Stakeholder dialogues are structured, evidence-informed deliberations that bring together researchers, administrators, insurers, professional associations, and practitioners to work through concrete policy problems. Unlike focus groups, which gather perspectives without expecting decisions, or parliamentary hearings, which stage positions for the record, a stakeholder dialogue is a decision-support mechanism: participants hold the authority, resources, or experiential knowledge needed to act on what is discussed. The Swiss team interviewed fourteen experts — eleven based in Switzerland and three internationally — who design, facilitate, or commission such dialogues, and analysed the interviews using reflexive thematic analysis, an interpretive method in which researchers actively construct themes as patterns of shared meaning while treating their own subjectivity as an analytic resource rather than a bias to be eliminated.

The study’s setting matters as much as its method. Switzerland shares responsibility for health between the federal Confederation, which regulates mandatory health insurance, and the cantons, which secure healthcare provision, plan hospitals, license professionals, and run prevention activities. Major reforms typically require agreement among the federal government, cantonal authorities, and corporatist actors such as insurers and professional associations — and most decisions can ultimately be challenged by popular referendum. Reforms that lack broad stakeholder support are routinely delayed, diluted, or rejected at the ballot box. In such a system, structured dialogue is not a democratic nicety; the study suggests it is often a practical precondition for policy change, and the country’s linguistic diversity adds a further layer of technical complexity to participant selection, documentation, and facilitation.

Across the interviews, three design levers emerged as the technical core of successful deliberation. The first is evidence input: participants treated a high-quality, accessible policy brief as the minimum condition for productive discussion. One expert put it bluntly — a well-structured brief that is not too long is essential, and a poor one jeopardizes the entire dialogue. Briefs function as what social scientists call boundary objects: shared artefacts that align epistemic communities and establish a common factual baseline, allowing participants to deliberate from the same premises. Several teams supplemented the main brief with targeted preparatory materials — purpose statements, participant biographies, guiding questions — to prevent unproductive divergence before the first session begins.

The second lever is agenda design and moderation, which experts identified as the most crucial and time-consuming part of the process. Moderation emerged as a professional skill in its own right, emphasising process expertise over topic authority. Skilled facilitators summarise and check what they have heard, ensure clear language everyone understands, and use structured turn-taking to equalise participation. In multilingual and multidisciplinary settings, the study argues, facilitators act as epistemic translators who bridge disciplinary idioms and guarantee procedural fairness in real time. The third lever is format: breakout groups give quieter participants room to speak, and some teams use creative techniques — one described asking stakeholders to build LEGO models of different scenarios and then weaving them into a shared narrative where no model is left aside. Venue symbolism matters too: alternative locations signal creativity, university settings signal neutrality, and informal forms of address reduce social distance.

Perhaps the study’s most counterintuitive finding concerns consensus. Forcing agreement, one expert explained, is inappropriate — a valid outcome is that there is no way forward. Well-run dialogues may legitimately culminate in a clarified impasse, provided the reasons for it are explicit and informative for subsequent work. This reframes the purpose of deliberation: legitimacy arises not from uniform agreement but from transparent reasoning and mutual understanding, a position aligned with deliberative-democratic theory. Participants described respectfully listening to reach a joint position or, when that is not possible, at least agreeing on the differences and respecting them. In a federal system where reforms live or die by broad support, documenting precisely why actors disagree can itself be a form of systemic learning.

Who is in the room — and on what terms — was treated as central to fairness and impact. Most teams use a mapping frame of interest multiplied by influence to balance decision-agency with lived experience, updating their stakeholder matrices annually. But the experts also flagged serious equity concerns: dialogues are very often elite-oriented, patient organisations are not legitimate representatives of all patients, and small countries suffer from a ‘usual suspects’ problem in which the same individuals are approached so frequently that key players become overburdened. Practical tactics included paying practitioners who lose income by attending, covering travel costs, delegating participation so community members elect representatives, and gender-aware facilitation such as women-only breakout sessions to rebalance voice. Conflicts of interest were framed as something to manage rather than exclude, ranging from formal declarations to transparency without forms.

The study is equally clear that talk without traction is worthless. A dialogue’s credibility rests on what it produces and what happens next: outputs ranged from policy briefs and option lists to prototypes of policy strategies, and several experts stressed the importance of early engagement — you should never surprise stakeholders with your results, because those involved are not surprised while those left out may become reluctant. Commitments were named explicitly in short closing reports, and follow-on mechanisms such as modified Delphi rounds, in which participants refine and prioritise options across two structured rounds, helped convert dialogue into aligned positions. Some teams track whether dialogue options are referenced in subsequent planning documents, and participants combined hard indicators such as policy uptake with soft ones like follow-up calls, citations, and social media diffusion.

Impact, the experts cautioned, is slow, plural, and multi-trace. Near-term proxies include participant satisfaction and a fit-for-purpose product; medium-term traces include pilots, policy mentions, and practice changes. Several interviewees warned against overspecifying impact claims when mandates are unclear — recommendations without implementers, budgets, or timelines risk stalling. The international interviews helped delineate what is specifically Swiss: at a global health organisation, large consultations governed by formal conflict-of-interest procedures fed directly into work plans and a global advocacy alliance, while one international expert noted that the term ‘stakeholder’ itself had been abandoned in their setting at the request of Indigenous partners, who consider it colonial. Swiss participants, by contrast, consistently located dialogues in inter-institutional policy preparation among cantonal actors, insurers, and professional associations.

The authors conclude that stakeholder dialogues function as boundary infrastructures connecting epistemic, institutional, and civic spheres — mechanisms at once for evidence translation, social learning, and collective reasoning. When deliberately designed, they enhance the quality of reasoning, trust, and coordination, transforming evidence use from a technical exercise into a relational practice in health policymaking. The study acknowledges limitations: as a qualitative study with a purposive expert sample, it does not claim statistical generalisability, it could not directly observe outcomes or trace long-term implementation paths, and policy briefs dominated the evidence-input data. Future work, the team suggests, should examine a wider range of inputs such as rapid reviews and visual explainers, combine ethnographic observation with long-term policy tracking, and pursue comparative analyses across political cultures. The message for health systems everywhere is that the future lies less in increasing the number of dialogues and more in enhancing their quality, fairness, and follow-up — ensuring that deliberation moves beyond conversation to foster collective learning and coordinated action.

Subject of Research: From evidence to action: expert perspectives on stakeholder dialogues in Swiss health policy

Article Title: From evidence to action: expert perspectives on stakeholder dialogues in Swiss health policy

Article References: Rubinelli, S., Mesa-Vieira, C., Peytremann-Bridevaux, I., Diviani, N., Mantwill, S., Messerli, N. G., & Fiordelli, M. (2026). From evidence to action: expert perspectives on stakeholder dialogues in Swiss health policy. International Journal of Public Health, 71, Article 1609991. https://doi.org/10.3389/ijph.2026.1609991

Image Credits: AI Generated

DOI: 10.3389/ijph.2026.1609991

Keywords: evidence, action, expert, perspectives, stakeholder, dialogues, Swiss, health, policy, scientific research