Hospital planning and design projects are known for their complexity, partly attributed to the many stakeholders involved. This study aims to understand how a Dutch hospital project, with transformative change goals for its future healthcare delivery, dealt with their stakeholder engagement in the project’s planning and design phase. This study addresses heterogeneity in stakeholder relationships, an underexplored aspect within stakeholder engagement literature. A qualitative study was conducted on the stakeholder engagement during 10 years of hospital planning and design. We used an abductive approach by reviewing project documentation and transcripts of interviews with project stakeholders (n = 22) to reconstruct how the project leadership dealt with the challenges of heterogeneity in the project’s specific context. This study explores dynamism and pluralism within the relationships with seven distinctive stakeholder groups from the hospital’s multi-stakeholder setting, uncovering engagement strategies based on unique combinations of actor and process-specific characteristics. Wider transformative change goals added to the challenges faced in ownership and alignment of goals. Findings highlight the strategies and competencies the project’s owner (and leadership) deployed, such as adapting the project organisation’s structure, investing in an in-house community of practice with a dedicated stakeholder engagement role and fostering enduring collegial relations and commitment.

Background The Dutch healthcare system relies heavily on residents. This group is thought to be especially susceptible because of the system of hierarchy and dependence in which they work. Multiple studies have related overtime, safety climate, and supervisory support to medical errors. The aim of this study was to examine these themes and their correlations. Methods This cross-sectional questionnaire included multiple validated scales, and demographic and employment data. Correlations between themes were calculated using linear regression analysis. Between-group analyses concerning residents’ current position, department, clinical setting, and experience level compared the mean composite scores. The survey was distributed through Dutch physician associations and social media platforms between February and April 2020. 492 medical residents were included. Results Weekly average overtime was 7.8 hours, which was mostly uncompensated. Residents who were not in a training program, surgical residents, and those working in hospitals reported significantly more overtime. Over one in three felt they had fallen short in the quality of care they delivered. One-third of the respondents did not have a designated supervisor, and supervisor support scored mediocre overall. Medical errors were associated with a poorer safety climate, but other associations were not observed. Conclusions Overtime is abundant in residents, especially in surgical specialties. Safety is a priority but has a tendency to crumble under pressure. Strikingly, a substantial part of the residents felt that they had performed medical procedures that they were not properly trained for and that they had fallen short in the quality of care they delivered. Supervisor support was mostly present in the development of competencies and work-related problems, but residents reported poor rewarding behaviors, and a third did not have a designated mentor. Medical training programs should acknowledge the importance of these themes and make tangible efforts to monitor the needs and experiences of residents.