Engagement in transformation: how to avoid losing the dressing room

Engagement is often treated as a soft element of transformation, when in reality it affects the legitimacy, quality, pace, and resilience of change. In many programmes, engagement still means briefings, slide decks, newsletters, and stakeholder updates. Those things have a place, but they are not the same as meaningful involvement; that is, the intended outcomes from the efforts of transformation, change, improvement etc. People can be well informed and still feel unheard, unconvinced, or unable to influence the work that will affect them. In practice, engagement matters because it shapes whether change is understood, trusted, workable, and capable of holding under pressure. NHS England’s Leading Large Scale Change guidance frames transformation in health and care as work that happens in complex environments and depends on creating the conditions for change, not simply communicating decisions once they have been made.[1]

Good engagement is one of the main ways leaders can avoid losing the dressing room before change has even reached practice.

A useful way to define the issue is to think of engagement as a spectrum rather than a single activity. The IAP2 Spectrum distinguishes between inform, consult, involve, collaborate, and empower, each increasing in its level of impact on decisions; thus making clear that not all engagement is equal and that communication alone sits at the lighter end of participation.[2] That is important because many organisations talk about engagement when what they are really doing is informing. Arnstein’s participation work, and later writing on tokenism in health settings, reinforces the same point more critically: people may be asked for views without having meaningful influence over decisions. In those cases, engagement can create the appearance of involvement without changing the balance of influence or improving the quality of the change itself.[3]

This matters for more than adoption alone.

Good engagement can improve the quality of design by surfacing operational realities early. It can strengthen legitimacy by making change feel credible rather than imposed. It can build trust and shared purpose across teams and organisations. It can also improve pace by identifying practical barriers before they become expensive delays.

NHS England’s literature review on co-production goes further, linking meaningful involvement with improved experience and, in some cases, improved quality and efficiency.[4] So engagement is not just about helping people to be bought in to a new change initiative. It can materially affect the quality of decisions and the durability of outcomes.

A further reason engagement matters is that people are more likely to support change they can make sense of and see themselves within. Normalisation Process Theory (NPT) is useful here, not as an abstract model, but because it describes something very practical: new ways of working become routine only when people can understand them, participate in them, enact them in practice, and continue to appraise them over time.[5] That is one reason communication alone is rarely enough. Awareness may be created through messaging, but meaningful engagement helps build the sense-making, ownership, and practical adaptation needed for change to become part of routine work.

What enables engagement and what creates resistance?

Engagement is shaped not only by how change is presented, but by how it is experienced. At an individual level, people are more likely to engage when they understand the purpose of the change, believe the case for it is credible, and feel capable of working differently. Resistance is more likely when change creates uncertainty, threatens autonomy or competence, increases workload, or feels weakly justified. Research on recipients’ reactions to organisational change suggests that responses are shaped by fairness, trust, control, and perceived impact, not simply by personality or attitude.[6][7]

At team level, engagement is strengthened by trust, local leadership, and psychological safety – the shared belief that people can raise concerns, ask questions, and challenge constructively without penalty. Where these conditions are present, teams are more likely to surface risks early, adapt change intelligently, and support each other through disruption. Where they are weak, even well-designed engagement activity may struggle to gain traction. Evidence from healthcare teams links psychological safety to speaking up, learning, and teamwork behaviours that matter directly in periods of change.[8][9]

This is important because what leaders sometimes describe as resistance may in fact reflect something more practical: uncertainty about the rationale, concern about workload, fear of losing control, poor prior experience of change, or lack of confidence that the new model will work in reality. Stronger engagement does not assume resistance is irrational. It treats concerns as information about what people need to participate credibly in change.

Common pitfalls in practice

1. Engagement is treated as one-way communication

This is probably the most common pitfall. Stakeholders are sent updates, invited to launch events, or asked to read briefing packs, but they are not meaningfully involved in shaping the intervention. The problem is not that communication is unimportant. It is that communication alone is usually too weak a mechanism for building ownership, surfacing constraints, or improving design. Under the IAP2 Spectrum, this type of activity sits mainly at the low impact (inform) level.[2] That may be appropriate for some audiences and decisions, but it should not be mistaken for involvement or collaboration.

2. Engagement starts too late

A second pitfall is that engagement begins after the core design has already been fixed. At that point, stakeholders are often being engaged mainly to secure agreement rather than to shape the change itself. This is one reason engagement can be experienced as performative. It also explains why practical issues emerge late, when they are harder to resolve. Leading Large Scale Change is relevant here because it emphasises mobilisation, shared purpose, and creating conditions for change in complex systems.[1] Those are critical planned upstream activities, not post-design communications tasks.

3. Engagement is broad in theory but vague in practice

Another common failure is a lack of precision. Organisations say they need “stakeholder engagement,” but do not define who needs to be informed, who should be consulted, who must be directly involved, and who should hold influence over the final design. As a result, the same generic engagement activity is applied to everyone. This is where the IAP2 Spectrum is especially useful as a practical tool: it forces clarity on the intended level of participation for different groups.[2] Stronger engagement is not necessarily about giving every stakeholder the same degree of influence. It is about being explicit, proportionate, and honest about the role different groups will play. This is largely determined by how much it will affect their practice and the level of influence they have in adopting or blocking the new ways of working and its intended outcome.

4. Engagement is often weakened by operational pressure, not bad intent

Not all engagement failure reflects poor design. Sometimes people are simply too stretched to engage well. Clinical and operational teams are often being asked to contribute to change while managing staffing pressures, demand, backlog, and competing priorities. In these circumstances, poor attendance or inconsistent participation may reflect capacity constraints rather than indifference. NHS England’s large-scale change guidance is explicit that transformation happens in complex health and care systems.[1] The practical implication is that engagement approaches need to recognise workload, sequencing, and timing, rather than treating limited participation as a purely behavioural problem.

5. Engagement is not linked to visible action

People quickly disengage if they are asked for views but see no visible effect on decisions, design, or delivery. This is where engagement slips into tokenism. The issue is not that every suggestion can or should be adopted. It is that organisations need to show what has been heard, what has changed, what has not changed, and why. Later literature on tokenism in patient and family engagement makes clear that participation becomes weak when people are given a circumscribed role without meaningful influence.[3] In practical terms, the test of engagement is not whether feedback was collected, but whether it was used transparently and credibly.

Why engagement is often done badly (or not done at all)

Weak engagement is not always the result of poor intent. In many programmes it reflects the conditions in which change is being pursued.

• Sometimes there is pressure to keep delivery moving, so engagement is seen as something that slows progress.

• Sometimes leaders anticipate resistance and therefore limit involvement to reduce challenge in the event it slows progress or blocks it altogether.

• Sometimes the evidence base is weak, incomplete, or contested, making it harder to explain the case for change confidently.

• Sometimes there is concern that opening the discussion will surface complexity the programme does not yet know how to address.

• In other cases, teams are already fatigued by repeated initiatives and there is little confidence that engagement will lead to anything different this time.

In those conditions, leaders often default to communication rather than engagement because it feels faster, safer, and easier to control. The problem is that this can delay resistance rather than resolve it. It may protect pace in the short term, but it often weakens trust, reduces the quality of design, and makes later adoption harder, thus posing a major hidden risk for delivery.[1]

Carrot, stick, and the balance between them

There is another tension that many discussions of engagement avoid: the role of the carrot as well as the stick.

Not all change is voluntary.

In real transformation there may be genuine non-negotiables driven by finance, safety, performance, regulation, or policy direction.

Leaders should be honest about that. Mandate can create urgency, focus, and clarity that change is required. But mandate on its own often delivers compliance at best. It may create pace, but it rarely creates deep ownership or sustained commitment.

Equally, a purely carrot-led approach can become consultation without direction, involvement without accountability, or goodwill without delivery discipline. Stronger engagement does not remove the need for clarity, urgency, or executive mandate. It combines them with meaningful involvement in the parts of change that can and should be shaped locally. That balance is more credible than pretending every decision is shared or, equally, pretending engagement is unnecessary because the answer has already been decided. This logic is consistent with both the participation spectrum and the practical lessons of leading change in complex systems.[1][2]

What stronger engagement looks like in practice

Stronger engagement starts early enough to influence design. It is clear about what is fixed and what is genuinely open to influence. It distinguishes between informing, consulting, involving, and collaborating rather than treating them as the same. It is designed around who needs to contribute, what they can add, and what barriers may limit participation. It creates visible feedback loops so stakeholders can see how input has shaped the work. It also accepts that in complex systems, engagement is not a one-off event. It needs to be maintained, revisited, and adapted as conditions change.

Co-production guidance is helpful here because it defines stronger involvement as partnership beginning at the earliest stages of design, development, and evaluation, rather than as a final-stage consultation exercise.[4][10] In practical terms, that means engagement should help improve the change itself, not simply improve the optics around it.

Conclusion

Ultimately, engagement should not be treated as a communications workstream running alongside the “real” work of transformation. In many cases, it is part of the real work. It affects whether change is seen as legitimate, whether problems are surfaced early, whether solutions are workable, and whether the team in the dressing room is willing to carry that change through the pressures of delivery.

Engagement beyond communication is not about being softer. It is about being more practical, more honest, and more likely to produce change that is credible and sustainable in the real world.[1][5]

References

[1] NHS England. Leading Large Scale Change: A practical guide. 2018.

[2] International Association for Public Participation (IAP2). Core Values, Ethics, Spectrum – The 3 Pillars of Public Participation and Origination of the IAP2 Spectrum of Public Participation. N.d.

[3] Majid U. The Dimensions of Tokenism in Patient and Family Engagement: A Concept Analysis of the Literature. Journal of Patient Experience. 2021.

[4] NHS England. How co-production is used to improve the quality of services and people’s experience of care: A literature review and related co-production resources. 2023.

[5] Murray E, Treweek S, Pope C, et al. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Medicine. 2010.  

[6] Khaw KW, Teoh KRH. Reactions towards organizational change: a systematic literature review. 2022.  

[7] Ling B, et al. Fairness matters for change: A multilevel study on organizational change fairness, perceived success, and employee’s change-oriented behaviors. Frontiers in Psychology. 2024.

[8] O’Donovan R, McAuliffe E. Measuring psychological safety in healthcare teams: developing an observational measure to raise team awareness. BMJ Open Quality. 2020.  

[9] Grailey KE, et al. The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis. BMJ Health Services Research. 2021.

[10] NHS England. Co-production: an introduction. 2023.