I once coached Celeste, a program director at a non-profit health system preparing to make her first presentation to the program investment committee. Celeste had evaluated her community health worker diabetes management program and knew the program saved money by reducing hospitalizations.
But she still felt uneasy. Would savings from decreased hospitalizations be enough to justify sustained investment in the program? What else would make the case? What did the committee members actually care about?
I have seen this challenge come up repeatedly for leaders aiming to advance health-equity investments, and I experienced it early in my career. Too often, I’ve seen it undermine the prospects for great programs that make real impact. There are far more forms of value than only financial return on investment, and omitting them from the analysis could undersell the program’s impact.
Even when your data is strong, your business case can fall short if it’s too narrow, too broad, or too remote from your collaborators’ interests. Finding the right balance rests on understanding and aligning with what value means to your stakeholders, especially those who make investment decisions.
Why Simple Stakeholder Interviews Fall Short
Many leaders rely on a familiar approach to this problem: conduct a few stakeholder interviews, ask what matters most, take notes, and move on to building the proposal or business case. While this process surfaces explicit needs, it often misses the deeper motivations that influence decisions.
Consider Celeste in the example above. She assumed that the committee would care only about cost savings. When she asked them direct questions about their priority outcomes, that assumption mostly held true.
This is where applying human-centered design (HCD) in stakeholder engagement made a big difference. HCD is a methodology focused on cultivating empathy and designing with the people you want to impact. It allows you to go beyond what stakeholders say explicitly, leveraging activities to uncover implicit needs, values, or motivations, which are observed and inferred through decisions, behaviors, and actions. HealthBeings has incorporated this design approach as part of its Blended Value stakeholder engagement method. HCD often focuses on end-users or beneficiaries, but in my experience, programs are more successful when you include funder and delivery organization stakeholders in your HCD research, too.
Using this hybrid approach, Celeste went deeper. She engaged committee members in a paired comparison exercise, showing them a series of two outcomes from HealthBegins’ Menu of Outcomes and Indicators and asking them to choose one from each pair, and then asked probing questions to understand the reasons behind their decisions. Through this approach, she uncovered additional motivations:
- The Endocrinology Department Leader was focused on attracting younger clinical talent. The leader knew that early-career professionals valued working in organizations committed to social impact, and they saw Celeste’s program as a potential recruitment asset.
- The Director of Quality Improvement was focused on increasing the institution’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score, and prioritized investments in programs that had potential to increase patient satisfaction.
Recruiting talent and improving patient satisfaction both have economic value to the health system. By incorporating and assigning monetary value to these outcomes in her business case, Celeste was able to unlock stronger support.
How to Incorporate Human-Centered Design
Human-centered design provides a way to go deeper with stakeholders. Here’s how you can start:
- Identify Your Stakeholders: Prioritize program participants with lived experience, program funders, delivery partners, executive sponsors, and the staff who will sustain the work.
- Map Their Influence and Authority: Clarify who has direct decision-making authority and who shapes opinions through influence.
- Leverage Motivational Interviewing: Motivational interviewing techniques – like keeping interviews flexible, asking open-ended questions, offering affirmations and reflective listening, and rolling with resistance – help you follow the stakeholder’s lead and meet them where they’re at.
- Explore What Value Means to Each Stakeholder: For some, value is primarily financial. For others, it’s about social mission, patient trust, or staff retention. Different definitions of value don’t have to conflict. The Blended Value for Health Equity method and model helps bring them together into a cohesive story.
- Explore Priority Outcomes and Preferences: Use activities such as card sorting and paired comparison. These tools help stakeholders surface preferences and priorities they might not express in a traditional interview.
- Select Indicators Together: Once you understand priority outcomes, brainstorm and choose potential indicators. This step creates buy-in and ensures you measure what they value most.
- Communicate using Narrative Frames: Tailor your communication to each stakeholder’s role and priority outcomes. For example, Celeste leveraged the Workforce Development frame for the department leader, and the Access and Quality frame for the quality leader. You can use the HealthBegins Making the Case for Health Equity tip sheet (offered as part of the Blended Value course) to tailor and communicate program outcomes to your stakeholders.
The Benefits of Investing in Human-Centered Stakeholder Engagement
Committing to authentic stakeholder engagement requires time and intention. But the value of that investment is substantial. It enables you to:
- Set up your program for sustained investment and impact. Alignment isn’t a one-time achievement, it’s the foundation for ongoing success. Building this foundation allows you to have ongoing and informal conversations with your stakeholders to ensure you stay on the right track.
- Reduce churn and rework: By aligning early, you avoid building proposals that miss the mark. When stakeholders feel ownership of your plan, they’re more likely to support it without requiring multiple revisions.
- Strengthen your professional capital. Leading this process builds credibility and can open career opportunities inside your organization.
- Develop further innovations for health equity: These conversations may inspire new, bold ideas with alignment built in.
In my experience, the leaders who do this well are the ones who can move health equity from a good idea to a funded priority. When you define value collaboratively, you’re not just making a better case, you’re building relationships that can sustain your work for years to come.
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If you’re ready to explore practical tools to guide this process, HealthBegins is now offering a Blended Value for Health Equity Course that provides a step-by-step approach to value alignment, calculation, and communication.