How much should we engage with a standard?

This morning I was on a conference call with Nicholas Oughtibridge from the NHS when he briefly outlined a series of levels at which an organisation can engage with standards. I thought his overview was highly worthwhile passing on, and with Nicholas’ permission, I share his document below. The document is shared under the UK Open Government Licence at Note that this requires attribution with “Contains public sector information licensed under the UK Open Government Licence v1.0.” (consider that atttributed)

Here is Nicholas’s document (thanks very much). I’ll comment a little below.


Levels of engagement framework

For each standard the contributors to the healthcare system in an enterprise or jurisdiction (referred to as a contributor in the remainder of this document) can choose their level of engagement in its design, development and maintenance.  Often standards come with associated products, where level of engagement is also a choice.  The level of engagement continuum ranges from avoidance through to control of all aspects of design, development and maintenance.  For simplicity, the continuum is broken down into the five tranches of control, leadership, involvement, acceptance and avoidance.  These five tranches are described in a framework below with illustrative examples.

There is a risk that multiple contributors will seek to control a particular area of standardisation.  This risk needs to be managed with a single governance model with representation for all contributors.


The highest level of engagement is control.  For this level, the contributor values the standard sufficiently to want to control the standard.  Typically a controlling contributor will fund and manage the design, development and maintenance of the standard so that it meets all of their requirements within the context of the healthcare system in an enterprise or jurisdiction.  This will often extend to funding the implementation of the standard throughout the healthcare system.  Compliance is often a combination of contractual, financial, regulatory and technical.

Adopting a control level of engagement risks being unable or unwilling to recognise and accommodate the requirements of other contributors to healthcare systems in the enterprise, jurisdiction or internationally.


Where it is not possible, practical or desirable to have a controlling level of engagement it is often desirable to lead other organisations so that standards are designed, developed and maintained in the interests of the contributor.  A contributor leading that design, development and maintenance will often fund their contribution, but probably not the whole cost of the standard.

Leadership ensures that the requirements of the enterprise or jurisdiction are accommodated by the standard or product so there is minimal need to tailor the standard or its products for deployment in the enterprise or jurisdiction’s healthcare system.  Leadership enables a broader range of stakeholders to contribute to the design, development and maintenance of the standard or product, sharing the burden without compromising utility.

Co-production with other parties reduces the cost of development to the contributor and broadens the pool of expertise to exploit.  The leadership level of engagement controls the quality of the standard or product.  Simply engaging without leadership risks the standard or product becoming unsuitable for use in the enterprise or jurisdiction.


For some standards or products leadership or control is available from other trusted contributors, organisations or jurisdictions.  Where the contributor has confidence in that leading or controlling party but wishes to exert a level of influence either as a body of expertise or to achieve a national objective it is appropriate to be actively engaged without leading.

Involvement can take many forms, including contributing to telephone conference calls, participation in workshops, undertaking specific work packages, developing software and hosting a secretariat service.

Involvement without leadership is also appropriate where the contributor has no ambition to improve the standard or product so that it better fits the enterprise or jurisdiction’s Healthcare System.

As with leadership, co-production with other parties reduces the cost of development to the contributor and broadens the pool of expertise to exploit.  Engaging without leadership risks the standard or product becoming unsuitable for use in the enterprise or jurisdiction.

Passive acceptance

For many standards the enterprise or jurisdiction has had no direct influence, despite depending on the standard for operations.  For many standards such as Simple Mail Transfer Protocol for e-mail or Hypertext Transfer Protocol this is not an issue.  For some however it is and it is appropriate to seek influence and possibly to strive to lead on-going development.


There are some standard which it is appropriate that the enterprise or jurisdiction does not adopt for various reasons, including incompatibility with legislation within a market or jurisdiction, incompatibility with architectural choices or fulfilling a use case which is not appropriate in the enterprise or jurisdiction

I think that’s a very governmental perspective – but it’s still very clearly laid out, and I’m very happy to be able to share it here.

What about vendors? I think that vendors get to go for control or leadership a lot less often than governments (though they achieve it more often when they do?). Most of us choose between Involvement and Passive acceptance (or Reluctant Dread – don’t forget that option). But a vendor’s choice is about more than control – it’s also about the people;

  • establishing bona-fides to prospective purchasers
  • being informed
  • upskilling & retaining key staff
  • keeping track of industry trends

Academics and consultants have their own model – as I’m finding out (being a consultant now). What about you? why do you participate (and which model do you follow with HL7?)


  1. The categories are very similar to what I use. See

    As for my model, lead where necessary, contribute often, monitor as much as possible, and kill only as a last resort.

  2. Brett Esler says:

    I think this is very useful model in developing an engagement strategy. I personally think I swing between ‘reluctant dread’ and ‘dreadfully reluctant’. 😉

  3. Charlie McCay says:

    I would agree with Keith that active engagement to kill or redirect a standard is sometimes as strong (and valid) a motivation as the desire to promote something that is already good. As Keith has said – this is often the most expensive form of engagement, but does provide returns. However I suggest that the desired outcome that results from engagement need to be considered alongside the level of engagement – and a business case needs to be made to justify the return on investment by taking both into account. It is true that a stitch in time often saves nine, but sometimes the need for nine stitches is the point where the business case becomes clear.

Leave a Reply

Your email address will not be published. Required fields are marked *

question razz sad evil exclaim smile redface biggrin surprised eek confused cool lol mad twisted rolleyes wink idea arrow neutral cry mrgreen


%d bloggers like this: