Collaborative Governance in Hospitals: A Scoping Review of Multi-Interest-Holder Engagement in Health System Decision-making, Organizational Planning, and Policy Development

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Introduction Hospitals are complex organizations whose governance, organizational, and policy decisions have important implications for patients, families, healthcare professionals, and communities. Increasingly, there is recognition that those affected by these decisions should be meaningfully engaged in shaping them. Multi-interest-holder engagement is viewed as critical to improving care quality, strengthening organizational accountability and responsiveness, advancing equity, and informing more effective decision-making. Yet, despite growing interest in collaborative governance and co-production, much of the literature has focused on the engagement of single interest-holder groups (most often patients) rather than examining how diverse end-users and knowledge-users engage together within shared decision-making processes. Furthermore, concerns persist regarding tokenism, power imbalances, inequitable participation, and the exclusion of structurally marginalized communities. These challenges may be amplified in multi-interest-holder engagement processes, where differences in authority, expertise, and social position can shape whose voices are heard and whose perspectives influence decisions. To date, no comprehensive synthesis has examined how multi-interest-holder engagement is operationalized within hospital governance, organizational design, and policy-making, or how social identities and their intersections shape these processes. This scoping review aims to map the international literature on multi-interest-holder engagement in hospital governance, organization, and policy-making. Specifically, it seeks to: (1) characterize the existing evidence regarding the engagement of interest-holders in hospital decision-making processes; and (2) examine what is known about the role of social identities, including sex, gender, race, ethnicity, disability, age, and their intersections, in shaping opportunities for engagement, engagement experiences, conflict and conflict resolution, and engagement outcomes. By synthesizing the breadth and nature of existing evidence, this review will identify key concepts, approaches, and knowledge gaps, while informing future research, policy, and practice aimed at strengthening collaborative governance and advancing equity within health systems. Methods and analysis The review will follow the recommendations for the conduct of scoping reviews developed by the Joanna Briggs Institute (JBI) Scoping Review Methodology Group. The review will include English-language literature published between 1st January 1990 and present, searched through MEDLINE (Ovid) EMBASE (Ovid), CINAHL (EBSCOhost), Scopus, PsycINFO (Ovid), Sociological Abstracts, Social Science Abstracts, Social Sciences Citation Index and Science Citation Index, and Worldwide Political Science Abstracts; together with grey literature. Literature that describes the simultaneous engagement of multiple groups in hospital-level organization, governance, and/or policy-making will be included. The review will encompass quantitative, qualitative and mixed methods studies. Screening and extraction will be completed by 2 independent reviewers and conflicts will be resolved by discussion or a third reviewer, with piloting at each study. Studies will be analyzed through a descriptive numerical summary and a content analysis. Ethics and dissemination No ethical or safety considerations are pertinent to this work. The results will be disseminated to end-users (including patients, family and community members) and knowledge users (including hospital decision-makers, healthcare workers, content experts (i.e., researchers), and policymakers by way of summary documents, infographics, meeting presentations and through peer-reviewed publication.

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