What a “Good” Stakeholder Engagement Framework Looks Like in Complex Health Systems
Health systems are complex by design. They involve multiple layers of government, diverse providers, communities with different needs, and a growing set of partners across data, digital, social care and policy. In this context, stakeholder engagement should not be viewed as a supporting activity — it is core system infrastructure.
Yet many organisations still approach engagement as ad hoc, personality-driven or project-specific. Comparable research across Primary Health Networks, government agencies and system stewards shows that organisations that engage well do so deliberately, consistently and at scale — through a clear, organisation-wide stakeholder engagement framework.
So what does a good stakeholder engagement framework actually look like in a complex health system?
Based on analysis of comparable frameworks across PHNs, health departments and other system-level organisations, six core components consistently appear.
1. A Clear Purpose Anchored to System Outcomes
Strong frameworks start by answering a simple question: why does engagement matter here?
In complex health systems, engagement is not about consultation for its own sake. It exists to:
Improve coordination across fragmented systems
Embed lived experience and frontline insight into decision-making
Support equity-led, place-based approaches
Enable shared problem-solving across sectors
Strengthen trust, legitimacy and system stewardship
Comparable frameworks consistently link engagement to how the organisation functions, not just what it values. This includes commissioning, integration, system planning, workforce support and policy influence.
A clear purpose positions engagement as everyone’s business, not a specialist add-on.
2. A Shared Engagement Philosophy and Principles
Across the frameworks reviewed, high-performing organisations articulate an explicit philosophy of engagement — how they believe engagement should be done, and what it should feel like for stakeholders.
Common themes include engagement that is:
Purposeful and proportionate
Relational rather than transactional
Inclusive and culturally responsive
Transparent and accountable
Focused on learning and improvement
Effective frameworks translate these principles into behavioural guidance, helping staff understand how to engage, not just what to do.
This creates consistency across teams while still allowing flexibility for different contexts.
3. A Clear Engagement Spectrum to Guide Proportionate Practice
Most frameworks draw on a participation spectrum (often IAP2 or a variant) to describe different levels of engagement — from information-sharing through to collaboration and shared decision-making.
What distinguishes stronger frameworks is not the labels used, but how expectations and appropriateness of engagement are framed:
As a tool for choosing the right level of engagement, not a hierarchy of “better” or “worse”
As something that shifts based on purpose, context and stakeholder expectations
As applicable across all stakeholders — not just communities or consumers
In complex systems, no single engagement approach fits all situations. A spectrum helps teams be explicit about intent, manage expectations, and avoid over- or under-engaging.
4. Clear Stakeholder Categories with Structured Guidance
The most practical frameworks provide a clear taxonomy of stakeholder groups, recognising that organisations engage very differently across communities, providers, funders, government and system partners.
Comparable frameworks commonly group stakeholders into categories such as:
Community and consumers
Service providers
System partners
Funders
Government and policy partners
Data, digital and research partners
Media and communication stakeholders
Critically, effective frameworks acknowledge that stakeholders move between categories depending on context — the categories are organising tools, not rigid boundaries.
For each category, strong frameworks consistently define:
Who is included
Why engagement matters
Who leads or coordinates engagement internally
What good engagement looks like in practice
This creates clarity, reduces duplication and supports a more coherent stakeholder experience.
5. Clear Accountability Without Over-Standardisation
One of the strongest insights from comparable frameworks is that not all engagement can or should be measured the same way.
High-performing frameworks balance two levels of accountability:
Category-level indicators, defined by teams closest to the relationship
Organisation-level indicators, kept intentionally simple
This avoids forcing universal metrics that don’t fit diverse engagement types, while still allowing leadership to see patterns, gaps and trends across the organisation.
Rather than measuring outcomes that sit outside engagement’s line of sight, effective frameworks focus on things engagement can genuinely influence — such as clarity, consistency, responsiveness and stakeholder experience.
6. Built-In Learning and Continuous Improvement
Finally, strong engagement frameworks are designed for adaptation, not static compliance.
Comparable frameworks emphasise:
Short feedback loops rather than annual reflection
Regular review of what is working and where engagement needs to shift
Central visibility of risks, issues and opportunities
Clear pathways for translating insight into practice improvement
This mirrors quality improvement approaches common in health systems — recognising that engagement maturity develops over time and requires intentional learning.
Engagement as System Infrastructure
Across PHNs, health departments and other strategic agencies, one message is consistent: good engagement does not happen by accident.
In complex health systems, stakeholder engagement frameworks work best when they:
Are organisation-wide, not team-specific
Balance consistency with flexibility
Focus on relationships, not just activities
Support both accountability and learning
Ultimately, a good stakeholder engagement framework is not about controlling engagement — it is about enabling better system behaviour at scale.
When done well, it becomes a quiet but powerful driver of coordination, equity and impact across the health system.
If your organisation is grappling with how to design, strengthen or scale stakeholder engagement in a complex system, we can help. Beacon Strategies works with health organisations, government agencies and system leaders to design practical, fit-for-purpose engagement frameworks that support coordination, equity and impact.
Learn more about how we can support your organisation by visiting our Organisational Strategy and Design page: https://beaconstrategies.net/org-strategy