Keywords

1 Introduction

International experiences in tourism and natural resources management demonstrated that participatory stakeholder engagement methods enhance the delivery of more useful and applicable strategies [1, 2]. The chances of reaching the goals are much higher as compared to the conventional top-down planning process. Through the conventional method a concept is forced onto the stakeholders by the decision-makers, while in collaborative planning, the stakeholders can have a say about what they would need, what they find important or even crucial.

A further advantage of stakeholder involvement in the strategy-making process is that a broad range of stakeholders will gain good knowledge and will become well-informed about the planning process and the strategy, while their experience, knowledge, and expertise can be drawn upon, and their ideas utilized. A traditional strategy-making process is usually linear and prescriptive, meaning that the local government (or a subcontracted company) assesses the conditions, needs, and financial resources of the municipality, as well as the legal and other requirements. The detail of the assessment is often limited by the staff's time and capacity, as well as the difficulties of access to relevant information and data. Thus, strategies developed this way often are not (or only to a small extent) implemented. The real needs of the population/community/region often only become visible through the involvement of stakeholders. Moreover, the flexible, collaborative implementation of the goals is much more probable if those who will be affected and concretely make changes in their activities approve of the aims and objectives of the work plan. The mutual engagement with the participatory process will result in a better strategy, and the transparent, collaborative planning process will increase the willingness to cooperate and implement the strategy [3]. Moreover, the endorsement is expected to go beyond the project's lifetime for effective implementation, also considering key stakeholders’ procedures for the participatory planning process.

Developing and testing health tourism products and service chains is a complex undertaking, in which industrial actors play the main role. However, since they are directly responsible for only a certain percentage of resource usage and related innovative cases, all actors have roles and responsibilities for the strategic development of nature-based health tourism (NHT). Therefore, it is essential to inform and involve stakeholders (municipalities, institutions, enterprises, civil society organizations, and communities) while improving harmonization among them [4]. This chapter describes the methodology identified and carried out in the HEALPS2 project to efficiently reach and engage stakeholders of Alpine NHT and to form a stakeholder group at the transnational level (including the engagement of EU-level actors and networks).

The key objectives are (1) to raise awareness of the complexity of developing NHT resource efficiency, and (2) to build common visions by harmonizing the interest of different players within the urban planning and environment conservation sectors. While the leading role may be taken by a variety of different members of the municipality, all stakeholders need to be involved, with clear individual responsibilities and roles in the process to ensure horizontal and vertical, as well as cross-sectoral cooperation between public authorities, local communities, and industrial players of Alpine destinations. A transnational and transversal approach is built on unique Alpine natural health resources and strengthens the Alpine territorial innovation capacity.

Key benefits identified in HEALPS2 with stakeholder group formation include:

  • investigation of issues from several perspectives;

  • understanding local needs;

  • better understanding and monitoring of the community perceptions;

  • collecting and sharing ideas and good practices;

  • networking, improvement of working relationships and gaining trust (these networks and new relations can also be used after the HEALPS 2 project end);

  • assistance/advisement at the decision-making;

  • achieving/ensuring more sustainable results;

  • raising awareness of NHT as a tourism product and its positive effects in the local region;

  • providing people and organizations with an opportunity for personal development through engagement activities;

  • identifying effective dissemination avenues;

  • using stakeholder meetings for marketing purposes (e.g. in press releases).

The following Fig. 1 details the steps and the key elements of the methodology for stakeholder engagement in NHT identified in the HEALPS2 project.

Fig. 1
A diagram exhibits methods that involve the identification, assessment, and development of potential stakeholders for N H T engagement.

HEALPS2 methodology for participatory stakeholder engagement

Full size image

Specifically, the main process foresees the three steps below described.

2 The Process of Stakeholder Engagement and Endorsement in the HEALPS2 Project

In the planning phase of the stakeholder endorsement process, HEALPS2 partners bore in mind that there is no single best way to involve them. The various steps and decisions are greatly interlinked, considering the specific context, issues, and needs. Therefore, it has been framed as a repeating process, allowing several feedback points during progression.

The methodology adopted in the project is based on the Quadruple Helix concept [5]. Participatory engagement of representatives from each research and innovation sector in all project phases is essential for creating results from which all involved stakeholders can benefit. The benefits of quadruple helix stakeholder engagement by the development of collaborative networks are evident: they allow access to knowledge, development of scientific competence, and competitive advantage through the acceleration of ideas. Complex issues can be tackled thanks to the intersection between the areas of expertise and the search for cooperation in finding solutions between academics, industry, government and civil society or the citizens [6].

Having established clear reasons for engagement, the stakeholder engagement process in HEALPS2 involved three main steps, identified as follows.

2.1 Step 1: Identify All Potential Stakeholders and Stakeholder Groups

The identification of the stakeholders to be involved or consulted in the engagement process while finding the right mix of participants and ensuring that no group is unintentionally (or perhaps, deliberately) excluded, is essential to providing legitimacy and credibility to the engagement process.

In the context of public participation, a stakeholder can be defined as any person with an interest in the project or anyone that could be potentially affected by its delivery or outputs.

Potential NHT stakeholders are (if applicable to the single destination):

  • national and local authorities, chambers

  • local/regional hotel association, environmental groups, (national) park organization

  • municipality workers and experts

  • protected areas

  • civil society organizations

  • economic leaders, analysts, experts

  • educational institutions

  • industries, major companies

  • transportation companies, public roads administration

  • public utilities

  • social institutions, consumer protection organizations

  • health care organizations

  • journalists, media contacts

  • the broader lay public, residents, and young people.

These institutions, companies, organizations, and individuals should be mapped and contacted, and a short-written introduction of the project should be communicated to them, as well as the possibility for further participation. If the aim is to be inclusive and open to whoever wants to be involved, the best approach is often to identify an initial list of relevant stakeholders. In this first step, it is important to consider not only how they may be able to contribute to the project but also what will motivate them to become involved.

Although it is important to try to include all relevant stakeholders, it must be emphasized that it is not necessary to include them to the same extent. Not all stakeholders are equally interested in and affected by the project. The purposes of stakeholders can vary from getting information/data, technical or professional assistance, or just general contributions, to having the opportunity to express their concerns (which is usually the case with the broader civil society). Good planning defines the scope of engagement so that different people can be involved only in those parts of the process which are most relevant to them, and goals can be achieved in practice. Thus, it is useful to identify stakeholders by considering all aspects of the area of influence throughout the entire cycle.

Another key issue to be decided is whether the stakeholder identification is performed by the project team, or in collaboration with other colleagues, organizations, and cross-sectoral stakeholders. Possible ways to identify all stakeholders include:

  • Consulting with colleagues to share knowledge about who may have an interest.

  • Brainstorming with other organizations that have been involved in similar activities or those working on similar topics.

  • Advertising, promoting the project and the engagement process (e.g. press releases about the project, leaflet, newsletter about the project, social media, website) and encouraging local organizations with an interest to come forward.

  • Using ‘snowball sampling’ techniques: one stakeholder identifies further stakeholders until no additional new stakeholders are identified.

  • Using existing partner networks: pre-existing networks are hugely valuable for beginning the process. It is one of the fastest and easiest ways of stakeholder involvement.

  • Performing thematic research based on professional areas/disciplines included in the project.

All the suggested techniques are more effective if properly combined, considering their strengths and weaknesses. On the one hand, using the existing networks maybe lead to quickly coming results, but some key players could be missed because of being more active in other nature-based health disciplines or topics. On the other hand, desktop research and/or brainstorming can produce new stakeholder contacts but are not directly reachable.

Step 1 should result in a complex list of potential stakeholders from different levels. The following Step 2 foresees to assess, analyze and prioritize relevant stakeholders.

2.2 Step 2: Assess and Prioritize Identified Stakeholders

There are several ways of analyzing, grouping, or mapping stakeholders in literature. As anticipated, the Quadruple helix framework is one of the most adopted approaches to identify stakeholders by sectors and their roles in the project. Quadruple helix framework is based on collaboration between the public sector, academic sector, private sector, and civil society sector.

The approach foresees classifying stakeholders based on their relevance and significance to the project. Power mapping is a conceptual way of determining who needs to be influenced in the project, who can influence the project target results, and who can be influenced to promote the broad adaptation of the project results.

The HEALPS2 project categorized stakeholders by their relationship to the investigated topic or project outcomes. Specifically, three groups were identified:

  1. 1.

    Primary stakeholders—people/groups that are directly affected, either positively or negatively, by the actions of an agency, institution, or organization. In some cases, some primary stakeholders are oppositely affected: a regulation that benefits one group may harm another. A rent control policy, for example, benefits tenants but may hurt landlords.

  2. 2.

    Secondary stakeholders—people/groups that are indirectly affected, also either positively or negatively, by the actions of an agency, institution, or organization, but are not regularly engaged in transactions with the projects and may not be essential for projects survival.

  3. 3.

    Key stakeholders—might belong to either or none of the first two groups, they are those who can have a positive or negative effect on an effort, or who are important within or to an organization, agency, or institution engaged in an action.

HEALPS2 partners are committed to identifying not only the primary stakeholders in each of the Alpine regions but more specifically the key stakeholders and stakeholder groups from the NHT industry who will benefit from and therefore contribute and be engaged to the project’s effort.

2.3 Step 3: Develop an Understanding of the Stakeholders Identified and Assessed

In a multi-stakeholder environment, it has to be considered that each stakeholder has its own set of goals and objectives and is often driven by a different set of needs. Often there are conflicting interests which could negatively affect the outcome of the engagement. Therefore, it is important to understand the perspectives of individual stakeholders and their relationships with each other when they are involved with planning and implementation.

Therefore, it is fundamental to understand the relevant stakeholders. Some key questions should be considered during this stage:

  • Is there an existing relationship between the project and the stakeholder? Is there an existing relationship between the stakeholders?

  • What knowledge do the different stakeholders have that may be relevant to the project?

  • What views are the stakeholders likely to have about the project and its outcomes? Will these views be positive or negative?

  • Is there a potential for any conflict amongst stakeholders? Or between stakeholders and the project?

  • What are the appropriate means of communication? Will they need to be adapted to reach certain groups or individuals?

  • Is there a willingness to engage? If not, why not and how could this be overcome?

  • Are there any barriers to participation and engagement (e.g. technical, physical, linguistic, geographical, political, time, information or knowledge)?

The completion of the three steps should take into account different elements, including tackling specific problems, for successful stakeholder engagement. These are described below.

3 Elements to Be Considered Along the Stakeholder Engagement Process

3.1 Key Points for Successful Stakeholder Engagement

The HEALPS2 consortium identified some key elements that emerged from the project experience as pivotal to successfully engaging stakeholders. Once all three steps of the process are completed, the possibility to participate should be directly communicated to the identified stakeholders. The communication could be delivered via regular mail, e-mail, telephone, or in any other channels of accessibility, as well as publicized on websites, in local newspapers and on the notice board of the municipality. The information should contain the fundamental details of the project as well as the main stages of participation. It is fundamental to maintain clear aims for engaging the selected stakeholders in the project, beyond their benefits and motivations of stakeholders to be involved.

Every engagement process is different and needs to be properly funded and managed. Each partner should plan their engagement and adapt the process to suit the needs of both the project and the stakeholders alike.

To this aim, here are a few key points to successful engagements:

  • engage in dialogue with stakeholders as equals and value their knowledge;

  • allow stakeholders to help plan their engagement;

  • use ‘knowledge brokers’ (who are connected to, and trusted by, different stakeholder groups) and experts in stakeholder engagement (including professional facilitators) if project teams do not have the expertise or experience;

  • be prepared to be flexible and adaptable, tailoring project activities and communication of findings;

  • ensure communication can be easily understood by all stakeholders—o not use complex or technical language unless this is asked for by the stakeholder;

  • tailor engagement to the practical and cultural needs of stakeholders, bringing the project to where they are, at times of the day and year that are suitable for them;

  • do not forget to provide feedback to stakeholders as soon as possible/promptly.

Factors like trust, openness, and commitment play an important role in working with the stakeholders. Once engagement has been achieved, it is important to maintain it by follow-up actions for a long-term, continued engagement. During the stakeholder activities, the following factors should be considered:

  • Clarity—it is very important to clarify the objectives and goals of the engagement and to evaluate the appropriateness of the techniques.

  • Management of information—stakeholders need to be persuaded of the benefits of sharing information. It may be necessary to present information in different ways as the attitudes and the way the information is processed by the stakeholders needs to be taken into account.

  • Support and capacity development—the knowledge the stakeholders possess about the project varies depending on the different levels of their involvement. To enable them to contribute ideas and visions, each stakeholder needs to be on the same level of understanding as the rest of the stakeholders.

  • Transparency—each stakeholder needs to be updated on the actions and opinions. They need to be assured that their concerns, requests, and expectations are addressed in a clear, open, and transparent manner.

  • Trust-building—letting the stakeholders know that every stakeholder’s view is valued and respected in the engagement process will give the assurance that their opinions are heard.

An example of the communication strategy adopted in the HEALPS2 project to inform and engage stakeholders is detailed in Chap. 8 [7].

3.2 Tackling Problems in Stakeholders Engagement

During the engagement process, the HEALPS2 project itself encountered some problems, which should be tackled proactively in a well-planned stakeholder engagement in the strategy-making process.

Many potential stakeholders could find low interest in cooperating at the meetings if they think their tasks are not important for the specific topic or strategy. Therefore, it is of utmost interest to create a positive background or a political will around them. The best way of this is a formal invitation by the mayor or the city council.

There might be opposite interests, like on economic terms, regarding aims and certain measures of the strategy/plan. This is a very good reason to conduct a proper stakeholder involvement: engaging stakeholders with opposite interests at an early stage in the process would help to get these problems promptly emerged, assessed and thus tackled.

A slow and erratic internal communication, or even the lack of it, leading to difficulties in reaching the right people, is a key problem to be considered. Communication problems could be mitigated by using more channels and means of communication, with dedicated time and efforts from the stakeholder manager.

The good use of channels and means of communication can be also important to avoid a low rate of participation and small attendance. Major societal actors should be addressed through their interests, valuable personal contacts, and efficient promotion.

Finally, involving too many stakeholders could slow down the strategy-making process. Utilize more groups with fewer people so that everyone may be heard and feels important—instead of overlooked—has shown success. If there are already existing groups, it is useful to leverage and organize their efforts and resources with a value-added approach. Conversely, if the groups themselves are poorly organized and utilized, they should be assisted in reorganizing or joining other groups.

4 Key Mechanisms for Stakeholder Engagement in NHT

4.1 Regional and Transnational Stakeholder Group

Throughout HEALPS2 project implementation, partners applied the stakeholders engagement process by involving target group representatives in Regional Stakeholders Groups (RSG). These groups were aimed at providing inputs to and feedback on HEALPS2 activities and outputs, with the participation in regular meetings at the local/regional level and the potential participation at interregional events. RSG meetings primarily contribute to the preparation and validation of the regional level outcomes with the engagement of RSG members in all activities, including some participation in interregional events.

In addition, the formation of the Transnational Stakeholders Group (TSG) helped to ensure, that organizations, regions and even institutions/networks outside the partnership learned about the possibilities offered by the tools developed as part of the project.

Based on prior relations and the contacts made during the proposal phase and the kick-off meeting, HEALPS2 partners mapped and approved the TSG members. The TSG was specifically aimed at involving representatives from territorial areas (also across the regions) that were not present in the consortium and had major experience in the exploitation of Alpine-specific natural healing resources, for the development of innovative tourism products and services chains.

TSG meetings primarily contribute to the validation of the regional-level outcomes and are interlinked with the RSG, with consultations and continuous feedback. Moreover, TSG members from countries with major progress in sustainable health tourism were invited to contribute with best practices and testing HEALPS2 solutions. Finally, the TSG can be used as an important vehicle to transfer the policy proposals and outputs to other regions and countries.

4.2 Engagement of EU-Level Actors and Cooperation with International Networks

One of the main activities in the HEALPS2 project was also the development of a concept for building a network of “Alpine Health Tourism Regions”.

To this aim, it was fundamental to connect with the European networks in the field of nature-based tourism and healthcare (e.g. NECSTouR—Network of European Regions for a Sustainable and Competitive Tourism), attending relevant conferences, workshops, inviting international experts to the events of the project. Efforts made at soliciting inputs from all important actors in the local, national, and European fields (from professional organizations to business and policymaking), and embedding the project’s results in European networks and policy frameworks, comprise an ongoing activity, complementing the joint strategy-building process. To achieve this aim, two major approaches were demonstrated valuable to be utilized:

  • Participation as speakers in meetings, networking and professional events during the project implementation (e.g. participation at EUSALP Annual Forum, and other-EU thematic events, workshops, and conferences).

  • Organization of public and invitation-based stakeholder events throughout the project (i.e. midterm workshop, final events, conferences), aimed at obtaining direct inputs and opinions from relevant stakeholders and networks.

5 Conclusions

This chapter presented the methodology adopted in HEALPS2 for participatory stakeholder engagement in NHT. The methodology integrates a process of stakeholder engagement and endorsement along three steps; the identification of the key points and the problems to be tackled for a successful stakeholder engagement; and the development of RSG and TSG that extend to the cooperation with EU-wide networks.

Developing health tourism products and service chains, and sustaining them with strategies and policies, is a complex undertaking. The adoption of the stakeholder engagement approaches throughout the HEALPS2 project showed that it is of utmost importance to properly identify, involve and communicate with the stakeholders who effectively complement the success of the project, and its outcomes, in enhancing NHT competitiveness. Factors like trust, openness, and commitment play an important role, together with the understanding of each stakeholder’s view, especially when there could be conflicting interests. Thus, the strategy-making process should be framed as a repeating process, allowing several feedback points during progression, and with both RSG and TSG systematically contributing to the implementation and improvement of project outcomes.