Healthcare Stakeholder Transformation Mapping by 2036: A Qualitative Foresight Study (Preprint)

BACKGROUND Healthcare transformation is reshaping stakeholders’ roles, relationships, responsibilities, and influence. Current stakeholder mapping approaches focus mainly on existing configurations, offering limited insight into how they may evolve. A foresight perspective could help address this gap. OBJECTIVE This study aimed to examine how the healthcare stakeholder ecosystem might evolve by 2036 and develop a Stakeholder Transformation Map showing anticipated changes in stakeholder roles, relationships, influence, decision-making authority, and responsibilities, along with emerging functions. METHODS An international qualitative foresight study was conducted from June to September 2026 with 30 experts across 16 countries, recruited through purposive and complementary snowball sampling. An 11-item online questionnaire included both structured-response and open-ended questions. We analyzed structured responses descriptively and examined qualitative data using inductive reflexive thematic analysis. Findings were then integrated through a foresight-oriented synthesis. RESULTS We identified four themes comprising 12 subthemes: redistribution of healthcare work and expertise; increasing patient agency without equivalent decision-making power; growing integration of technology actors; and the distribution of influence, authority, control, and accountability. Although 29/30 participants (96.7%) identified potential emerging stakeholders, 23/30 (76.7%) selected changes in roles or responsibilities as the most significant dimension of transformation. The findings suggested that new stakeholders may emerge alongside the reconfiguration of established functions, while future relationships and decision-making arrangements remain uncertain. CONCLUSIONS Healthcare stakeholder transformation may involve both the reshaping of established roles and the emergence of new actors who challenge existing boundaries. The Stakeholder Transformation Map provides a foresight-oriented approach to exploring continuity, transformation, potential discontinuity, and uncertainty, moving stakeholder analysis beyond static representations to consider interconnected possibilities for 2036. CLINICALTRIAL -