. This poses a challenge to novice project managers to experienced investigators. These may potentially limit control mechanisms, and thus impede organizational performance. On the contrary, it is difficult to generate interest and involvement in projects, which are perceived to have little or immediate relevance. Finally and most importantly, while most of the ShE literature emphasizes the positive benefits of stakeholder engagement, it less frequently addresses the potential costs and risks with the adoption of a stakeholder perspective.

Above all, it is impossible to engage with stakeholders and to do stakeholder management in an authentic and effective way without dealing with the multiplicity of ethical issues that arise. These issues arise, first of all, because the stakeholders’ interests can conflict along key ethical dimensions. Therefore, engaging with them must be sensitive to the rights of the parties involved, as well as to the overall harms and benefits, which accrue from managerial action. Second, it is not always apparent when there may be conflicts of interests or hidden advantages or hidden disadvantages among key stakeholders and decision makers. Obviously, these conflicts must be disclosed, and many organizations have specific procedures for handling such conflicts. However, given the nature of the decisions that are to be made, managers must be willing to accept that effective stakeholder management places them squarely in the realm of ethical decision making.

It is not always possible to anticipate all of the ethical issues and conflicts, which may develop in such a multi-stakeholder environment. Therefore, the traditional method of assigning responsibility for solving these problems to an ethics committee does not always work. Clinical project managers must be willing to make choices based on both good ethics (based on PMI’s code of ethics and professional conduct) and on the overall purpose and values of their institution that is best for all stakeholders ( 27 ). While some ethical issues can be anticipated at the start of the project, all should be subjected to discussion among the project stakeholders to find the best possible course of action.

Assuming that the challenges reviewed above can be overcome, additional “higher order” issues will emerge. These will consist of how to best promote the operational adaptability, viability, and implementation of the changes in an acceptable timeframe. Project managers will need to ask if the benefits of managing a full stakeholder analysis are really greater than the costs associated with it. Efforts will also need to be directed toward retrospective analysis, i.e., did real cases go badly because the stakeholder views were not sought out? The difficulty of these questions varies in different clinical settings but it is essential that they be resolved for maximum project effectiveness.

In summary, the concept of promoting stakeholder engagement and management is a relatively recent one in the clinical research arena; hence, there are many lessons to be learnt in the coming years. As this is an iterative process, although the current efforts from funding agencies such as PCORI are necessary but are insufficient to respond to the above challenges. All indications are that attempts to meet these challenges will nevertheless provide significant benefits for project management effectiveness.

From a clinical standpoint, stakeholder engagement and management is pivotal to the development and deployment of community-oriented national and global health initiatives. The ultimate purpose of such engagement is the efficient use of time, money, and resources thereby positively impact existing and/or emerging healthcare challenges.

For the purpose of our review, we have followed the guidelines of PMBOK ® ( 7 ), which provides a common vocabulary to guide the processes. In doing so, our review outlines a systematic model for planning, managing, and implementing stakeholder engagement based on PMBOK ® guidelines. Further, the application of the project management knowledge, skills, tools, and techniques can augment the chances of success, even in complex projects.

This review has drawn on the experience of stakeholder engagement in private organizations and government agencies and has argued that the process is equally viable in hospital program development and in clinical research. It has taken the view that the concept of stakeholder engagement and a proper stakeholder management framework is more than a useful adjunct to pursuing project or program goals and is actually pivotal for enhancing organizational success.

These guidelines have been broken down into a number of component parts. It emphasizes that the stakeholders should first be identified, that their interests and expectations should be understood, and that their level of power and influence should be understood as well. A plan for communicating with stakeholders has been outlined and techniques for encouraging their participation and management have been laid out.

Author Contributions

All authors intellectually contributed to the design, analysis, and interpretation of the results and to drafting the critical review of manuscript. All authors reviewed and approved the final version of the manuscript.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors would like to sincerely thank Professor Philip Kotler, S. C. Johnson & Son Distinguished Professor of International Marketing, Kellogg School of Management, Northwestern University, USA for his time, advice, and his valuable comments on the earlier versions of our manuscript, which enormously improved the quality of the final manuscript. We are also grateful for the comments from the anonymous reviewers. We gratefully acknowledge the National Institutes of Health; National Institute of Mental Health; Duke Endowment; South Carolina Department of Health and Human Services. As of the end of 2012, the Duke Endowment had provided more than $7.25 million in support of the program. Additional funding has come from the South Carolina Department of Health and Human Services, the National Institute of Mental Health (NIMH), and the National Institutes of Health (NIH). NIMH and NIH awarded two grants (one in 2009 and one in 2012) totaling $3.04 million to support evaluation of project outcomes (on quality, economic impact, utilization, and sustainability). In addition to grant funding, user fees and third-party insurance cover some program-related costs; for example, beginning in 2013, BlueCross BlueShield of South Carolina began covering use of telemedicine in mental health. However, the funders had no involvement in study design, data collection, data analysis and interpretation, preparation of the manuscript, or in the decision to submit the manuscript for publication.

Appendix: Examples of Stakeholder Engagement

Statewide telepsychiatry initiative.

In one of our landmark study by the author (MN), the South Carolina Department of Mental Health partnered with the University of South Carolina School of Medicine, Department of Health and Human Services and 18 predominantly rural hospitals from the South Carolina Hospital Association to establish the statewide telepsychiatry initiative. In this public-private-academic partnership, the psychiatrists were available via teleconference 16 h a day, 7 days a week, to assess and treat patients with mental health issues at hospital emergency departments.

The clinicians called the psychiatrist on duty whenever they have a patient who needed a mental health assessment and/or counseling and provide relevant medical records and details. Through a secure video link, the psychiatrists were able to assess the patient and makes recommendations about needed treatment and follow-up, including referrals to community-based resources.

The advantage of such program was that, it drastically reduced emergency department wait times, inpatient admissions, as well as costs; increased attendance at follow-up outpatient appointments; and generated higher level of satisfaction among patients and clinicians. Additional evidence includes post-implementation surveys that gauge the satisfaction of patients and clinicians with the program.

In such an innovative approach, the stakeholder (State Department of Mental Health, University of South Carolina, Department of Neuropsychiatry and Behavioral Science, Hospital, Physicians and Nurses from the South Carolina Hospital Association, and Patients) engagement proved to be feasible, necessary, and beneficial in clinical environment.

Outcome of the initiatives – did it work?

The program has reduced emergency department (ED) wait times, inpatient admissions, and costs; increased attendance at follow-up outpatient appointments; and generated high levels of satisfaction among patients and clinicians.

Shorter ED Wait Times: From March 2009 through 2014, the average waiting time for patients with mental health problems at the 18 participating EDs fell by roughly 50%. Fewer hospitalizations: during the same timeframe, 11% of ED patients assessed by a psychiatrist were hospitalized, half of the 22% admission rate among similarly cared-for patients in South Carolina EDs not offering this program.

Health care utilization: Telepsychiatry consultations resulted in an estimated $1,400 less per mental health patient compared to patients seen in ED’s that did not have telepsychiatry due primarily to the reductions in hospital admissions.

Greater attendance at follow-up appointments: About 46% of patients served by the program attended an outpatient follow-up appointment within 30ădays of the initial ED visit, well above the 16% attendance rate among similar ED patients cared for in South Carolina hospitals not offering the program. Similarly, 54% of patients served by the program attended a follow-up appointment within 90ădays versus 20% among ED patients in hospitals not offering the program.

High satisfaction among patients and staff: More than 80% of patients served by the program reported being satisfied with the process and services received. In addition, 84% of ED physicians and staff believe that the program has improved patient care; 91% report being satisfied with program-related procedures; and 84% express satisfaction with the technology used.

How we did it: Planning and development process key steps included the following:

Decision to focus on telepsychiatry : The increasing popularity of telemedicine and its potential to bring services to underserved geographic areas made telepsychiatry a logical initial target for these discussions. After reviewing the use of telemedicine in South Carolina and other States, the partners collectively decided to create and implement a telepsychiatry program in hospital EDs.

Securing of funding for demonstration project : In 2007, program leaders contacted the Duke Endowment (a non-profit foundation that supports innovative health care programs) for funding a demonstration project. In 2008, the Duke Endowment agreed to provide a $3.7 million, 3-year grant for this purpose.

Project planning : Four hospitals agreed to participate in the demonstration project, which launched in March 2009. In advance of this date, the partners and participating hospitals worked together to hire and train six psychiatrists, install and test the video equipment in EDs, and set up an EMR system linking the psychiatrists with the EDs.

Program expansion : After the demonstration project went smoothly, program leaders decided in June 2009 to expand the program to three additional sites and have continued to add more sites gradually since that time. From March 2009 through August 2014, more than 20,000 telepsychiatry ED consults have taken place. As of August 2014, 20 hospitals participate, with plans to add 6 more in 2014.

Standardization of training : As the initiative expanded, program leaders standardized the training process for psychiatrists and ED staff, as outlined below:

Psychiatrist training : Participating psychiatrists complete 6ăh of clinical training by viewing videos prepared by University of South Carolina School of Medicine faculty. Supplemented with handouts, the videos cover child and adolescent psychiatry, adult psychiatry, geriatric psychiatry, addiction psychiatry, risk assessment, and legal issues. Newly hired psychiatrists also undergo peer review every 2ăweeks during their first 3ămonths of employment. In addition, during this initial 3-month period, the supervising psychiatrist meets with other hospital physicians to review and discuss consultations performed by newly hired psychiatrists.

ED staff training : ED staffs in participating hospitals watch a video that explains the videoconferencing system and reviews the goals of the program and the training and credentials of the participating psychiatrists. A member of the project leadership team visits each participating ED to discuss questions or concerns that staff might have about the program.

Ongoing meetings to resolve problems, plan expansion : Representatives of the partnering organizations and the participating hospitals meet on a quarterly basis to share program-related experiences, resolve any issues or problems that arise, and discuss and plan for expansion to other EDs. Typically, hospital administrators, providers, researchers, and information technology staff come to these meetings; representatives of non-participating hospitals are also welcome to attend to learn more about the program.

Resources used and skills needed

Staffing : Six full-time psychiatrists and one part-time psychiatrist staff the program, under the supervision of a lead psychiatrist. The program includes several stakeholders namely a director, coordinator, fiscal technician, programmer, and two information resource consultants (subject matter experts; SMEs). Faculty and staff members from the University of South Carolina and Emory University, staff members from the Department of Mental Health and from the South Carolina Office of Research and Statistics also provide support to the program.

Costs : Hard data on the program’s total annual cost are not available. Major program expenses consist of staff salaries and the upfront and ongoing expenses associated with the videoconferencing and EMR technologies.