Raising Awareness of Pre-Symptomatic Genetic Testing

ERIC Educational Resources Information Center

Boerwinkel, Dirk Jan; Knippels, Marie-Christine; Waarlo, Arend Jan

2011-01-01

Presymptomatic genetic testing generates socioscientific issues in which decision making is complicated by several complexity factors. These factors include weighing of advantages and disadvantages, different interests of stakeholders, uncertainty of genetic information and conflicting values. Education preparing students for future decision…

Sharing the floodplain: Mediated modeling for environmental management

USGS Publications Warehouse

Metcalf, S.S.; Wheeler, E.; BenDor, T.K.; Lubinski, S.J.; Hannon, B.M.

2010-01-01

Complex ecosystems, such as the Upper Mississippi River (UMR), present major management challenges. Such systems often provide a range of ecosystem services that are differentially valued by stakeholders representing distinct interests (e.g., agriculture, conservation, navigation) or institutions (e.g., federal and state agencies). When no single entity has the knowledge or authority to resolve conflicts over shared resource use, stakeholders may struggle to jointly understand the scope of the problem and to reach reasonable compromises. This paper explores mediated modeling as a group consensus building process for understanding relationships between ecological, economic and cultural well-being in the UMR floodplain. We describe a workshop structure used to engage UMR stakeholders that may be extended to resource use conflicts in other complex ecosystems. We provide recommendations for improving on these participatory methods in structuring future efforts. In conclusion, we suggest that tools which facilitate collaborative learning, such as mediated modeling, need to be incorporated at an institutional level as a vital element of integrated ecosystem management. ?? 2008 Elsevier Ltd.

Distinguishing values from science in decision making: Setting harvest quotas for mountain lions in Montana

USGS Publications Warehouse

Mitchell, Michael S.; Cooley, Hilary; Gude, Justin A.; Kolbe, Jay; Nowak, J. Joshua; Proffitt, Kelly M.; Sells, Sarah N.; Thompson, Mike

2018-01-01

The relative roles of science and human values can be difficult to distinguish when informal processes are used to make complex and contentious decisions in wildlife management. Structured Decision Making (SDM) offers a formal process for making such decisions, where scientific results and concepts can be disentangled from the values of differing stakeholders. We used SDM to formally integrate science and human values for a citizen working group of ungulate hunting advocates, lion hunting advocates, and outfitters convened to address the contentious allocation of harvest quotas for mountain lions (Puma concolor) in west‐central Montana, USA, during 2014. A science team consisting of mountain lion biologists and population ecologists convened to support the working group. The science team used integrated population models that incorporated 4 estimates of mountain lion density to estimate population trajectories for 5 alternative harvest quotas developed by the working group. Results of the modeling predicted that effects of each harvest quota were consistent across the 4 density estimates; harvest quotas affected predicted population trajectories for 5 years after implementation but differences were not strong. Based on these results, the focus of the working group changed to differences in values among stakeholders that were the true impediment to allocating harvest quotas. By distinguishing roles of science and human values in this process, the working group was able to collaboratively recommend a compromise solution. This solution differed little from the status quo that had been the focus of debate, but the SDM process produced understanding and buy‐in among stakeholders involved, reducing disagreements, misunderstanding, and unproductive arguments founded on informal application of scientific data and concepts. Whereas investments involved in conducting SDM may be unnecessary for many decisions in wildlife management, the investment may be beneficial for complex, contentious, and multiobjective decisions that integrate science and human values.

COMPREHENSIVE ASSESSMENT OF COMPLEX TECHNOLOGIES: INTEGRATING VARIOUS ASPECTS IN HEALTH TECHNOLOGY ASSESSMENT.

PubMed

Lysdahl, Kristin Bakke; Mozygemba, Kati; Burns, Jacob; Brönneke, Jan Benedikt; Chilcott, James B; Ward, Sue; Hofmann, Bjørn

2017-01-01

Despite recent development of health technology assessment (HTA) methods, there are still methodological gaps for the assessment of complex health technologies. The INTEGRATE-HTA guidance for effectiveness, economic, ethical, socio-cultural, and legal aspects, deals with challenges when assessing complex technologies, such as heterogeneous study designs, multiple stakeholder perspectives, and unpredictable outcomes. The objective of this article is to outline this guidance and describe the added value of integrating these assessment aspects. Different methods were used to develop the various parts of the guidance, but all draw on existing, published knowledge and were supported by stakeholder involvement. The guidance was modified after application in a case study and in response to feedback from internal and external reviewers. The guidance consists of five parts, addressing five core aspects of HTA, all presenting stepwise approaches based on the assessment of complexity, context, and stakeholder involvement. The guidance on effectiveness, health economics and ethics aspects focus on helping users choose appropriate, or further develop, existing methods. The recommendations are based on existing methods' applicability for dealing with problems arising with complex interventions. The guidance offers new frameworks to identify socio-cultural and legal issues, along with overviews of relevant methods and sources. The INTEGRATE-HTA guidance outlines a wide range of methods and facilitates appropriate choices among them. The guidance enables understanding of how complexity matters for HTA and brings together assessments from disciplines, such as epidemiology, economics, ethics, law, and social theory. This indicates relevance for a broad range of technologies.

How stakeholder roles, power, and negotiation impact natural resource policy: A political economy view

USGS Publications Warehouse

Caughlan, L.

2002-01-01

Natural resource management decisions are complicated by multiple property rights, management objectives, and stakeholders with varying degrees of influence over the decision making process. In order to make efficient decisions, managers must incorporate the opinions and values of the involved stakeholders as well as understand the complex institutional constraints and opportunities that influence the decision-making process. Often this type of information is not understood until after a decision has been made, which can result in wasted time and effort.The purpose of my dissertation was to show how institutional frameworks and stakeholder involvement influence the various phases of the resource management decision-making process in a public choice framework. The intent was to assist decision makers and stakeholders by developing a methodology for formally incorporating stakeholders'' objectives and influence into the resource management planning process and to predict the potential success of rent-seeking activity based on stakeholder preferences and level of influence. Concepts from decision analysis, institutional analysis, and public choice economics were used in designing this interdisciplinary framework. The framework was then applied to an actual case study concerning elk and bison management on the National Elk Refuge and Grand Teton National Park near Jackson, Wyoming. The framework allowed for the prediction of the level of support and conflict for all relevant policy decisions, and the identification of each stakeholder''s level of support or opposition for each management decision.

A Phenomenographic Investigation of the Ways Engineering Students Experience Innovation

ERIC Educational Resources Information Center

Fila, Nicholas David

2017-01-01

Innovation has become an important phenomenon in engineering and engineering education. By developing novel, feasible, viable, and valued solutions to complex technical and human problems, engineers support the economic competitiveness of organizations, make a difference in the lives of users and other stakeholders, drive societal and scientific…

Sustainability: Why the Language and Ethics of Sustainability Matter in the Geoscience Classroom

ERIC Educational Resources Information Center

Metzger, Ellen P.; Curren, Randall R.

2017-01-01

Because challenges to sustainability arise at the intersection of human and biophysical systems they are inescapably embedded in social contexts and involve multiple stakeholders with diverse and often conflicting needs and value systems. Addressing complex and solution-resistant problems such as climate change, biodiversity loss, and…

Parenthood in America: Undervalued, Underpaid, Under Siege.

ERIC Educational Resources Information Center

Westman, Jack C., Ed.

Largely missing from debates about family values, childcare, education, and the future of children is the complex vocation called "parenthood." This book examines parenthood in the home, the community, and in society, and identifies parental stressors that have increased since the 1960s, calling on stakeholders to provide help with…

Project Stakeholder Management in the Clinical Research Environment: How to Do it Right

PubMed Central

Pandi-Perumal, Seithikurippu R.; Akhter, Sohel; Zizi, Ferdinard; Jean-Louis, Girardin; Ramasubramanian, Chellamuthu; Edward Freeman, R.; Narasimhan, Meera

2015-01-01

This review introduces a conceptual framework for understanding stakeholder management (ShM) in the clinical and community-based research environment. In recent years, an evolution in practice has occurred in many applicants for public and non-governmental funding of public health research in hospital settings. Community health research projects are inherently complex, have sought to involve patients and other stakeholders in the center of the research process. Substantial evidence has now been provided that stakeholder involvement is essential for management effectiveness in clinical research. Feedback from stakeholders has critical value for research managers inasmuch as it alerts them to the social, environmental, and ethical implications of research activities. Additionally, those who are directly affected by program development and clinical research, the patients, their families, and others, almost universally have a strong motivation to be involved in the planning and execution of new program changes. The current overview introduces a conceptual framework for ShM in the clinical research environment and offers practical suggestions for fostering meaningful stakeholder engagement. The fifth edition of PMBOK® of the Project Management Institute, has served as basis for many of the suggested guidelines that are put forward in this article. PMID:26042053

Project Stakeholder Management in the Clinical Research Environment: How to Do it Right.

PubMed

Pandi-Perumal, Seithikurippu R; Akhter, Sohel; Zizi, Ferdinard; Jean-Louis, Girardin; Ramasubramanian, Chellamuthu; Edward Freeman, R; Narasimhan, Meera

2015-01-01

This review introduces a conceptual framework for understanding stakeholder management (ShM) in the clinical and community-based research environment. In recent years, an evolution in practice has occurred in many applicants for public and non-governmental funding of public health research in hospital settings. Community health research projects are inherently complex, have sought to involve patients and other stakeholders in the center of the research process. Substantial evidence has now been provided that stakeholder involvement is essential for management effectiveness in clinical research. Feedback from stakeholders has critical value for research managers inasmuch as it alerts them to the social, environmental, and ethical implications of research activities. Additionally, those who are directly affected by program development and clinical research, the patients, their families, and others, almost universally have a strong motivation to be involved in the planning and execution of new program changes. The current overview introduces a conceptual framework for ShM in the clinical research environment and offers practical suggestions for fostering meaningful stakeholder engagement. The fifth edition of PMBOK(®) of the Project Management Institute, has served as basis for many of the suggested guidelines that are put forward in this article.

Putting people into water quality modelling.

NASA Astrophysics Data System (ADS)

Strickert, G. E.; Hassanzadeh, E.; Noble, B.; Baulch, H. M.; Morales-Marin, L. A.; Lindenschmidt, K. E.

2017-12-01

Water quality in the Qu'Appelle River Basin, Saskatchewan is under pressure due to nutrient pollution entering the river system from major cities, industrial zones and agricultural areas. Among these stressors, agricultural activities are basin-wide; therefore, they are the largest non-point source of water pollution in this region. The dynamics of agricultural impacts on water quality are complex and stem from decisions and activities of two distinct stakeholder groups, namely grain farmers and cattle producers, which have different business plans, values, and attitudes towards water quality. As a result, improving water quality in this basin requires engaging with stakeholders to: (1) understand their perspectives regarding a range of agricultural Beneficial Management Practices (BMPs) that can improve water quality in the region, (2) show them the potential consequences of their selected BMPs, and (3) work with stakeholders to better understand the barriers and incentives to implement the effective BMPs. In this line, we held a series of workshops in the Qu'Appelle River Basin with both groups of stakeholders to understand stakeholders' viewpoints about alternative agricultural BMPs and their impact on water quality. Workshop participants were involved in the statement sorting activity (Q-sorts), group discussions, as well as mapping activity. The workshop outcomes show that stakeholder had four distinct viewpoints about the BMPs that can improve water quality, i.e., flow and erosion control, fertilizer management, cattle site management, as well as mixed cattle and wetland management. Accordingly, to simulate the consequences of stakeholder selected BMPs, a conceptual water quality model was developed using System Dynamics (SD). The model estimates potential changes in water quality at the farm, tributary and regional scale in the Qu'Appelle River Basin under each and/or combination of stakeholder selected BMPs. The SD model was then used for real-time engagement of stakeholders in simulations to demostrate the potential effects of BMPs on water quality. This exercise helped us to better understand the stakeholders' viewpoints to propose effective BMPs and policies that are in-line with stakeholders' values and preferences.

“Because we all trust and care about each other”: Exploring Tensions Translating a Theater-based HIV Prevention Intervention into a New Context

PubMed Central

Mouw, Mary Sherwyn; Taboada, Arianna; Steinert, Scarlett; Willis, Stephanie; Lightfoot, Alexandra F.

2016-01-01

Background A theater-based HIV prevention intervention developed in urban California was piloted with a new partnership in North Carolina. Objectives To describe the experience of translating a complex program with an enhanced partnership approach; barriers and facilitators of implementation in the new setting; and challenges and benefits of interdisciplinary, collaborative interventions. Methods We gathered perspectives of local stakeholders involved in program implementation through process evaluation interviews and focus groups with undergraduates, a college instructor, school district administrators, and high school teachers. Results Implementing the intervention in a new setting proved feasible and successful; however, mistaken assumptions and unrecognized similarities about teaching priorities, philosophies, and values produced latent tensions amongst stakeholder groups, and were a limiting factor in partnership functioning. Conclusions Implementing a cross-disciplinary intervention in a new setting is best achieved through a local community-engaged process, with active involvement of relevant stakeholders. We suggest strategies to strengthen community partnerships cooperating in implementation of complex, context-tailored interventions. PMID:27346770

A Value Chain Analysis of ghost nets in the Arafura Sea: identifying trans-boundary stakeholders, intervention points and livelihood trade-offs.

PubMed

Butler, J R A; Gunn, R; Berry, H L; Wagey, G A; Hardesty, B D; Wilcox, C

2013-07-15

Lost or discarded fishing nets are a significant component of marine debris which has trans-boundary impacts in large marine ecosystems. Such 'ghost nets' cause the by-catch of marine fauna and require retrieval from coastlines where they wash up. Identifying the causes of discarded nets and feasible intervention points requires analysis of a complex value chain and the stakeholders within it, yet no studies have attempted this. In this paper we combine Value Chain Analysis, commonly applied to understand value-adding for a commodity, with elements of Life Cycle Assessment and social network analysis to examine the drivers, stakeholders, economic, environmental and social costs and benefits in the life of a trawl net. We use the Arafura Sea as a case study, which is shared by Indonesia, Papua New Guinea and Australia, and is the focus of a Trans-boundary Diagnostic Assessment (TDA) within the Arafura-Timor Seas Ecosystem Action program (ATSEA). We follow a trawl net through four sub-systems: manufacture of webbing in South Korea, fishing and loss by an Indonesian vessel, retrieval as ghost net on the northern Australian coastline by Indigenous rangers, and disposal or re-cycling as 'GhostNet Art' by Indigenous artists. Primary stakeholders along the value chain incur economic and social benefits, and economic and environmental costs. There is an anomaly in the chain between Indonesian fishermen and Indigenous rangers, artists and communities due to the lack of market linkages between these primary stakeholders. The first 'nexus of influence' where reductions in net losses and environmental costs can be achieved is through interactions between GhostNets Australia, the World Wide Fund for Nature and the Australian Government, which can influence Indonesian fishery management institutions and fishing crews. The second nexus is via the international art market which by publicising GhostNet Art can raise awareness amongst fish consumers about the impacts of ghost nets, and hence influence Indonesian fishing companies. GhostNets Australia is a key bridging organisation in the network, linking stakeholders across scales and sub-systems. Feasible preventative interventions are discussed to rectify the anomaly in the value chain. The importance of GhostNets Australia and ATSEA in the evolving adaptive co-management and trans-boundary governance of fisheries is highlighted. However, the prevention of ghost nets will result in trade-offs in benefits for the livelihoods of primary stakeholders. The utility of the method for analysing marine debris in TDAs, and ATSEA in particular, is discussed. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Structured decision making as a framework for large-scale wildlife harvest management decisions

USGS Publications Warehouse

Robinson, Kelly F.; Fuller, Angela K.; Hurst, Jeremy E.; Swift, Bryan L.; Kirsch, Arthur; Farquhar, James F.; Decker, Daniel J.; Siemer, William F.

2016-01-01

Fish and wildlife harvest management at large spatial scales often involves making complex decisions with multiple objectives and difficult tradeoffs, population demographics that vary spatially, competing stakeholder values, and uncertainties that might affect management decisions. Structured decision making (SDM) provides a formal decision analytic framework for evaluating difficult decisions by breaking decisions into component parts and separating the values of stakeholders from the scientific evaluation of management actions and uncertainty. The result is a rigorous, transparent, and values-driven process. This decision-aiding process provides the decision maker with a more complete understanding of the problem and the effects of potential management actions on stakeholder values, as well as how key uncertainties can affect the decision. We use a case study to illustrate how SDM can be used as a decision-aiding tool for management decision making at large scales. We evaluated alternative white-tailed deer (Odocoileus virginianus) buck-harvest regulations in New York designed to reduce harvest of yearling bucks, taking into consideration the values of the state wildlife agency responsible for managing deer, as well as deer hunters. We incorporated tradeoffs about social, ecological, and economic management concerns throughout the state. Based on the outcomes of predictive models, expert elicitation, and hunter surveys, the SDM process identified management alternatives that optimized competing objectives. The SDM process provided biologists and managers insight about aspects of the buck-harvest decision that helped them adopt a management strategy most compatible with diverse hunter values and management concerns.

Contribution of the Multi-attribute Value Theory to conflict resolution in groundwater management. Application to the Mancha Oriental system (Spain)

NASA Astrophysics Data System (ADS)

Apperl, B.; Pulido-Velazquez, M.; Andreu, J.; Llopis-Albert, C.

2012-04-01

The implementation of the EU Water Framework Directive, with consideration of environmental, economic and social objectives, claims for participatory water resource management methods. To deal with different conflicting objectives it is necessary to apply a method for clarifying stakeholders' positions (identifying values and opinions of stakeholders, and quantifying their valuations), improving transparency with respect to outcomes of alternatives, and moving the discussion from alternatives towards fundamental objectives (value-thinking approach) and valuing trade-offs, facilitating negotiation. The method allows the incorporation of stakeholders in the planning process, which should guarantee a higher acceptance of the policies to be implemented. This research has been conducted in the Mancha Oriental groundwater system Spain, subject to an intensive use of groundwater for irrigation. The main goals according to the WFD are: a good qualitative and quantitative status of the aquifer and a good quantitative and ecological status of related surface water resources (mainly the Jucar river and dependent ecosystems). The aim is to analyze the contribution of the MAVT for conflict resolution and a sustainable groundwater management, involving the stakeholders in the valuation process. A complex set of objectives and attributes has been defined. The alternatives have been evaluated according to the compliance of ecological, economic and social interests. Results show that the acceptation of alternatives depends strongly on the combination of measures and the implementation status. A high conflict potential is expected from alternatives consisting of one unique measure. Uncertainties of the results are notable, but do not influence heavily on the alternative ranking. Different future scenarios also influence on the preference of alternatives. For instance, an expected reduction of future groundwater resources by climate change increases the conflict potential, with two observed reactions: acceptance of more rigorous measures, on one hand, and a tendency to soft measures with the same cost, as a reaction to the decreased effectiveness of the alternatives. The implementation of the method to a very complex case study, with many conflicting objectives and alternatives and uncertain outcomes, including future scenarios (climate change) illustrate the potential of the method for supporting management decisions.

Design Requirements for Communication-Intensive Interactive Applications

NASA Astrophysics Data System (ADS)

Bolchini, Davide; Garzotto, Franca; Paolini, Paolo

Online interactive applications call for new requirements paradigms to capture the growing complexity of computer-mediated communication. Crafting successful interactive applications (such as websites and multimedia) involves modeling the requirements for the user experience, including those leading to content design, usable information architecture and interaction, in profound coordination with the communication goals of all stakeholders involved, ranging from persuasion to social engagement, to call for action. To face this grand challenge, we propose a methodology for modeling communication requirements and provide a set of operational conceptual tools to be used in complex projects with multiple stakeholders. Through examples from real-life projects and lessons-learned from direct experience, we draw on the concepts of brand, value, communication goals, information and persuasion requirements to systematically guide analysts to master the multifaceted connections of these elements as drivers to inform successful communication designs.

Improving the Efficiency and Quality of the Value Assessment Process for Companion Diagnostic Tests: The Companion test Assessment Tool (CAT).

PubMed

Canestaro, William J; Pritchard, Daryl E; Garrison, Louis P; Dubois, Robert; Veenstra, David L

2015-08-01

Companion diagnostic tests (CDTs) have emerged as a vital technology in the effective use of an increasing number of targeted drug therapies. Although CDTs can offer a multitude of potential benefits, assessing their value within a health technology appraisal process can be challenging because of a complex array of factors that influence clinical and economic outcomes. To develop a user-friendly tool to assist managed care and other health care decision makers in screening companion tests and determining whether an intensive technology review is necessary and, if so, where the review should be focused to improve efficiency. First, we conducted a systematic literature review of CDT cost-effectiveness studies to identify value drivers. Second, we conducted key informant interviews with a diverse group of stakeholders to elicit feedback and solicit any additional value drivers and identify desirable attributes for an evidence review tool. A draft tool was developed based on this information that captured value drivers, usability features, and had a particular focus on practical use by nonexperts. Finally, the tool was pilot tested with test developers and managed care evidence evaluators to assess face-validity and usability. The tool was also evaluated using several diverse examples of existing companion diagnostics and refined accordingly. We identified 65 cost-effectiveness studies of companion diagnostic technologies. The following factors were most commonly identified as value drivers from our literature review: clinical validity of testing; efficacy, safety, and cost of baseline and alternative treatments; cost and mortality of health states; and biomarker prevalence and testing cost. Stakeholders identified the following additional factors that they believed influenced the overall value of a companion test: regulatory status, actionability, utility, and market penetration. These factors were used to maximize the efficiency of the evidence review process. Stakeholders also stated that a tool should be easy to use and time efficient. Cognitive interviews with stakeholders led to minor changes in the draft tool to improve usability and relevance. The final tool consisted of 4 sections: (1) eligibility for review (2 questions), (2) prioritization of review (3 questions), (3) clinical review (3 questions), and (4) economic review (5 questions). Although the evaluation of CDTs can be challenging because of limited evidence and the added complexity of incorporating a diagnostic test into drug treatment decisions, using a pragmatic tool to identify tests that do not need extensive evaluation may improve the efficiency and effectiveness of CDT value assessments.

Building more effective sea level rise models for coastal management

NASA Astrophysics Data System (ADS)

Kidwell, D.; Buckel, C.; Collini, R.; Meckley, T.

2017-12-01

For over a decade, increased attention on coastal resilience and adaptation to sea level rise has resulted in a proliferation of predictive models and tools. This proliferation has enhanced our understanding of our vulnerability to sea level rise, but has also led to stakeholder fatigue in trying to realize the value of each advancement. These models vary in type and complexity ranging from GIS-based bathtub viewers to modeling systems that dynamically couple complex biophysical and geomorphic processes. These approaches and capabilities typically have the common purpose using scenarios of global and regional sea level change to inform adaptation and mitigation. In addition, stakeholders are often presented a plethora of options to address sea level rise issues from a variety of agencies, academics, and consulting firms. All of this can result in confusion, misapplication of a specific model/tool, and stakeholder feedback of "no more new science or tools, just help me understand which one to use". Concerns from stakeholders have led to the question; how do we move forward with sea level rise modeling? This presentation will provide a synthesis of the experiences and feedback derived from NOAA's Ecological Effects of Sea level Rise (EESLR) program to discuss the future of predictive sea level rise impact modeling. EESLR is an applied research program focused on the advancement of dynamic modeling capabilities in collaboration with local and regional stakeholders. Key concerns from stakeholder engagement include questions about model uncertainty, approaches for model validation, and a lack of cross-model comparisons. Effective communication of model/tool products, capabilities, and results is paramount to address these concerns. Looking forward, the most effective predictions of sea level rise impacts on our coast will be attained through a focus on coupled modeling systems, particularly those that connect natural processes and human response.

Value flow mapping: Using networks to inform stakeholder analysis

NASA Astrophysics Data System (ADS)

Cameron, Bruce G.; Crawley, Edward F.; Loureiro, Geilson; Rebentisch, Eric S.

2008-02-01

Stakeholder theory has garnered significant interest from the corporate community, but has proved difficult to apply to large government programs. A detailed value flow exercise was conducted to identify the value delivery mechanisms among stakeholders for the current Vision for Space Exploration. We propose a method for capturing stakeholder needs that explicitly recognizes the outcomes required of the value creating organization. The captured stakeholder needs are then translated into input-output models for each stakeholder, which are then aggregated into a network model. Analysis of this network suggests that benefits are infrequently linked to the root provider of value. Furthermore, it is noted that requirements should not only be written to influence the organization's outputs, but also to influence the propagation of benefit further along the value chain. A number of future applications of this model to systems architecture and requirement analysis are discussed.

Hearing the Voice of Remote Aboriginal and Torres Strait Islander Training Stakeholders Using Research Methodologies and Theoretical Frames of Reference

ERIC Educational Resources Information Center

Guenther, John; Osborne, Sam; Arnott, Allan; McRae-Williams, Eva

2017-01-01

Researchers in remote Aboriginal and Torres Strait Islander contexts within Australia are frequently faced with the challenges of working in an intercultural space where channels of communication are garbled with interference created by the complexities of misunderstood worldviews, languages, values and expectations. A concern of many researchers…

A framework for multi-stakeholder decision-making and ...

EPA Pesticide Factsheets

We propose a decision-making framework to compute compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives. In our setting, we shape the stakeholder dis-satisfaction distribution by solving a conditional-value-at-risk (CVaR) minimization problem. The CVaR problem is parameterized by a probability level that shapes the tail of the dissatisfaction distribution. The proposed approach allows us to compute a family of compromise solutions and generalizes multi-stakeholder settings previously proposed in the literature that minimize average and worst-case dissatisfactions. We use the concept of the CVaR norm to give a geometric interpretation to this problem +and use the properties of this norm to prove that the CVaR minimization problem yields Pareto optimal solutions for any choice of the probability level. We discuss a broad range of potential applications of the framework that involve complex decision-making processes. We demonstrate the developments using a biowaste facility location case study in which we seek to balance stakeholder priorities on transportation, safety, water quality, and capital costs. This manuscript describes the methodology of a new decision-making framework that computes compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives as needed for SHC Decision Science and Support Tools project. A biowaste facility location is employed as the case study

Facilitating ethical reflection among scientists using the ethical matrix.

PubMed

Jensen, Karsten Klint; Forsberg, Ellen-Marie; Gamborg, Christian; Millar, Kate; Sandøe, Peter

2011-09-01

Several studies have indicated that scientists are likely to have an outlook on both facts and values that are different to that of lay people in important ways. This is one significant reason it is currently believed that in order for scientists to exercise a reliable ethical reflection about their research it is necessary for them to engage in dialogue with other stakeholders. This paper reports on an exercise to encourage a group of scientists to reflect on ethical issues without the presence of external stakeholders. It reports on the use of a reflection process with scientists working in the area of animal disease genomics (mainly drawn from the EADGENE EC Network of Excellence). This reflection process was facilitated by using an ethical engagement framework, a modified version of the Ethical Matrix. As judged by two criteria, a qualitative assessment of the outcomes and the participants' own assessment of the process, this independent reflective exercise was deemed to be successful. The discussions demonstrated a high level of complexity and depth, with participants demonstrating a clear perception of uncertainties and the context in which their research operates. Reflection on stakeholder views and values appeared to be embedded within the discussions. The finding from this exercise seems to indicate that even without the involvement of the wider stakeholder community, valuable reflection and worthwhile discourse can be generated from ethical reflection processes involving only scienitific project partners. Hence, the previous assumption that direct stakeholder engagement is necessary for ethical reflection does not appear to hold true in all cases; however, other reasons for involving a broad group of stakeholders relating to governance and social accountability of science remain.

Comparing multi-criteria decision analysis and integrated assessment to support long-term water supply planning

PubMed Central

Maurer, Max; Lienert, Judit

2017-01-01

We compare the use of multi-criteria decision analysis (MCDA)–or more precisely, models used in multi-attribute value theory (MAVT)–to integrated assessment (IA) models for supporting long-term water supply planning in a small town case study in Switzerland. They are used to evaluate thirteen system scale water supply alternatives in four future scenarios regarding forty-four objectives, covering technical, social, environmental, and economic aspects. The alternatives encompass both conventional and unconventional solutions and differ regarding technical, spatial and organizational characteristics. This paper focuses on the impact assessment and final evaluation step of the structured MCDA decision support process. We analyze the performance of the alternatives for ten stakeholders. We demonstrate the implications of model assumptions by comparing two IA and three MAVT evaluation model layouts of different complexity. For this comparison, we focus on the validity (ranking stability), desirability (value), and distinguishability (value range) of the alternatives given the five model layouts. These layouts exclude or include stakeholder preferences and uncertainties. Even though all five led us to identify the same best alternatives, they did not produce identical rankings. We found that the MAVT-type models provide higher distinguishability and a more robust basis for discussion than the IA-type models. The needed complexity of the model, however, should be determined based on the intended use of the model within the decision support process. The best-performing alternatives had consistently strong performance for all stakeholders and future scenarios, whereas the current water supply system was outperformed in all evaluation layouts. The best-performing alternatives comprise proactive pipe rehabilitation, adapted firefighting provisions, and decentralized water storage and/or treatment. We present recommendations for possible ways of improving water supply planning in the case study and beyond. PMID:28481881

Comparative analysis of sustainable value distribution for stakeholders in the mining industry

NASA Astrophysics Data System (ADS)

Lorenc, Sylwia; Kustra, Arkadiusz

2018-01-01

The objective of this article is the analysis and comparison of the value distribution process that takes place in enterprises for stakeholders. The following coal mining enterprises are subject of this work: JSW S.A., KGHM S.A., and LW Bogdanka S.A, for which the directions of value distribution in the years 2011-2016 were presented. The article defines the main groups of the partnerships' stakeholders, such as the owners, staff, suppliers, equity providers, the country budget and the local governments' budgets. The sustainable value benchmark was defined as the benefits received by the stakeholders through the allocation of financial surplus. The value defined for the abovementioned stakeholders was assessed according to the Free Cash Flow (FCF) methodology.

Public and stakeholder participation for managing and reducing the risks of shale gas development.

PubMed

North, D Warner; Stern, Paul C; Webler, Thomas; Field, Patrick

2014-01-01

Emerging technologies pose particularly strong challenges for risk governance when they have multidimensional and inequitable impacts, when there is scientific uncertainty about the technology and its risks, when there are strong value conflicts over the perceived benefits and risks, when decisions must be made urgently, and when the decision making environment is rife with mistrust. Shale gas development is one such emerging technology. Drawing on previous U.S. National Research Council committee reports that examined risk decision making for complex issues like these, we point to the benefits and challenges of applying the analytic-deliberative process recommended in those reports for stakeholder and public engagement in risk decision making about shale gas development in the United States. We discuss the different phases of such a process and conclude by noting the dangers of allowing controversy to ossify and the benefits of sound dialogue and learning among publics, stakeholders, industry, and regulatory decision makers.

Issues and approaches for ensuring effective communication on acceptable daily exposure (ADE) values applied to pharmaceutical cleaning.

PubMed

Olson, Michael J; Faria, Ellen C; Hayes, Eileen P; Jolly, Robert A; Barle, Ester Lovsin; Molnar, Lance R; Naumann, Bruce D; Pecquet, Alison M; Shipp, Bryan K; Sussman, Robert G; Weideman, Patricia A

2016-08-01

This manuscript centers on communication with key stakeholders of the concepts and program goals involved in the application of health-based pharmaceutical cleaning limits. Implementation of health-based cleaning limits, as distinct from other standards such as 1/1000th of the lowest clinical dose, is a concept recently introduced into regulatory domains. While there is a great deal of technical detail in the written framework underpinning the use of Acceptable Daily Exposures (ADEs) in cleaning (for example ISPE, 2010; Sargent et al., 2013), little is available to explain how to practically create a program which meets regulatory needs while also fulfilling good manufacturing practice (GMP) and other expectations. The lack of a harmonized approach for program implementation and communication across stakeholders can ultimately foster inappropriate application of these concepts. Thus, this period in time (2014-2017) could be considered transitional with respect to influencing best practice related to establishing health-based cleaning limits. Suggestions offered in this manuscript are intended to encourage full and accurate communication regarding both scientific and administrative elements of health-based ADE values used in pharmaceutical cleaning practice. This is a large and complex effort that requires: 1) clearly explaining key terms and definitions, 2) identification of stakeholders, 3) assessment of stakeholders' subject matter knowledge, 4) formulation of key messages fit to stakeholder needs, 5) identification of effective and timely means for communication, and 6) allocation of time, energy, and motivation for initiating and carrying through with communications. Copyright © 2016 Elsevier Inc. All rights reserved.

Value Assessment Frameworks for HTA Agencies: The Organization of Evidence-Informed Deliberative Processes.

PubMed

Baltussen, Rob; Jansen, Maarten Paul Maria; Bijlmakers, Leon; Grutters, Janneke; Kluytmans, Anouck; Reuzel, Rob P; Tummers, Marcia; der Wilt, Gert Jan van

2017-02-01

Priority setting in health care has been long recognized as an intrinsically complex and value-laden process. Yet, health technology assessment agencies (HTAs) presently employ value assessment frameworks that are ill fitted to capture the range and diversity of stakeholder values and thereby risk compromising the legitimacy of their recommendations. We propose "evidence-informed deliberative processes" as an alternative framework with the aim to enhance this legitimacy. This framework integrates two increasingly popular and complementary frameworks for priority setting: multicriteria decision analysis and accountability for reasonableness. Evidence-informed deliberative processes are, on one hand, based on early, continued stakeholder deliberation to learn about the importance of relevant social values. On the other hand, they are based on rational decision-making through evidence-informed evaluation of the identified values. The framework has important implications for how HTA agencies should ideally organize their processes. First, HTA agencies should take the responsibility of organizing stakeholder involvement. Second, agencies are advised to integrate their assessment and appraisal phases, allowing for the timely collection of evidence on values that are considered relevant. Third, HTA agencies should subject their decision-making criteria to public scrutiny. Fourth, agencies are advised to use a checklist of potentially relevant criteria and to provide argumentation for how each criterion affected the recommendation. Fifth, HTA agencies must publish their argumentation and install options for appeal. The framework should not be considered a blueprint for HTA agencies but rather an aspirational goal-agencies can take incremental steps toward achieving this goal. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The importance of symbolic and engaged participation in evidence-based quality improvement in a complex integrated healthcare system: response to "The science of stakeholder engagement in research".

PubMed

Hamilton, Alison B; Yano, Elizabeth M

2017-09-01

In this commentary, we respond to the commentary provided by Goodman and Sanders Thompson regarding our paper on multilevel stakeholder engagement in a VA implementation trial of evidence-based quality improvement (EBQI) in women's health primary care. We clarify our overall approach to engagement (comprised of both symbolic and engaged participation, according to the authors' classification rubric), highlighting that symbolic participation is of more import and value than the authors suggest, especially in the context of a hierarchical healthcare system. We contend that the issue of power-and how power matters in stakeholder engagement-needs to be considered in this context rather than in global "community" terms. In response to the authors' call for greater detail, we clarify our planning processes as well as our approach to veteran engagement. We concur with Goodman and Sanders Thompson that the science of stakeholder engagement necessitates a broader understanding of best practices as well as the impact of engagement on implementation outcomes.

Redefining responsible research and innovation for the advancement of biobanking and biomedical research.

PubMed

Yu, Helen

2016-12-01

One of the core objectives of responsible research and innovation (RRI) is to maximize the value of publicly funded research so that it may be returned to benefit society. However, while RRI encourages innovation through societal engagement, it can give rise to complex and previously untested issues that challenge the existing legal frameworks on intellectual property (IP) and public entitlement to benefits of research. In the case of biobanking, the personal nature of human biological materials and often altruistic intention of participants to donate samples intensifies the need to adhere to RRI principles with respect to the research, development, and commercialization of innovations derived from biobanks. However, stakeholders participate and collaborate with others in the innovation process to fulfill their own agenda. Without IP to safeguard investments in R&D, stakeholders may hesitate to contribute to the translation of discoveries into innovations. To realize the public benefit objective, RRI principles must protect the interests of stakeholders involved in the translation and commercialization of knowledge. This article explores the seemingly contradictory and competing objectives of open science and commercialization and proposes a holistic innovation framework directed at improving RRI practice for positive impact on obtaining the optimal social and economic values from research.

Stakeholder Views of Nanosilver Linings: Macroethics Education and Automated Text Analysis Through Participatory Governance Role Play in a Workshop Format.

PubMed

Dempsey, Joshua; Stamets, Justin; Eggleson, Kathleen

2017-06-01

The Nanosilver Linings role play case offers participants first-person experience with interpersonal interaction in the context of the wicked problems of emerging technology macroethics. In the fictional scenario, diverse societal stakeholders convene at a town hall meeting to consider whether a nanotechnology-enabled food packaging industry should be offered incentives to establish an operation in their economically struggling Midwestern city. This original creative work was built with a combination of elements, selected for their established pedagogical efficacy (e.g. active learning, case-based learning) and as topical dimensions of the realistic scenario (e.g. nanosilver in food packaging, occupational safety and health). The product life cycle is used as a framework for integrated consideration of scientific, societal, and ethical issues. The Nanosilver Linings hypothetical case was delivered through the format of the 3-hour workshop Ethics when Biocomplexity meets Human Complexity, providing an immersive, holistic ethics learning experience for STEM graduate students. Through their participation in the Nanosilver Linings case and Ethics when Biocomplexity meets Human Complexity workshop, four cohorts of science and engineering doctoral students reported the achievement of specific learning objectives pertaining to a range of macroethics concepts and professional practices, including stakeholder perspectives, communication, human values, and ethical frameworks. Automated text analysis of workshop transcripts revealed differences in sentiment and in ethical framework (consequentialism/deontology) preference between societal stakeholder roles. These resources have been recognized as ethics education exemplars by the U.S. National Academy of Engineering .

Values Engagement in Evaluation: Ideas, Illustrations, and Implications

ERIC Educational Resources Information Center

Hall, Jori N.; Ahn, Jeehae; Greene, Jennifer C.

2012-01-01

Values-engagement in evaluation involves both describing stakeholder values and prescribing certain values. Describing stakeholder values is common practice in responsive evaluation traditions. Prescribing or advocating particular values is only "explicitly" part of democratic, culturally responsive, critical, and other openly…

Advancing Sustainable Bioenergy: Evolving Stakeholder Interests and the Relevance of Research

NASA Astrophysics Data System (ADS)

Johnson, Timothy Lawrence; Bielicki, Jeffrey M.; Dodder, Rebecca S.; Hilliard, Michael R.; Ozge Kaplan, P.; Andrew Miller, C.

2013-02-01

The sustainability of future bioenergy production rests on more than continual improvements in its environmental, economic, and social impacts. The emergence of new biomass feedstocks, an expanding array of conversion pathways, and expected increases in overall bioenergy production are connecting diverse technical, social, and policy communities. These stakeholder groups have different—and potentially conflicting—values and cultures, and therefore different goals and decision making processes. Our aim is to discuss the implications of this diversity for bioenergy researchers. The paper begins with a discussion of bioenergy stakeholder groups and their varied interests, and illustrates how this diversity complicates efforts to define and promote "sustainable" bioenergy production. We then discuss what this diversity means for research practice. Researchers, we note, should be aware of stakeholder values, information needs, and the factors affecting stakeholder decision making if the knowledge they generate is to reach its widest potential use. We point out how stakeholder participation in research can increase the relevance of its products, and argue that stakeholder values should inform research questions and the choice of analytical assumptions. Finally, we make the case that additional natural science and technical research alone will not advance sustainable bioenergy production, and that important research gaps relate to understanding stakeholder decision making and the need, from a broader social science perspective, to develop processes to identify and accommodate different value systems. While sustainability requires more than improved scientific and technical understanding, the need to understand stakeholder values and manage diversity presents important research opportunities.

Advancing sustainable bioenergy: evolving stakeholder interests and the relevance of research.

PubMed

Johnson, Timothy Lawrence; Bielicki, Jeffrey M; Dodder, Rebecca S; Hilliard, Michael R; Kaplan, P Ozge; Miller, C Andrew

2013-02-01

The sustainability of future bioenergy production rests on more than continual improvements in its environmental, economic, and social impacts. The emergence of new biomass feedstocks, an expanding array of conversion pathways, and expected increases in overall bioenergy production are connecting diverse technical, social, and policy communities. These stakeholder groups have different-and potentially conflicting-values and cultures, and therefore different goals and decision making processes. Our aim is to discuss the implications of this diversity for bioenergy researchers. The paper begins with a discussion of bioenergy stakeholder groups and their varied interests, and illustrates how this diversity complicates efforts to define and promote "sustainable" bioenergy production. We then discuss what this diversity means for research practice. Researchers, we note, should be aware of stakeholder values, information needs, and the factors affecting stakeholder decision making if the knowledge they generate is to reach its widest potential use. We point out how stakeholder participation in research can increase the relevance of its products, and argue that stakeholder values should inform research questions and the choice of analytical assumptions. Finally, we make the case that additional natural science and technical research alone will not advance sustainable bioenergy production, and that important research gaps relate to understanding stakeholder decision making and the need, from a broader social science perspective, to develop processes to identify and accommodate different value systems. While sustainability requires more than improved scientific and technical understanding, the need to understand stakeholder values and manage diversity presents important research opportunities.

Quantifying Stakeholder Values of VET Provision in the Netherlands

ERIC Educational Resources Information Center

van der Sluis, Margriet E.; Reezigt, Gerry J.; Borghans, Lex

2014-01-01

It is well-known that the quality of vocational education and training (VET) depends on how well a given programme aligns with the values and interests of its stakeholders, but it is less well-known what these values and interests are and to what extent they are shared across different groups of stakeholders. We use vignettes to quantify the…

Using complexity science and negotiation theory to resolve boundary-crossing water issues

NASA Astrophysics Data System (ADS)

Islam, Shafiqul; Susskind, Lawrence

2018-07-01

Many water governance and management issues are complex. The complexity of these issues is related to crossing of multiple boundaries: political, social and jurisdictional, as well as physical, ecological and biogeochemical. Resolution of these issues usually requires interactions of many parties with conflicting values and interests operating across multiple boundaries and scales to make decisions. The interdependence and feedback among interacting variables, processes, actors and institutions are hard to model and difficult to forecast. Thus, decision-making related to complex water problems needs be contingent and adaptive. This paper draws on a number of ideas from complexity science and negotiation theory that may make it easier to cope with the complexities and difficulties of managing boundary crossing water disputes. It begins with the Water Diplomacy Framework that was developed and tested over the past several years. Then, it uses three key ideas from complexity science (interdependence and interconnectedness; uncertainty and feedback; emergence and adaptation) and three from negotiation theory (stakeholder identification and engagement; joint fact finding; and value creation through option generation) to show how application of these ideas can help enhance effectiveness of water management.

Managing Complex IT Security Processes with Value Based Measures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abercrombie, Robert K; Sheldon, Frederick T; Mili, Ali

2009-01-01

Current trends indicate that IT security measures will need to greatly expand to counter the ever increasingly sophisticated, well-funded and/or economically motivated threat space. Traditional risk management approaches provide an effective method for guiding courses of action for assessment, and mitigation investments. However, such approaches no matter how popular demand very detailed knowledge about the IT security domain and the enterprise/cyber architectural context. Typically, the critical nature and/or high stakes require careful consideration and adaptation of a balanced approach that provides reliable and consistent methods for rating vulnerabilities. As reported in earlier works, the Cyberspace Security Econometrics System provides amore » comprehensive measure of reliability, security and safety of a system that accounts for the criticality of each requirement as a function of one or more stakeholders interests in that requirement. This paper advocates a dependability measure that acknowledges the aggregate structure of complex system specifications, and accounts for variations by stakeholder, by specification components, and by verification and validation impact.« less

Collective intelligence of the artificial life community on its own successes, failures, and future.

PubMed

Rasmussen, Steen; Raven, Michael J; Keating, Gordon N; Bedau, Mark A

2003-01-01

We describe a novel Internet-based method for building consensus and clarifying conflicts in large stakeholder groups facing complex issues, and we use the method to survey and map the scientific and organizational perspectives of the artificial life community during the Seventh International Conference on Artificial Life (summer 2000). The issues addressed in this survey included artificial life's main successes, main failures, main open scientific questions, and main strategies for the future, as well as the benefits and pitfalls of creating a professional society for artificial life. By illuminating the artificial life community's collective perspective on these issues, this survey illustrates the value of such methods of harnessing the collective intelligence of large stakeholder groups.

100 Metrics to Assess and Communicate the Value of Biomedical Research: An Ideas Book.

PubMed

Guthrie, Susan; Krapels, Joachim; Lichten, Catherine A; Wooding, Steven

2017-01-01

Biomedical research affects society in many ways. It has been shown to improve health, create jobs, add to our knowledge, and foster new collaborations. Despite the complexity of modern research, many of the metrics used to evaluate the impacts of research still focus on the traditional, often academic, part of the research pathway, covering areas such as the amount of grant funding received and the number of peer-reviewed publications. In response to increasing expectations of accountability and transparency, the Association of American Medical Colleges (AAMC), in collaboration with RAND Europe, undertook a project to help communicate the wider value of biomedical research. The initiative developed resources to support academic medical centers in evaluating the outcomes and impacts of their research using approaches relevant to various stakeholders, including patients, providers, administrators, and legislators. This study presents 100 ideas for metrics that can be used to assess and communicate the value of biomedical research. The list is not comprehensive, and the metrics are not fully developed, but they should serve to stimulate and broaden thinking about how academic medical centers can communicate the value of their research to a broad range of stakeholders.

100 Metrics to Assess and Communicate the Value of Biomedical Research

PubMed Central

Guthrie, Susan; Krapels, Joachim; Lichten, Catherine A.; Wooding, Steven

2017-01-01

Abstract Biomedical research affects society in many ways. It has been shown to improve health, create jobs, add to our knowledge, and foster new collaborations. Despite the complexity of modern research, many of the metrics used to evaluate the impacts of research still focus on the traditional, often academic, part of the research pathway, covering areas such as the amount of grant funding received and the number of peer-reviewed publications. In response to increasing expectations of accountability and transparency, the Association of American Medical Colleges (AAMC), in collaboration with RAND Europe, undertook a project to help communicate the wider value of biomedical research. The initiative developed resources to support academic medical centers in evaluating the outcomes and impacts of their research using approaches relevant to various stakeholders, including patients, providers, administrators, and legislators. This study presents 100 ideas for metrics that can be used to assess and communicate the value of biomedical research. The list is not comprehensive, and the metrics are not fully developed, but they should serve to stimulate and broaden thinking about how academic medical centers can communicate the value of their research to a broad range of stakeholders. PMID:28983437

Advancing sustainable bioenergy: Evolving stakeholder interests and the relevance of research

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnson, Timothy L; Bielicki, Dr Jeffrey M; Dodder, Rebecca

2013-01-01

The sustainability of future bioenergy production rests on more than continual improvements in its environmental, economic, and social impacts. The emergence of new biomass feedstocks, an expanding array of conversion pathways, and expected increases in overall bioenergy production are connecting diverse technical, social, and policy communities. These stakeholder groups have different and potentially conflicting values and cultures, and therefore different goals and decision making processes. Our aim is to discuss the implications of this diversity for bioenergy researchers. The paper begins with a discussion of bioenergy stakeholder groups and their varied interests, and illustrates how this diversity complicates efforts tomore » define and promote sustainable bioenergy production. We then discuss what this diversity means for research practice. Researchers, we note, should be aware of stakeholder values, information needs, and the factors affecting stakeholder decision making if the knowledge they generate is to reach its widest potential use. We point out how stakeholder participation in research can increase the relevance of its products, and argue that stakeholder values should inform research questions and the choice of analytical assumptions. Finally, we make the case that additional natural science and technical research alone will not advance sustainable bioenergy production, and that important research gaps relate to understanding stakeholder decision making and the need, from a broader social science perspective, to develop processes to identify and accommodate different value systems. While sustainability requires more than improved scientific and technical understanding, the need to understand stakeholder values and manage diversity presents important research opportunities.« less

Experiences of using a participatory action research approach to strengthen district local capacity in Eastern Uganda

PubMed Central

Tetui, Moses; Coe, Anna-Britt; Hurtig, Anna-Karin; Ekirapa-Kiracho, Elizabeth; Kiwanuka, Suzanne N.

2017-01-01

ABSTRACT Background: To achieve a sustained improvement in health outcomes, the way health interventions are designed and implemented is critical. A participatory action research approach is applauded for building local capacity such as health management. Thereby increasing the chances of sustaining health interventions. Objective: This study explored stakeholder experiences of using PAR to implement an intervention meant to strengthen the local district capacity. Methods: This was a qualitative study featuring 18 informant interviews and a focus group discussion. Respondents included politicians, administrators, health managers and external researchers in three rural districts of eastern Uganda where PAR was used. Qualitative content analysis was used to explore stakeholders’ experiences. Results: ‘Being awakened’ emerged as an overarching category capturing stakeholder experiences of using PAR. This was described in four interrelated and sequential categories, which included: stakeholder involvement, being invigorated, the risk of wide stakeholder engagement and balancing the risk of wide stakeholder engagement. In terms of involvement, the stakeholders felt engaged, a sense of ownership, felt valued and responsible during the implementation of the project. Being invigorated meant being awakened, inspired and supported. On the other hand, risks such as conflict, stress and uncertainty were reported, and finally these risks were balanced through tolerance, risk-awareness and collaboration. Conclusions: The PAR approach was desirable because it created opportunities for building local capacity and enhancing continuity of interventions. Stakeholders were awakened by the approach, as it made them more responsive to systems challenges and possible local solutions. Nonetheless, the use of PAR should be considered in full knowledge of the undesirable and complex experiences, such as uncertainty, conflict and stress. This will enable adequate preparation and management of stakeholder expectations to maximize the benefits of the approach. PMID:28856974

Multicriteria decision analysis: Overview and implications for environmental decision making

USGS Publications Warehouse

Hermans, Caroline M.; Erickson, Jon D.; Erickson, Jon D.; Messner, Frank; Ring, Irene

2007-01-01

Environmental decision making involving multiple stakeholders can benefit from the use of a formal process to structure stakeholder interactions, leading to more successful outcomes than traditional discursive decision processes. There are many tools available to handle complex decision making. Here we illustrate the use of a multicriteria decision analysis (MCDA) outranking tool (PROMETHEE) to facilitate decision making at the watershed scale, involving multiple stakeholders, multiple criteria, and multiple objectives. We compare various MCDA methods and their theoretical underpinnings, examining methods that most realistically model complex decision problems in ways that are understandable and transparent to stakeholders.

Redefining responsible research and innovation for the advancement of biobanking and biomedical research

PubMed Central

Yu, Helen

2016-01-01

Abstract One of the core objectives of responsible research and innovation (RRI) is to maximize the value of publicly funded research so that it may be returned to benefit society. However, while RRI encourages innovation through societal engagement, it can give rise to complex and previously untested issues that challenge the existing legal frameworks on intellectual property (IP) and public entitlement to benefits of research. In the case of biobanking, the personal nature of human biological materials and often altruistic intention of participants to donate samples intensifies the need to adhere to RRI principles with respect to the research, development, and commercialization of innovations derived from biobanks. However, stakeholders participate and collaborate with others in the innovation process to fulfill their own agenda. Without IP to safeguard investments in R&D, stakeholders may hesitate to contribute to the translation of discoveries into innovations. To realize the public benefit objective, RRI principles must protect the interests of stakeholders involved in the translation and commercialization of knowledge. This article explores the seemingly contradictory and competing objectives of open science and commercialization and proposes a holistic innovation framework directed at improving RRI practice for positive impact on obtaining the optimal social and economic values from research. PMID:28852540

From Synergy to Complexity: The Trend Toward Integrated Value Chain and Landscape Governance.

PubMed

Ros-Tonen, Mirjam A F; Reed, James; Sunderland, Terry

2018-07-01

This Editorial introduces a special issue that illustrates a trend toward integrated landscape approaches. Whereas two papers echo older "win-win" strategies based on the trade of non-timber forest products, ten papers reflect a shift from a product to landscape perspective. However, they differ from integrated landscape approaches in that they emanate from sectorial approaches driven primarily by aims such as forest restoration, sustainable commodity sourcing, natural resource management, or carbon emission reduction. The potential of such initiatives for integrated landscape governance and achieving landscape-level outcomes has hitherto been largely unaddressed in the literature on integrated landscape approaches. This special issue addresses this gap, with a focus on actor constellations and institutional arrangements emerging in the transition from sectorial to integrated approaches. This editorial discusses the trends arising from the papers, including the need for a commonly shared concern and sense of urgency; inclusive stakeholder engagement; accommodating and coordinating polycentric governance in landscapes beset with institutional fragmentation and jurisdictional mismatches; alignment with locally embedded initiatives and governance structures; and a framework to assess and monitor the performance of integrated multi-stakeholder approaches. We conclude that, despite a growing tendency toward integrated approaches at the landscape level, inherent landscape complexity renders persistent and significant challenges such as balancing multiple objectives, equitable inclusion of all relevant stakeholders, dealing with power and gender asymmetries, adaptive management based on participatory outcome monitoring, and moving beyond existing administrative, jurisdictional, and sectorial silos. Multi-stakeholder platforms and bridging organizations and individuals are seen as key in overcoming such challenges.

Worlds apart? A scoping review addressing different stakeholder perspectives on barriers to family involvement in the care for persons with severe mental illness.

PubMed

Landeweer, Elleke; Molewijk, Bert; Hem, Marit Helene; Pedersen, Reidar

2017-05-15

Empirical evidence shows that family involvement (FI) can play a pivotal role in the coping and recovery of persons with severe mental illness (SMI). Nevertheless, various studies demonstrate that FI in mental healthcare services is often not (sufficiently) realized. In order to develop more insights, this scoping review gives an overview of how various stakeholders conceptualize, perceive and experience barriers to FI. Central questions are: 1) What are the main barriers to FI reported by the different key stakeholders (i.e. the persons with SMI, their families and the professionals, and 2) What are the differences and similarities between the various stakeholders' perspectives on these barriers. A systematic search into primary studies regarding FI was conducted in four databases: Medline/Pubmed, Cinahl, PsychInfo and Web of Knowledge with the use of a PICO scheme. Thematic analysis focused on stakeholder perspectives (i.e. which stakeholder group reports the barrier) and types of barriers (i.e. which types of barriers are addressed). Thirty three studies were included. The main barriers reported by the stakeholder groups reveal important similarities and differences between the stakeholder groups and were related to: 1) the person with SMI, 2) the family, 3) the professionals, 4) the organization of care and 5) the culture-paradigm. Our stakeholder approach elicits the different stakeholders' concepts, presuppositions and experiences of barriers to FI, and gives fundamental insights on how to deal with barriers to FI. The stakeholders differing interpretations and perceptions of the barriers related to FI is closely related to the inherent complexity involved in FI in itself. In order to deal better with these barriers, openly discussing and reflecting upon each other's normative understandings of barriers is needed. Differences in perceptions of barriers to FI can itself be a barrier. To deal with barriers to FI, a dialogical approach on how the different stakeholders perceive and value FI and its barriers is required. Methods such as moral case deliberation or systematic ethics reflections can be useful.

Bridging clinical researcher perceptions and health IT realities: A case study of stakeholder creep.

PubMed

Panyard, Daniel J; Ramly, Edmond; Dean, Shannon M; Bartels, Christie M

2018-02-01

We present a case report detailing a challenge in health information technology (HIT) project implementations we term "stakeholder creep": not thoroughly identifying which stakeholders need to be involved and why before starting a project, consequently not understanding the true effort, skill sets, social capital, and time required to complete the project. A root cause analysis was performed post-implementation to understand what led to stakeholder creep. HIT project stakeholders were given a questionnaire to comment on these misconceptions and a proposed implementation tool to help mitigate stakeholder creep. Stakeholder creep contributed to an unexpected increase in time (3-month delayed go-live) and effort (68% over expected HIT work hours). Four main clinician/researcher misconceptions were identified that contributed to the development of stakeholder creep: 1) that EHR IT is a single group; 2) that all EHR IT members know the entire EHR functionality; 3) that changes to an EHR need the input of just a single EHR IT member; and 4) that the technological complexity of a project mirrors the clinical complexity. HIT project stakeholders similarly perceived clinicians/researchers to hold these misconceptions. The proposed stakeholder planning tool was perceived to be feasible and helpful. Stakeholder creep can negatively affect HIT project implementations. Projects may be susceptible to stakeholder creep when clinicians/researchers hold misconceptions related to HIT organization and processes. Implementation tools, such as the proposed stakeholder checklist, could be helpful in preempting and mitigating the effect of stakeholder creep. Copyright © 2017 Elsevier B.V. All rights reserved.

Better Buying Power Principles: What Are They

DTIC Science & Technology

2016-02-01

Principles What Are They? Frank Kendall Inevitably, whenever any senior leader embarks on a set of initiatives intended to improve an organization’s...the direction of the title of the initiative by various stakeholders who are trying to show the leader that they are aligned with his or her intent...policies—but they seldom outlast the leaders who spon- sor them, and the hype associated with them usually exceeds their value. The complexity of

The Business Value Web: Resourcing Business Processes and Solutions in Higher Education

ERIC Educational Resources Information Center

Norris, Donald M.; Olson, Mark A.

2003-01-01

Value is the benefit derived from an enterprise's assets by its stakeholders. For colleges and universities, value is derived by students, faculty, staff, other knowledge seekers, alumni, donors, suppliers, and stakeholders. They derive value through experiencing the institution's programs, services, knowledge assets, and other resources. This…

CALFED--An experiment in science and decisionmaking

USGS Publications Warehouse

Taylor, Kimberly A.; Jacobs, Katharine L.; Luoma, Samuel N.

2003-01-01

The CALFED Bay-Delta Program faces a challenging assignment: to develop a collaborative state-federal management plan for the complex river system and involve multiple stakeholders (primarily municipal, agricultural, and environmental entities) whose interests frequently are in direct conflict. Although many resource-management issues involve multiple stakeholders and conflict is integral to their discussion, the CALFED experience is unique because of its shared state and federal roles, the magnitude and significance of stakeholder participation, and the complexity of the scientific issues involved.

Understanding the value of emergency care: a framework incorporating stakeholder perspectives.

PubMed

Sharp, Adam L; Cobb, Enesha M; Dresden, Scott M; Richardson, Derek K; Sabbatini, Amber K; Sauser, Kori; Kocher, Keith E

2014-09-01

In the face of escalating spending, measuring and maximizing the value of health services has become an important focus of health reform. Recent initiatives aim to incentivize high-value care through provider and hospital payment reform, but the role of the emergency department (ED) remains poorly defined. To achieve an improved understanding of the value of emergency care, we have developed a framework that incorporates the perspectives of stakeholders in the delivery of health services. A pragmatic review of the literature informed the design of this framework to standardize the definition of value in emergency care and discuss outcomes and costs from different stakeholder perspectives. The viewpoint of patient, provider, payer, health system, and society is each used to assess value for emergency medical conditions. We found that the value attributed to emergency care differs substantially by stakeholder perspective. Potential targets to improve ED value may be aimed at improving outcomes or controlling costs, depending on the acuity of the clinical condition. The value of emergency care varies by perspective, and a better understanding is achieved when specific outcomes and costs can be identified, quantified, and measured. Using this framework can help stakeholders find common ground to prioritize which costs and outcomes to target for research, quality improvement efforts, and future health policy impacting emergency care. Copyright © 2014 Elsevier Inc. All rights reserved.

Stakeholders apply the GRADE evidence-to-decision framework to facilitate coverage decisions.

PubMed

Dahm, Philipp; Oxman, Andrew D; Djulbegovic, Benjamin; Guyatt, Gordon H; Murad, M Hassan; Amato, Laura; Parmelli, Elena; Davoli, Marina; Morgan, Rebecca L; Mustafa, Reem A; Sultan, Shahnaz; Falck-Ytter, Yngve; Akl, Elie A; Schünemann, Holger J

2017-06-01

Coverage decisions are complex and require the consideration of many factors. A well-defined, transparent process could improve decision-making and facilitate decision-maker accountability. We surveyed key US-based stakeholders regarding their current approaches for coverage decisions. Then, we held a workshop to test an evidence-to-decision (EtD) framework for coverage based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A total of 42 individuals (including 19 US stakeholders as well as international health policymakers and GRADE working group members) attended the workshop. Of the 19 stakeholders, 14 (74%) completed the survey before the workshop. Almost all of their organizations (13 of 14; 93%) used systematic reviews for coverage decision-making; few (2 of 14; 14%) developed their own evidence synthesis; a majority (9 of 14; 64%) rated the certainty of evidence (using various systems); almost all (13 of 14; 93%) denied formal consideration of resource use; and half (7 of 14; 50%) reported explicit criteria for decision-making. At the workshop, stakeholders successfully applied the EtD framework to four case studies and provided narrative feedback, which centered on contextual factors affecting coverage decisions in the United States, the need for reliable data on subgroups of patients, and the challenge of decision-making without formal consideration of resource use. Stakeholders successfully applied the EtD framework to four case studies and highlighted contextual factors affecting coverage decisions and affirmed its value. Their input informed the further development of a revised EtD framework, now publicly available (http://gradepro.org/). Published by Elsevier Inc.

Strategies for Values Inquiry: An Exploratory Case Study

ERIC Educational Resources Information Center

Renger, Ralph; Bourdeau, Beth

2004-01-01

Values inquiry refers to systematic investigation of the values relevant to a program, including understanding those outcomes most prized by stakeholders. Although much attention has been given to stakeholder involvement, the literature on value inquiries per se as an approach is limited. This paper demonstrates how several of the steps used in…

In the eye of the stakeholder: The challenges of governing social forest values.

PubMed

Sténs, Anna; Bjärstig, Therese; Nordström, Eva-Maria; Sandström, Camilla; Fries, Clas; Johansson, Johanna

2016-02-01

This study examines which kinds of social benefits derived from forests are emphasised by Swedish stakeholders and what governance modes and management tools they accept. Our study shows that there exists a great variety among stakeholders' perceptions of forests' social values, where tourism and recreation is the most common reference. There are also differences in preferred governance modes and management where biomass and bioenergy sectors advocate business as usual (i.e. framework regulations and voluntarism) and other stakeholders demand rigid tools (i.e. coercion and targeting) and improved landscape planning. This divide will have implications for future policy orientations and require deliberative policy processes and improved dialogue among stakeholders and authorities. We suggest that there is a potential for these improvements, since actors from almost all stakeholder groups support local influence on governance and management, acknowledged and maintained either by the authorities, i.e. targeting, or by the stakeholders themselves, i.e. voluntarism.

Exploring the perspectives and preferences for HTA across German healthcare stakeholders using a multi-criteria assessment of a pulmonary heart sensor as a case study.

PubMed

Wahlster, Philip; Goetghebeur, Mireille; Schaller, Sandra; Kriza, Christine; Kolominsky-Rabas, Peter

2015-04-28

Health technology assessment and healthcare decision-making are based on multiple criteria and evidence, and heterogeneous opinions of participating stakeholders. Multi-criteria decision analysis (MCDA) offers a potential framework to systematize this process and take different perspectives into account. The objectives of this study were to explore perspectives and preferences across German stakeholders when appraising healthcare interventions, using multi-criteria assessment of a heart pulmonary sensor as a case study. An online survey of 100 German healthcare stakeholders was conducted using a comprehensive MCDA framework (EVIDEM V2.2). Participants were asked to provide i) relative weights for each criterion of the framework; ii) performance scores for a health pulmonary sensor, based on available data synthesized for each criterion; and iii) qualitative feedback on the consideration of contextual criteria. Normalized weights and scores were combined using a linear model to calculate a value estimate across different stakeholders. Differences across types of stakeholders were explored. The survey was completed by 54 participants. The most important criteria were efficacy, patient reported outcomes, disease severity, safety, and quality of evidence (relative weight >0.075 each). Compared to all participants, policymakers gave more weight to budget impact and quality of evidence. The quantitative appraisal of a pulmonary heart sensor revealed differences in scoring performance of this intervention at the criteria level between stakeholder groups. The highest value estimate of the sensor reached 0.68 (on a scale of 0 to 1, 1 representing maximum value) for industry representatives and the lowest value of 0.40 was reported for policymakers, compared to 0.48 for all participants. Participants indicated that most qualitative criteria should be considered and their impact on the quantitative appraisal was captured transparently. The study identified important variations in perspectives across German stakeholders when appraising a healthcare intervention and revealed that MCDA can demonstrate the value of a specified technology for all participating stakeholders. Better understanding of these differences at the criteria level, in particular between policymakers and industry representatives, is important to focus innovation aligned with patient health and healthcare system values and constraints.

Stakeholder value-linked sustainability assessment: Evaluating remedial alternatives for the Portland Harbor Superfund Site, Portland, Oregon, USA.

PubMed

Apitz, Sabine E; Fitzpatrick, Anne G; McNally, Amanda; Harrison, David; Coughlin, Conor; Edwards, Deborah A

2018-01-01

Regulatory decisions on remediation should consider affected communities' needs and values, and how these might be impacted by remedial options; this process requires that diverse stakeholders are able to engage in a transparent consideration of value trade-offs and of the distribution of risks and benefits associated with remedial actions and outcomes. The Stakeholder Values Assessment (SVA) tool was developed to evaluate remedial impacts on environmental quality, economic viability, and social equity in the context of stakeholder values and priorities. Stakeholder values were linked to the pillars of sustainability and also to a range of metrics to evaluate how sediment remediation affects these values. Sediment remedial alternatives proposed by the US Environmental Protection Agency (USEPA) for the Portland Harbor Superfund Site were scored for each metric, based upon data provided in published feasibility study (FS) documents. Metric scores were aggregated to generate scores for each value; these were then aggregated to generate scores for each pillar of sustainability. In parallel, the inferred priorities (in terms of regional remediation, restoration, planning, and development) of diverse stakeholder groups (SGs) were used to evaluate the sensitivity and robustness of the values-based sustainability assessment to diverse SG priorities. This approach, which addresses social indicators of impact and then integrates them with indicators of environmental and economic impacts, goes well beyond the Comprehensive Environmental Response, Compensation and Liability Act's (CERCLA) 9 criteria for evaluating remedial alternatives because it evaluates how remedial alternatives might be ranked in terms of the diverse values and priorities of stakeholders. This approach identified trade-offs and points of potential contention, providing a systematic, semiquantitative, transparent valuation tool that can be used in community engagement. Integr Environ Assess Manag 2018;14:43-62. © 2017 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC). © 2017 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Engaging stakeholders for adaptive management using structured decision analysis

USGS Publications Warehouse

Irwin, Elise R.; Kathryn, D.; Kennedy, Mickett

2009-01-01

Adaptive management is different from other types of management in that it includes all stakeholders (versus only policy makers) in the process, uses resource optimization techniques to evaluate competing objectives, and recognizes and attempts to reduce uncertainty inherent in natural resource systems. Management actions are negotiated by stakeholders, monitored results are compared to predictions of how the system should respond, and management strategies are adjusted in a “monitor-compare-adjust” iterative routine. Many adaptive management projects fail because of the lack of stakeholder identification, engagement, and continued involvement. Primary reasons for this vary but are usually related to either stakeholders not having ownership (or representation) in decision processes or disenfranchisement of stakeholders after adaptive management begins. We present an example in which stakeholders participated fully in adaptive management of a southeastern regulated river. Structured decision analysis was used to define management objectives and stakeholder values and to determine initial flow prescriptions. The process was transparent, and the visual nature of the modeling software allowed stakeholders to see how their interests and values were represented in the decision process. The development of a stakeholder governance structure and communication mechanism has been critical to the success of the project.

Using social network analysis to examine the decision-making process on new vaccine introduction in Nigeria.

PubMed

Wonodi, C B; Privor-Dumm, L; Aina, M; Pate, A M; Reis, R; Gadhoke, P; Levine, O S

2012-05-01

The decision-making process to introduce new vaccines into national immunization programmes is often complex, involving many stakeholders who provide technical information, mobilize finance, implement programmes and garner political support. Stakeholders may have different levels of interest, knowledge and motivations to introduce new vaccines. Lack of consensus on the priority, public health value or feasibility of adding a new vaccine can delay policy decisions. Efforts to support country-level decision-making have largely focused on establishing global policies and equipping policy makers with the information to support decision-making on new vaccine introduction (NVI). Less attention has been given to understanding the interactions of policy actors and how the distribution of influence affects the policy process and decision-making. Social network analysis (SNA) is a social science technique concerned with explaining social phenomena using the structural and relational features of the network of actors involved. This approach can be used to identify how information is exchanged and who is included or excluded from the process. For this SNA of vaccine decision-making in Nigeria, we interviewed federal and state-level government officials, officers of bilateral and multilateral partner organizations, and other stakeholders such as health providers and the media. Using data culled from those interviews, we performed an SNA in order to map formal and informal relationships and the distribution of influence among vaccine decision-makers, as well as to explore linkages and pathways to stakeholders who can influence critical decisions in the policy process. Our findings indicate a relatively robust engagement of key stakeholders in Nigeria. We hypothesized that economic stakeholders and implementers would be important to ensure sustainable financing and strengthen programme implementation, but some economic and implementation stakeholders did not appear centrally on the map; this may suggest a need to strengthen the decision-making processes by engaging these stakeholders more centrally and earlier.

Stakeholder opinions on the use of the added value approach in siting radioactive waste management facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kojo, Matti; Richardson, Phil

In some countries nuclear waste facility siting programs include social and economic benefits, compensation, local empowerment and motivation measures and other incentives for the potential host community. This can generally be referred to as an 'added value approach'. Demonstration of the safety of a repository is seen as a precondition of an added value approach. Recently much focus has been placed on studying and developing public participation approaches but less on the use of such incentive and community benefit packages, although they are becoming a more common element in many site selection strategies for nuclear waste management facilities. The primarymore » objective of this paper is to report on an ongoing study of stakeholders' opinions of the use of an added value approach in siting a radioactive waste facility in the Czech Republic, Poland and Slovenia. The paper argues that an added value approach should adapt to the interests and needs of stakeholders during different stages of a siting process. The main question posed in the study is as follows: What are the measures which should be included in 'added value approach' according to the stakeholders? The research data consists of stakeholders' responses to a survey focusing on the use of added value (community benefits) and incentives in siting nuclear waste management facilities. The survey involved use of a questionnaire developed as part of the EU-funded IPPA* project in three countries: the Czech Republic, Poland and Slovenia. (* Implementing Public Participation Approaches in Radioactive Waste Disposal, FP7 Contract Number: 269849). The target audiences for the questionnaires were the stakeholders represented in the national stakeholder groups established to discuss site selection for a nuclear waste repository in their country. A total of 105 questionnaires were sent to the stakeholders between November 2011 and January 2012. 44 questionnaires were returned, resulting in a total response rate of 41% (10/29 in the Czech Republic, 11/14 in Poland and in 23/64 in Slovenia). (authors)« less

Fuzzy cognitive mapping in support of integrated ecosystem assessments: Developing a shared conceptual model among stakeholders.

PubMed

Vasslides, James M; Jensen, Olaf P

2016-01-15

Ecosystem-based approaches, including integrated ecosystem assessments, are a popular methodology being used to holistically address management issues in social-ecological systems worldwide. In this study we utilized fuzzy logic cognitive mapping to develop conceptual models of a complex estuarine system among four stakeholder groups. The average number of categories in an individual map was not significantly different among groups, and there were no significant differences between the groups in the average complexity or density indices of the individual maps. When ordered by their complexity scores, eight categories contributed to the top four rankings of the stakeholder groups, with six of the categories shared by at least half of the groups. While non-metric multidimensional scaling (nMDS) analysis displayed a high degree of overlap between the individual models across groups, there was also diversity within each stakeholder group. These findings suggest that while all of the stakeholders interviewed perceive the subject ecosystem as a complex series of social and ecological interconnections, there are a core set of components that are present in most of the groups' models that are crucial in managing the system towards some desired outcome. However, the variability in the connections between these core components and the rest of the categories influences the exact nature of these outcomes. Understanding the reasons behind these differences will be critical to developing a shared conceptual model that will be acceptable to all stakeholder groups and can serve as the basis for an integrated ecosystem assessment. Copyright © 2015 Elsevier Ltd. All rights reserved.

Introduced and invasive species in novel rangeland ecosystems: friends or foes?

USGS Publications Warehouse

Belnap, Jayne; Ludwig, John A.; Wilcox, Bradford P.; Betancourt, Julio L.; Dean, W. Richard J.; Hoffmann, Benjamin D.; Milton, Sue J.

2012-01-01

Globally, new combinations of introduced and native plant and animal species have changed rangelands into novel ecosystems. Whereas many rangeland stakeholders (people who use or have an interest in rangelands) view intentional species introductions to improve forage and control erosion as beneficial, others focus on unintended costs, such as increased fire risk, loss of rangeland biodiversity, and threats to conservation efforts, specifically in nature reserves and parks. These conflicting views challenge all rangeland stakeholders, especially those making decisions on how best to manage novel ecosystems. To formulate a conceptual framework for decision making, we examined a wide range of novel ecosystems, created by intentional and unintentional introductions of nonnative species and land-use–facilitated spread of native ones. This framework simply divides decision making into two types: 1) straightforward–certain, and 2) complex–uncertain. We argue that management decisions to retain novel ecosystems are certain when goods and services provided by the system far outweigh the costs of restoration, for example in the case of intensively managed Cenchrus pastures. Decisions to return novel ecosystems to natural systems are also certain when the value of the system is low and restoration is easy and inexpensive as in the case of biocontrol of Opuntia infestations. In contrast, decisions whether to retain or restore novel ecosystems become complex and uncertain in cases where benefits are low and costs of control are high as, for example, in the case of stopping the expansion of Prosopis and Juniperus into semiarid rangelands. Decisions to retain or restore novel ecosystems are also complex and uncertain when, for example, nonnative Eucalyptus trees expand along natural streams, negatively affecting biodiversity, but also providing timber and honey. When decision making is complex and uncertain, we suggest that rangeland managers utilize cost–benefit analyses and hold stakeholder workshops to resolve conflicts.

Techniques for assessing extramarket values

Treesearch

Donald F. Dennis

1995-01-01

Central to effective policy development and management of natural resources is an understanding of the trade-offs stakeholders are willing to accept and the values they hold. Although market prices reflect society's preferences to some degree, they clearly do not encompass all values or costs. Conjoint techniques offer a means to estimate and analyze stakeholder...

Defining Value in Cancer Care: AVBCC 2013 Steering Committee Report.

PubMed

Zweigenhaft, Burt; Bosserman, Linda; Kenney, James T; Lawless, Grant D; Marsland, Thomas A; Deligdish, Craig K; Burgoyne, Douglas S; Knopf, Kevin B; Long, Douglas M; McKercher, Patrick; Owens, Gary M; Hennessy, John E; Lang, James R; Malin, Jennifer; Natelson, Leonard; Palmgren, Matthew C; Slotnik, Jayson; Shockney, Lillie D; Vogenberg, F Randy

2013-07-01

The AVBCC Annual Meeting experiences exponential growth in attendance and participation as oncologists, payers, employers, managed care executives, patient advocates, and drug manufacturers convened in Hollywood, FL, on May 2-5, 2013, for the Third Annual Conference of the Association for Value-Based Cancer Care (AVBCC). The conference presented an all-inclusive open forum for stakeholder dialogue and integration across the cancer care continuum, facilitating an open dialogue among the various healthcare stakeholders to align their perspectives around the urgent need to address value in cancer care, costs, patient education, safety, outcomes, and quality. The AVBCC 2013 Steering Committee was held on the first day of the conference to define value in cancer care. The committee was divided into 7 groups, each representing a key stakeholder in oncology. The goal of the Steering Committee was to define value from the particular point of view of each of the stakeholder groups and to suggest how that particular perspective can contribute to the value proposition in oncology, by balancing cost, quality, and access to care to improve overall patient outcomes. The following summary highlights the major points addressed by each group.

Stakeholders' views on data sharing in multicenter studies.

PubMed

Mazor, Kathleen M; Richards, Allison; Gallagher, Mia; Arterburn, David E; Raebel, Marsha A; Nowell, W Benjamin; Curtis, Jeffrey R; Paolino, Andrea R; Toh, Sengwee

2017-09-01

To understand stakeholders' views on data sharing in multicenter comparative effectiveness research studies and the value of privacy-protecting methods. Semistructured interviews with five US stakeholder groups. We completed 11 interviews, involving patients (n = 15), researchers (n = 10), Institutional Review Board and regulatory staff (n = 3), multicenter research governance experts (n = 2) and healthcare system leaders (n = 4). Perceptions of the benefits and value of research were the strongest influences toward data sharing; cost and security risks were primary influences against sharing. Privacy-protecting methods that share summary-level data were acknowledged as being appealing, but there were concerns about increased cost and potential loss of research validity. Stakeholders were open to data sharing in multicenter studies that offer value and minimize security risks.

Scholarship for Nuclear Communications and Methods for Evaluation of Nuclear Project Acceptability

DOE Office of Scientific and Technical Information (OSTI.GOV)

Golay, Michael

This project aims to go beyond effective communication in understanding how to design nuclear enterprise projects that will gain stakeholder acceptability. Much of what we are studying is generally applicable to controversial projects, and we expect our results to be of broad value beyond the nuclear arena. Acceptability is more than effective communication; it also requires varying degrees of engagement with a disparate number of stakeholder groups. In the nuclear enterprise, previous attempts have been well designed physically (i.e., technologically sound), but have floundered by being insensitive concerning acceptance. Though effective communication is a necessary, but insufficient, condition for suchmore » success, there is a lack of scholarship regarding how to gain stakeholder acceptance for new controversial projects, including nuclear ones. Our work is building a model for use in assessing the performance of a project in the area of acceptability. In the nuclear-social nexus, gaining acceptance requires a clear understanding of factors regarded as being important by the many stakeholders that are common to new nuclear project (many of whom hold an effective veto power). Projects tend to become socially controversial when public beliefs, expert opinion and decision-maker understanding are misaligned. As such, stakeholder acceptance is hypothesized as both an ongoing process and an initial project design parameter comprised of complex, social, cognitive and technical components. Controversial projects may be defined as aspects of modern technologies that some people question, or are cautious about. They could range from genetic modifications, biological hazards, effects of chemical agents, nuclear radiation or hydraulic fracturing operations. We intend that our work will result in a model likely to be valuable for refining project design and implementation to increase the knowledge needed for successful management of stakeholder relationships.« less

Collaborative Response and Recovery from a Foot-and-Mouth Disease Animal Health Emergency: Supporting Decision Making in a Complex Environment with Multiple Stakeholders

DTIC Science & Technology

2013-12-01

RESPONSE AND RECOVERY FROM A FOOT-AND- MOUTH DISEASE ANIMAL HEALTH EMERGENCY: SUPPORTING DECISION MAKING IN A COMPLEX ENVIRONMENT WITH MULTIPLE...Thesis 4. TITLE AND SUBTITLE COLLABORATIVE RESPONSE AND RECOVERY FROM A FOOT-AND- MOUTH DISEASE ANIMAL HEALTH EMERGENCY: SUPPORTING DECISION MAKING...200 words ) This thesis recommends ways to support decision makers who must operate within the multi-stakeholder complex situation of response and

On the use of Empirical Data to Downscale Non-scientific Scepticism About Results From Complex Physical Based Models

NASA Astrophysics Data System (ADS)

Germer, S.; Bens, O.; Hüttl, R. F.

2008-12-01

The scepticism of non-scientific local stakeholders about results from complex physical based models is a major problem concerning the development and implementation of local climate change adaptation measures. This scepticism originates from the high complexity of such models. Local stakeholders perceive complex models as black-box models, as it is impossible to gasp all underlying assumptions and mathematically formulated processes at a glance. The use of physical based models is, however, indispensible to study complex underlying processes and to predict future environmental changes. The increase of climate change adaptation efforts following the release of the latest IPCC report indicates that the communication of facts about what has already changed is an appropriate tool to trigger climate change adaptation. Therefore we suggest increasing the practice of empirical data analysis in addition to modelling efforts. The analysis of time series can generate results that are easier to comprehend for non-scientific stakeholders. Temporal trends and seasonal patterns of selected hydrological parameters (precipitation, evapotranspiration, groundwater levels and river discharge) can be identified and the dependence of trends and seasonal patters to land use, topography and soil type can be highlighted. A discussion about lag times between the hydrological parameters can increase the awareness of local stakeholders for delayed environment responses.

Building a picture: Prioritisation of exotic diseases for the pig industry in Australia using multi-criteria decision analysis.

PubMed

Brookes, V J; Hernández-Jover, M; Cowled, B; Holyoake, P K; Ward, M P

2014-01-01

Diseases that are exotic to the pig industry in Australia were prioritised using a multi-criteria decision analysis framework that incorporated weights of importance for a range of criteria important to industry stakeholders. Measurements were collected for each disease for nine criteria that described potential disease impacts. A total score was calculated for each disease using a weighted sum value function that aggregated the nine disease criterion measurements and weights of importance for the criteria that were previously elicited from two groups of industry stakeholders. One stakeholder group placed most value on the impacts of disease on livestock, and one group placed more value on the zoonotic impacts of diseases. Prioritisation lists ordered by disease score were produced for both of these groups. Vesicular diseases were found to have the highest priority for the group valuing disease impacts on livestock, followed by acute forms of African and classical swine fever, then highly pathogenic porcine reproductive and respiratory syndrome. The group who valued zoonotic disease impacts prioritised rabies, followed by Japanese encephalitis, Eastern equine encephalitis and Nipah virus, interspersed with vesicular diseases. The multi-criteria framework used in this study systematically prioritised diseases using a multi-attribute theory based technique that provided transparency and repeatability in the process. Flexibility of the framework was demonstrated by aggregating the criterion weights from more than one stakeholder group with the disease measurements for the criteria. This technique allowed industry stakeholders to be active in resource allocation for their industry without the need to be disease experts. We believe it is the first prioritisation of livestock diseases using values provided by industry stakeholders. The prioritisation lists will be used by industry stakeholders to identify diseases for further risk analysis and disease spread modelling to understand biosecurity risks to this industry. Copyright © 2013 Elsevier B.V. All rights reserved.

Making Research Results Relevant and Useable: Presenting Complex Organizational Context Data to Nonresearch Stakeholders in the Nursing Home Setting.

PubMed

Estabrooks, Carole A; Knopp-Sihota, Jennifer A; Cummings, Greta G; Norton, Peter G

2016-08-01

The success of evidence-based practice depends on clearly and effectively communicating often complex data to stakeholders. In our program of research, Translating Research in Elder Care (TREC), we focus on improving the quality and safety of care delivered to nursing home residents in western Canada. More specifically, we investigate associations among organizational context, the use of best practices and resident outcomes. Our data are complex and we have been challenged with presenting these data in a way that is not only intuitive, but also useful for our stakeholders. To illustrate a technique of organizing and presenting complex data to nonresearch stakeholders. Using observational data previously collected within the TREC study, we used k-means cluster analysis to categorize nursing home resident care units or facilities within our sample into two distinct groups-those with more favorable contexts (work environment) and those with less favorable contexts. We then produced scatter plots to illustrate group differences between context and various quality indicators among resident care units or facilities. Care aides working on units with more favorable context reported higher use of best practices. When aggregated at the nursing home facility level, facilities with low rates of both urinary tract infections and indwelling catheter use are higher in organizational context. When feeding back these results to stakeholders, we identify their units so that they are able to visually assess their units, both relative to each other and relative to all other units and facilities both within and among provinces. Although we have not formally evaluated this method, we have used it extensively as part of the feedback we provide to stakeholders. As we are examining modifiable aspects of context, the stakeholder can then identify areas for improvement and thus implement a focused plan. © 2016 Sigma Theta Tau International.

Monitoring and Research of the Colorado River Ecosystem: When Is Enough Enough?

NASA Astrophysics Data System (ADS)

Schmidt, J. C.

2014-12-01

The Glen Canyon Dam Adaptive Management Program (GCDAMP) is a well-funded ( $10 million/yr.) river rehabilitation program with long-term monitoring and research focused on 400 km of the Colorado River in Glen, Marble, and Grand Canyons downstream from Lake Powell. More than 15 years of substantive science concerning hydrology, hydraulics, sediment transport, geomorphology, aquatic and fish ecology, riparian ecology, and socio-economics has yielded significant insights that guide experimental river management initiatives, such as a new protocol to annually release sediment-triggered controlled floods; administratively called the High Flow Experimental Protocol (HFEP). Implementation of the HFEP requires nearly real-time monitoring of sediment delivery from key sand producing tributaries, transport in and calculation of sand mass balance in segments of the Colorado River, and defined uncertainty of those processes and conditions (see: http://www.gcmrc.gov/). The HFEP aims to rebuild sandbars within the active channel, but many stakeholders remain focused on other aquatic ecosystem, riparian ecosystem, archaeological resources, or cultural values that are linked in complex ways to active channel conditions. Tension exists within the GCDAMP about how funding is allocated for innovative data collection, analysis, and publication strategies that allow implementation of the HFEP, and to also measure derivative resource conditions about which some stakeholders have concern. Monitoring and research initiatives that attempt to incorporate traditional cultural values also have high uncertainty when resource condition is linked with the simple implementation paradigm of the HFEP. Thus, the GCDAMP is faced with the complex challenge of allocating sufficient resources to monitor active channel processes and characteristics, resolve remaining scientific uncertainties, and develop new strategies for incorporating science insights into engineering and policy decisions, while also monitoring terrestrial resources supported by stakeholders but only indirectly linked with dam operations. The challenge of balancing these scientific and adaptive management objectives is substantial.

Separating 'emotion' from 'the science': Exploring the perceived value of information for parents and families of children with autistic spectrum disorder.

PubMed

O'Reilly, Michelle; Karim, Khalid; Lester, Jessica Nina

2015-07-01

Autistic spectrum disorder (ASD) is a life-long condition. In recent years, there has been a rise in the number of children diagnosed with ASD and a greater recognition that parents need clear, accessible information communicated through different modalities. The objective of this research was to explore the views of stakeholders regarding their information needs, current information modalities and the perceived barriers and complexities of information. Three focus groups with the same stakeholders were conducted with a range of individuals from a variety of backgrounds, all of whom had a personal and/or professional interest in ASD. The same stakeholders were included in all three groups to promote depth of analysis and to facilitate rapport. All focus groups were audio-recorded, transcribed and analysed using thematic analysis. Three main issues were identified, including (1) the value of particular information sources; (2) the vulnerability of families and (3) the need for validated evidence. It was concluded, therefore, that information should be available through a multitude of modalities, accounting for the educational ability and economic status of families. The information should also be communicated in an accessible style, should be presented as trustworthy and clinical professionals may play a key role in translating information. Such information also needs to account for practical problems inherent to having a child with ASD, including time constraints and fatigue. © The Author(s) 2014.

Benefits and Limitations of Real Options Analysis for the Practice of River Flood Risk Management

NASA Astrophysics Data System (ADS)

Kind, Jarl M.; Baayen, Jorn H.; Botzen, W. J. Wouter

2018-04-01

Decisions on long-lived flood risk management (FRM) investments are complex because the future is uncertain. Flexibility and robustness can be used to deal with future uncertainty. Real options analysis (ROA) provides a welfare-economics framework to design and evaluate robust and flexible FRM strategies under risk or uncertainty. Although its potential benefits are large, ROA is hardly used in todays' FRM practice. In this paper, we investigate benefits and limitations of a ROA, by applying it to a realistic FRM case study for an entire river branch. We illustrate how ROA identifies optimal short-term investments and values future options. We develop robust dike investment strategies and value the flexibility offered by additional room for the river measures. We benchmark the results of ROA against those of a standard cost-benefit analysis and show ROA's potential policy implications. The ROA for a realistic case requires a high level of geographical detail, a large ensemble of scenarios, and the inclusion of stakeholders' preferences. We found several limitations of applying the ROA. It is complex. In particular, relevant sources of uncertainty need to be recognized, quantified, integrated, and discretized in scenarios, requiring subjective choices and expert judgment. Decision trees have to be generated and stakeholders' preferences have to be translated into decision rules. On basis of this study, we give general recommendations to use high discharge scenarios for the design of measures with high fixed costs and few alternatives. Lower scenarios may be used when alternatives offer future flexibility.

A conceptual model for the development process of confirmatory adaptive clinical trials within an emergency research network.

PubMed

Mawocha, Samkeliso C; Fetters, Michael D; Legocki, Laurie J; Guetterman, Timothy C; Frederiksen, Shirley; Barsan, William G; Lewis, Roger J; Berry, Donald A; Meurer, William J

2017-06-01

Adaptive clinical trials use accumulating data from enrolled subjects to alter trial conduct in pre-specified ways based on quantitative decision rules. In this research, we sought to characterize the perspectives of key stakeholders during the development process of confirmatory-phase adaptive clinical trials within an emergency clinical trials network and to build a model to guide future development of adaptive clinical trials. We used an ethnographic, qualitative approach to evaluate key stakeholders' views about the adaptive clinical trial development process. Stakeholders participated in a series of multidisciplinary meetings during the development of five adaptive clinical trials and completed a Strengths-Weaknesses-Opportunities-Threats questionnaire. In the analysis, we elucidated overarching themes across the stakeholders' responses to develop a conceptual model. Four major overarching themes emerged during the analysis of stakeholders' responses to questioning: the perceived statistical complexity of adaptive clinical trials and the roles of collaboration, communication, and time during the development process. Frequent and open communication and collaboration were viewed by stakeholders as critical during the development process, as were the careful management of time and logistical issues related to the complexity of planning adaptive clinical trials. The Adaptive Design Development Model illustrates how statistical complexity, time, communication, and collaboration are moderating factors in the adaptive design development process. The intensity and iterative nature of this process underscores the need for funding mechanisms for the development of novel trial proposals in academic settings.

Defining Value in Cancer Care: AVBCC 2013 Steering Committee Report

PubMed Central

Zweigenhaft, Burt; Bosserman, Linda; Kenney, James T.; Lawless, Grant D.; Marsland, Thomas A.; Deligdish, Craig K.; Burgoyne, Douglas S.; Knopf, Kevin B.; Long, Douglas M.; McKercher, Patrick; Owens, Gary M.; Hennessy, John E.; Lang, James R.; Malin, Jennifer; Natelson, Leonard; Palmgren, Matthew C.; Slotnik, Jayson; Shockney, Lillie D.; Vogenberg, F. Randy

2013-01-01

The AVBCC Annual Meeting experiences exponential growth in attendance and participation as oncologists, payers, employers, managed care executives, patient advocates, and drug manufacturers convened in Hollywood, FL, on May 2–5, 2013, for the Third Annual Conference of the Association for Value-Based Cancer Care (AVBCC). The conference presented an all-inclusive open forum for stakeholder dialogue and integration across the cancer care continuum, facilitating an open dialogue among the various healthcare stakeholders to align their perspectives around the urgent need to address value in cancer care, costs, patient education, safety, outcomes, and quality. The AVBCC 2013 Steering Committee was held on the first day of the conference to define value in cancer care. The committee was divided into 7 groups, each representing a key stakeholder in oncology. The goal of the Steering Committee was to define value from the particular point of view of each of the stakeholder groups and to suggest how that particular perspective can contribute to the value proposition in oncology, by balancing cost, quality, and access to care to improve overall patient outcomes. The following summary highlights the major points addressed by each group. PMID:24991360

A Framework for Multi-Stakeholder Decision-Making and Conflict Resolution (abstract)

EPA Science Inventory

This contribution describes the implementation of the conditional-value-at-risk (CVaR) metric to create a general multi-stakeholder decision-making framework. It is observed that stakeholder dissatisfactions (distance to their individual ideal solutions) can be interpreted as ran...

A framework for multi-stakeholder decision-making and conflict resolution

EPA Science Inventory

We propose a decision-making framework to compute compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives. In our setting, we shape the stakeholder dis-satisfaction distribution by solving a conditional-value-at-risk (CVaR) minimiz...

Futuragua: Fostering Cross-Scale Knowledge to Inform Social-Environmental Decision Processes for Building Drought Resilience in Highly Seasonal Environments

NASA Astrophysics Data System (ADS)

McDaniels, T.; Steyn, D. G.; Johnson, M. S.; Small, M.; Leclerc, G.; Vignola, R.; Chan, K.; Grossmann, I.; Wong-Parodi, G.

2014-12-01

Improving resilience to drought in complex social-environmental systems (SES) is extraordinarily important, particularly for rural tropical locations where small changes in climate regimes can have dramatic SES impacts. Efforts to build drought resilience must necessarily be planned and implemented within SES governance systems that involve linkages in water and land use administration from local to national levels. These efforts require knowledge and understanding that links climate and weather forecasts to regional and local hydrology, to social-economic and environmental systems, and to governance processes. In order to provide structure for such complex choices and investments, we argue that a focus on structured decision processes that involve linkages among science, technological perspectives, and public values conducted with agencies and stakeholders will provide a crucial framework for comparing and building insight for pursuing alternative courses of action to build drought resilience. This paper focuses on a regional case study in the seasonally-dry northwest region of Costa Rica, in watersheds rated as most threatened in the country in terms of drought. We present the overall framework guiding the transdisciplinary efforts to link scientific and technical understanding to public values, in order to foster civil society actions that lead to improved drought resilience. Initial efforts to characterize hydrological and climate regimes will be reported along with our approach to linking natural science findings, social inventories in terms of perspectives on SES, and the psychology and patterns of reliance on forecast information that provide the basis for characterizing public understanding. The overall linkage of technical and value information is focused on creating and comparing alternative actions that can potentially build resilience in short and long time frames by building decision making processes involving stakeholders, agencies and interested parties.

Value Perceptions as Influences upon Engagement

ERIC Educational Resources Information Center

Swanson, Lee A.

2009-01-01

This study was designed to assess whether changes in stakeholders' perceptions about the value generated by an institution might influence the nature of their engagement with it. Quantitative and qualitative analysis of research data revealed a positive correlation between stakeholders who believed an institution generated social or economic value…

Moral dimensions of human-wildlife conflict.

PubMed

Lute, Michelle L; Navarrete, Carlos David; Nelson, Michael Paul; Gore, Meredith L

2016-12-01

Despite increasing support for conservation globally, controversy over specific conservation policies persists among diverse stakeholders. Investigating the links between morals in relation to conservation can help increase understanding about why humans support or oppose policy, especially related to human-wildlife conflict or human conflict over wildlife. Yet the moral dimension of human-wildlife conflict has mostly gone unconsidered and unmeasured; thus, policy and programmatic efforts to reduce controversy may be missing a key part of the equation. We conducted a web-based survey (n = 1239 respondents) in Michigan (U.S.A.) to investigate cognitive and emotional influences on the value-behavior relationship. Respondents were identified by their interest and involvement in Michigan wolf management. The survey consisted of questions about values, emotions, cognitions, and behaviors relative to wolves in Michigan. We used path analysis to explore whether emotions and cognitions mediated the relationship between value and behavior. Most respondents attributed intrinsic value to wolves (n = 734) and all life (n = 773) and engaged in behaviors that benefited wolf populations and ecosystems regardless of stakeholder group (e.g., environmentalist, farmer). Attributing intrinsic value to wolves was positively related to favorable emotions toward wolves and cognitive assessments that hunting and trapping of wolves is unacceptable. Despite similarities in attribution of intrinsic value, groups differed in emotions and cognitions about wolf hunting. These differences provide a useful way to predict stakeholder behavior. Our findings may inform interventions aimed at increasing support for wolf management policies and positive interactions among stakeholders and wildlife. Leveraging agreement over intrinsic value may foster cooperation among stakeholders and garner support for controversial conservation policy. © 2016 Society for Conservation Biology.

Systematic Identification of Stakeholders for Engagement with Systems Modeling Efforts in the Snohomish Basin, Washington, USA

EPA Science Inventory

Even as stakeholder engagement in systems dynamic modeling efforts is increasingly promoted, the mechanisms for identifying which stakeholders should be included are rarely documented. Accordingly, for an Environmental Protection Agency’s Triple Value Simulation (3VS) mode...

Measuring value for low-acuity care across settings.

PubMed

Morgan, Sofie Rahman; Smith, Meaghan A; Pitts, Stephen R; Shesser, Robert; Uscher-Pines, Lori; Ward, Michael J; Pines, Jesse M

2012-09-01

Increasing healthcare costs have created an emphasis on improving value, defined as how invested time, money, and resources improve health. The role of emergency departments (EDs) within value-driven health systems is still undetermined. Often questioned is the value of an ED visit for conditions that could be reasonably treated elsewhere such as office-based, urgent, and retail clinics. This paper presents a conceptual approach to assess the value of these low-acuity visits. It adapts an existing analytic model to highlight specific factors that impact key stakeholders' (patients, insurers, and society) assessments of the value of ED-based care compared with care in alternative settings. These factors are presented in 3 equations, 1 for each stakeholder, emphasizing how tangible and intangible benefits of care weigh against direct and indirect costs and how each perspective influences value. Aligning value among groups could allow stakeholders to influence each other and could guide rational change in the delivery of acute medical care for low-acuity conditions.

Quality control of goji (fruits of Lycium barbarum L. and L. chinense Mill.): A value chain analysis perspective.

PubMed

Yao, Ruyu; Heinrich, Michael; Wang, Zigui; Weckerle, Caroline S

2018-06-14

Goji (fruits of Lycium barbarum L. and L. chinense Mill., Solanaceae) have been used as a traditional food and medicine for hundreds of years in Asian countries and are now consumed globally. Quality of herbal medicines is critical for safe use and has been shown to be affected by value chains. Using a value chain (VC) framework, we aim at understanding the influence of different VC types on goji quality and revenue of stakeholders. Participant observation and semi-structured interviews were conducted during five months of fieldwork in the main production areas in China with a total of 65 stakeholders. Quality of goji, behaviour and financial performance of stakeholders was documented and analysed for different VCs. Ten different types of VCs were identified. VCs with vertical integration and horizontal collaboration were found to have a more coherent quality control and better goji quality as well as improved stakeholders' financial performance. Vertical integration at different levels was found for independent farmer-based VCs, horizontal collaboration was found in the cooperative-based VCs. Full vertically integrated VCs were found in large-scale production. Goji quality and stakeholders' revenues are linked with different types of VCs which mirror stakeholders' behaviour driven by target markets. Considering their positive influence on quality and revenues, well-developed vertically integrated value chains are likely to become more important in the near future. Copyright © 2018. Published by Elsevier B.V.

Stakeholder influence in public sector information systems strategy implementation-The case of public hospitals in South Africa.

PubMed

Hwabamungu, Boroto; Brown, Irwin; Williams, Quentin

2018-01-01

Recent literature on organisational strategy has called for greater emphasis on individuals (stakeholders) and what they do in the process of strategizing. Public sector organisations have to engage with an array of heterogeneous stakeholders in fulfilling their mandate. The public health sector in particular needs to engage with a diversity of stakeholders at local, regional and national levels when strategising. The purpose of this study is to investigate the influence of stakeholder relations on the implementation of Information Systems (IS) strategy in public hospitals in South Africa. An interpretive approach using two provinces was employed. The Activity Analysis and Development (ActAD) framework, an enhanced form of activity theory, was used as the theoretical framework. Data was collected using semi-structured interviews, meetings, documents analysis, physical artefacts and observation. The collected data was analysed using thematic analysis. Findings reveal that IS strategy implementation in public hospitals involves a large and complex network of stakeholder groups at different levels, and over different time periods. These stakeholder groups act in accordance with formal and informal roles, rules and modalities. Various contextual conditions together with the actions of, and interactions between stakeholder groups give rise to the situationality of stakeholder relations dynamics and strategy implementation. The multiple actions and interactions over time lead to the realisation of some aspects of the IS strategy in public hospitals. Given the complexity and dynamism of the context there are also certain unplanned implementations as well. These relationships are captured in a Stakeholder Relations Influence (SRI) framework. The SRI framework can be assistive in the assessment and mapping of stakeholders and stakeholder relations, and the assessment of the implications of these relations for effective IS strategy implementation in public hospitals. The framework can also provide the basis for the development of appropriate corrective measures in the implementation of strategies and policies in public institutions such as public hospitals. Copyright © 2017 Elsevier B.V. All rights reserved.

Stakeholders' Views of South Korea's Higher Education Internationalization Policy

ERIC Educational Resources Information Center

Cho, Young Ha; Palmer, John D.

2013-01-01

The study investigated the stakeholders' perceptions of South Korea's higher education internationalization policy. Based on the research framework that defines four policy values--propriety, effectiveness, diversity, and engagement, the convergence model was employed with a concurrent mixed method sampling strategy to analyze the stakeholders'…

A Marketing Plan for Scientists: Building Effective Products and Connecting with Stakeholders in Meaningful Ways

EPA Science Inventory

A disconnect often occurs between the creation of scientific research outputs and their use by intended stakeholders. Even with the diligent efforts of scientists to create products of value, many scientific outputs are underutilized by intended stakeholders. Marketing methods ca...

Implementation of cardiovascular disease prevention in primary health care: enhancing understanding using normalisation process theory.

PubMed

Volker, Nerida; Williams, Lauren T; Davey, Rachel C; Cochrane, Thomas; Clancy, Tanya

2017-02-24

The reorientation of primary health care towards prevention is fundamental to addressing the rising burden of chronic disease. However, in Australia, cardiovascular disease prevention practice in primary health care is not generally consistent with existing guidelines. The Model for Prevention study was a whole-of-system cardiovascular disease prevention intervention, with one component being enhanced lifestyle modification support and addition of a health coaching service in the general practice setting. To determine the feasibility of translating intervention outcomes into real world practice, implementation work done by stakeholders was examined using Normalisation Process Theory as a framework. Data was collected through interviews with 40 intervention participants and included general practitioners, practice nurses, practice managers, lifestyle advisors and participants. Data analysis was informed by normalisation process theory constructs. Stakeholders were in agreement that, while prevention is a key function of general practice, it was not their usual work. There were varying levels of engagement with the intervention by practice staff due to staff interest, capacity and turnover, but most staff reconfigured their work for required activities. The Lifestyle Advisors believed staff had varied levels of interest in and understanding of, their service, but most staff felt their role was useful. Patients expanded their existing relationships with their general practice, and most achieved their lifestyle modification goals. While the study highlighted the complex nature of the change required, many of the new or enhanced processes implemented as part of the intervention could be scaled up to improve the systems approach to prevention. Overcoming the barriers to change, such as the perception of CVD prevention as a 'hard sell', is going to rely on improving the value proposition for all stakeholders. The study provided a detailed understanding of the work required to implement a complex cardiovascular disease prevention intervention within general practice. The findings highlighted the need for multiple strategies that engage all stakeholders. Normalisation process theory was a useful framework for guiding change implementation.

Business Modeling to Implement an eHealth Portal for Infection Control: A Reflection on Co-Creation With Stakeholders.

PubMed

van Limburg, Maarten; Wentzel, Jobke; Sanderman, Robbert; van Gemert-Pijnen, Lisette

2015-08-13

It is acknowledged that the success and uptake of eHealth improve with the involvement of users and stakeholders to make technology reflect their needs. Involving stakeholders in implementation research is thus a crucial element in developing eHealth technology. Business modeling is an approach to guide implementation research for eHealth. Stakeholders are involved in business modeling by identifying relevant stakeholders, conducting value co-creation dialogs, and co-creating a business model. Because implementation activities are often underestimated as a crucial step while developing eHealth, comprehensive and applicable approaches geared toward business modeling in eHealth are scarce. This paper demonstrates the potential of several stakeholder-oriented analysis methods and their practical application was demonstrated using Infectionmanager as an example case. In this paper, we aim to demonstrate how business modeling, with the focus on stakeholder involvement, is used to co-create an eHealth implementation. We divided business modeling in 4 main research steps. As part of stakeholder identification, we performed literature scans, expert recommendations, and snowball sampling (Step 1). For stakeholder analyzes, we performed "basic stakeholder analysis," stakeholder salience, and ranking/analytic hierarchy process (Step 2). For value co-creation dialogs, we performed a process analysis and stakeholder interviews based on the business model canvas (Step 3). Finally, for business model generation, we combined all findings into the business model canvas (Step 4). Based on the applied methods, we synthesized a step-by-step guide for business modeling with stakeholder-oriented analysis methods that we consider suitable for implementing eHealth. The step-by-step guide for business modeling with stakeholder involvement enables eHealth researchers to apply a systematic and multidisciplinary, co-creative approach for implementing eHealth. Business modeling becomes an active part in the entire development process of eHealth and starts an early focus on implementation, in which stakeholders help to co-create the basis necessary for a satisfying success and uptake of the eHealth technology.

Value of decision analysis in stakeholder interactions for the restoration and recovery from the Gulf of Mexico oil spill

EPA Science Inventory

The importance of stakeholder involvement in the management of watersheds is receiving greater recognition than in the past; however, interacting with stakeholders is frequently accomplished using informal procedures. It is essential to structure elicitations so that they can be ...

Integration: valuing stakeholder input in setting priorities for socially sustainable egg production.

PubMed

Swanson, J C; Lee, Y; Thompson, P B; Bawden, R; Mench, J A

2011-09-01

Setting directions and goals for animal production systems requires the integration of information achieved through internal and external processes. The importance of stakeholder input in setting goals for sustainable animal production systems should not be overlooked by the agricultural animal industries. Stakeholders play an integral role in setting the course for many aspects of animal production, from influencing consumer preferences to setting public policy. The Socially Sustainable Egg Production Project (SSEP) involved the development of white papers on various aspects of egg production, followed by a stakeholder workshop to help frame the issues for the future of sustainable egg production. Representatives from the environmental, food safety, food retail, consumer, animal welfare, and the general farm and egg production sectors participated with members of the SSEP coordination team in a 1.5-d workshop to explore socially sustainable egg production. This paper reviews the published literature on values integration methodologies and the lessons learned from animal welfare assessment models. The integration method used for the SSEP stakeholder workshop and its outcome are then summarized. The method used for the SSEP stakeholder workshop can be used to obtain stakeholder input on sustainable production in other farm animal industries.

An integrated multi-criteria scenario evaluation web tool for participatory land-use planning in urbanized areas: The Ecosystem Portfolio Model

USGS Publications Warehouse

Labiosa, Bill; Forney, William M.; Hearn,, Paul P.; Hogan, Dianna M.; Strong, David R.; Swain, Eric D.; Esnard, Ann-Margaret; Mitsova-Boneva, D.; Bernknopf, R.; Pearlstine, Leonard; Gladwin, Hugh

2013-01-01

Land-use land-cover change is one of the most important and direct drivers of changes in ecosystem functions and services. Given the complexity of the decision-making, there is a need for Internet-based decision support systems with scenario evaluation capabilities to help planners, resource managers and communities visualize, compare and consider trade-offs among the many values at stake in land use planning. This article presents details on an Ecosystem Portfolio Model (EPM) prototype that integrates ecological, socio-economic information and associated values of relevance to decision-makers and stakeholders. The EPM uses a multi-criteria scenario evaluation framework, Geographic Information Systems (GIS) analysis and spatially-explicit land-use/land-cover change-sensitive models to characterize changes in important land-cover related ecosystem values related to ecosystem services and functions, land parcel prices, and community quality-of-life (QoL) metrics. Parameters in the underlying models can be modified through the interface, allowing users in a facilitated group setting to explore simultaneously issues of scientific uncertainty and divergence in the preferences of stakeholders. One application of the South Florida EPM prototype reported in this article shows the modeled changes (which are significant) in aggregate ecological value, landscape patterns and fragmentation, biodiversity potential and ecological restoration potential for current land uses compared to the 2050 land-use scenario. Ongoing refinements to EPM, and future work especially in regard to modifiable sea level rise scenarios are also discussed.

Bringing the ecosystem services concept into marine management decisions, supporting ecosystems-based management.

NASA Astrophysics Data System (ADS)

Tweddle, J. F.; Byg, A.; Davies, I.; Gubbins, M.; Irvine, K.; Kafas, A.; Kenter, J.; MacDonald, A.; Murray, R. B. O.; Potts, T.; Slater, A. M.; Wright, K.; Scott, B. E.

2016-02-01

The marine environment is under increasing use, putting pressure on marine ecosystems and increasing competition for space. New activities (e.g. renewable energy developments), evolving marine policies (e.g. implementation of marine protected areas), and climate change may drive changes in biodiversity and resulting ecosystem services (ES) that society and business utilise from coastal and marine systems. A process is needed that integrates ecological assessment of changes with stakeholder perceptions and valuation of ES, whilst balancing ease of application with the ability to deal with complex social-economic-ecological issues. The project "Cooperative participatory assessment of the impact of renewable technology on ecosystem services: CORPORATES" involved natural and social scientists, law and policy experts, and marine managers, with the aim of promoting more integrated decision making using ES concepts in marine management. CORPORATES developed a process to bring ES concepts into stakeholders' awareness. The interactive process, involving 2 workshops, employs interludes of knowledge exchange by experts on ecological processes underpinning ES and on law and policy. These enable mapping of benefits linked to activities, participatory system modelling, and deliberation of policy impacts on different sectors. The workshops were attended by industry representatives, regulatory/advisory partners, and other stakeholders (NGOs, SMEs, recreationalists, local government). Mixed sector groups produced new insights into links between activities and ES, and highlighted cross-sector concerns. Here we present the aspects of the process that successfully built shared understanding between industry and stakeholders of inter-linkages and interactions between ES, benefits, activities, and economic and cultural values. These methods provide an ES-based decision-support model for exchanging societal-ecological knowledge and providing stakeholder interaction in marine planning, supporting ecosystem-based management.

Bringing the ecosystem services concept into marine management decisions, supporting ecosystems-based management.

NASA Astrophysics Data System (ADS)

Tweddle, J. F.; Byg, A.; Davies, I.; Gubbins, M.; Irvine, K.; Kafas, A.; Kenter, J.; MacDonald, A.; Murray, R. B. O.; Potts, T.; Slater, A. M.; Wright, K.; Scott, B. E.

2016-12-01

The marine environment is under increasing use, putting pressure on marine ecosystems and increasing competition for space. New activities (e.g. renewable energy developments), evolving marine policies (e.g. implementation of marine protected areas), and climate change may drive changes in biodiversity and resulting ecosystem services (ES) that society and business utilise from coastal and marine systems. A process is needed that integrates ecological assessment of changes with stakeholder perceptions and valuation of ES, whilst balancing ease of application with the ability to deal with complex social-economic-ecological issues. The project "Cooperative participatory assessment of the impact of renewable technology on ecosystem services: CORPORATES" involved natural and social scientists, law and policy experts, and marine managers, with the aim of promoting more integrated decision making using ES concepts in marine management. CORPORATES developed a process to bring ES concepts into stakeholders' awareness. The interactive process, involving 2 workshops, employs interludes of knowledge exchange by experts on ecological processes underpinning ES and on law and policy. These enable mapping of benefits linked to activities, participatory system modelling, and deliberation of policy impacts on different sectors. The workshops were attended by industry representatives, regulatory/advisory partners, and other stakeholders (NGOs, SMEs, recreationalists, local government). Mixed sector groups produced new insights into links between activities and ES, and highlighted cross-sector concerns. Here we present the aspects of the process that successfully built shared understanding between industry and stakeholders of inter-linkages and interactions between ES, benefits, activities, and economic and cultural values. These methods provide an ES-based decision-support model for exchanging societal-ecological knowledge and providing stakeholder interaction in marine planning, supporting ecosystem-based management.

Factors influencing the adoption and implementation of teledentistry in the UK, with a focus on orthodontics.

PubMed

Patel, Reena N; Antonarakis, Gregory S

2013-10-01

Utilizing Rogers' diffusion of innovation theory, this study aims to develop a better understanding of the challenges faced in teledental projects, and outline the factors that impact upon the adoption and implementation of teledental projects, with a focus on orthodontics, thus attempting to provide an explanation for the low uptake in the UK, as well as to suggest factors to encourage success. A literature search was carried out to obtain information concerning teledentistry (and telemedicine) from both primary and secondary research sources. Using the relevant information obtained, Rogers' diffusion of innovation theory was used as a framework, which was subsequently applied to the key stakeholder groups of a healthcare organization. The model describes five characteristics of an innovation: relative advantage, compatibility, complexity, trialability and observability. These attributes are discussed in the context of key stakeholder groups within a healthcare organization: clinicians, patients, hospital managers, and healthcare decision-makers and funders. Each stakeholder group is motivated by different values and experiences, which in turn influence their decision to adopt a new technology. Implementing teledental applications necessitates full comprehension and consideration of the healthcare environment and also a commitment to completely integrate teledentistry within that environment. This is a process that demands strategic alignment with clinical and organizational goals, clinical engagement and strong political support. The challenges within each stakeholder group must be specifically targeted. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Stakeholder values and ecosystems in developing open access to research data.

NASA Astrophysics Data System (ADS)

Wessels, Bridgette; Sveinsdottir, Thordis; Smallwood, Rod

2014-05-01

One aspect of understanding how to develop open access to research data is to understand the values of stakeholders in the emerging open data ecosystem. The EU FP7 funded project Policy RECommendations for Open Access to Research Data in Europe (RECODE) (Grant Agreement No: 321463) undertook such research to identify stakeholder values and mapped the emerging ecosystem. In this paper we outline and discuss the findings of this research. We address three key objectives, which are: (a) the identification and mapping of the diverse range of stakeholder values in Open Access data and data dissemination and preservation; (b) mapping stakeholder values on to research ecosystems using case studies from different disciplinary perspectives; and (c) evaluate and identify good practice in addressing conflicting value chains and stakeholder fragmentation. The research was structured on three related actions: (a) an analysis of policy and related documents and protocols, in order to map the formal expression of values and motivations; (b) conducting five case studies in particle physics, health sciences, bioengineering, environmental research and archaeology. These explored issues of data size; quality control, ethics and data security; replication of large datasets; interoperability; and the preservation of diverse types of data; and (c) undertaking a validation and dissemination workshop that sought to better understand how to match policies with stakeholder drivers and motivations to increase their effectiveness in promoting Open Access to research data. The research findings include that there is clearly an overall drive for Open Data Access within the policy documents, which is part of a wider drive for open science in general. This is underpinned by the view of science as an open enterprise. Although there is a strong argument for publicly funded science to be made open to the public the details of how to make research data open as yet still unclear. Our research found that discussions of Open Data tend to refer to science as a single sector, leading to differences between disciplines being ignored in policy making. Each discipline has different methods for gathering and analysing data, some disciplines deal with sensitive data, and others deal with data that may have IPR or legal issues. We recommend that these differences are recognised, as they will inform the debate about subject specific requirements and common infrastructures for Open Data Access.

Engaging civil society through deliberative dialogue to create the first Mental Health Strategy for Canada: Changing Directions, Changing Lives.

PubMed

Mulvale, Gillian; Chodos, Howard; Bartram, Mary; MacKinnon, Mary Pat; Abud, Manon

2014-12-01

Citizen engagement through deliberative dialogue is increasingly being used to address 'wicked problems' in policy-making, such as the development of national mental health policy. In 2012, the Mental Health Commission of Canada (MHCC), a national organization funded by and operating at arm's length from the federal government, released the first Mental Health Strategy for Canada: Changing Directions, Changing Lives (Mental Health Commission of Canada, 2012). Despite much-needed reform, Canada, unlike most other industrialized countries, had never previously developed a national Mental Health Strategy (the Strategy). This was due to a mix of policy factors, including a federalist system of government where primary responsibility for healthcare resides with provincial and territorial governments and a highly diverse set of stakeholder groups with diverging core ideas for mental health reform that were rooted in deeply held value differences. In this case study, we review the essential role that engagement of civil society played in the creation of the Strategy, beginning with the efforts to create a national body to shine the light on the need for mental health reform in Canada, followed by the development of a framework of specific goals based on core principles to guide the development of the Strategy, and ultimately, the creation of the Strategy itself. We discuss the various approaches to civil society engagement in each step of this process and focus in particular on how deliberative approaches helped build trust and common ground amongst stakeholders around complex, and often contentious, issues. The nature and outcomes of the deliberative processes including the key tensions between different stakeholder perspectives and values are described. We close by highlighting the lessons learned in a process that culminated with a Strategy that received strong endorsement from stakeholders across Canada. Mental Health Commission of Canada (2012). Changing Directions Changing Lives, The Mental Health Strategy for Canada. Calgary, AB: MHCC. Copyright © 2014 Elsevier Ltd. All rights reserved.

Sustainable Land Management and Adult Education: Issues for the Stakeholders of Australia's Tropical Savannas.

ERIC Educational Resources Information Center

Benson, Rebecca

1998-01-01

Sustainable land management is an important consideration for stakeholders in Australia's tropical savannas. Land-management-education providers must deal with issues of access and the impact of values and perceptions on behavior. Adult educators must take on the role of negotiating attitudes and beliefs among stakeholders. (SK)

The Evolving Identity of School Counselors as Defined by the Stakeholders

ERIC Educational Resources Information Center

Perkins, Gerra; Oescher, Jeffrey; Ballard, Mary B.

2010-01-01

To better understand the evolving identity of school counselors, this article examines the value stakeholders place on the roles of elementary school counselors. The School Counselor Role Survey (SCRS) was administered to assess stakeholders' perceptions of the importance of the school counselor roles advocated by The Education Trust and the…

Modeling for Ecosystem Services: Challenges and Opportunities

NASA Astrophysics Data System (ADS)

Guswa, A. J.; Brauman, K. A.; Ghile, Y.

2012-12-01

Ecosystem services are those values provided to human society by the structure and processes of ecosystems and landscapes. Water-related services include the transformation of precipitation impulses into supplies of water for hydropower, irrigation, and industrial and municipal uses, the retention and removal of applied nutrients and pollutants, flood-damage mitigation, recreation, and the provision of cultural and aesthetic values. Incorporation of changes to the value of these services in land-use planning and decision making requires identification of the relevant services, engagement of stakeholders, knowledge of how land-use changes impact water quality, quantity, and timing, and mechanisms for putting value on the hydrologic and biogeochemical changes. We present three examples that highlight the characteristics, challenges, and opportunities associated with prototypical decisions that incorporate ecosystem services values: scenario analysis, payment for ecosystem services, and optimal spatial planning. Through these examples, we emphasize the challenges of data availability, model resolution and complexity, and attribution of value. We also provide some suggestions for ways forward.

Nuclear waste transportation: case studies of identifying stakeholder risk information needs.

PubMed Central

Drew, Christina H; Grace, Deirdre A; Silbernagel, Susan M; Hemmings, Erin S; Smith, Alan; Griffith, William C; Takaro, Timothy K; Faustman, Elaine M

2003-01-01

The U.S. Department of Energy (DOE) is responsible for the cleanup of our nation's nuclear legacy, involving complex decisions about how and where to dispose of nuclear waste and how to transport it to its ultimate disposal site. It is widely recognized that a broad range of stakeholders and tribes should be involved in this kind of decision. All too frequently, however, stakeholders and tribes are only invited to participate by commenting on processes and activities that are near completion; they are not included in the problem formulation stages. Moreover, it is often assumed that high levels of complexity and uncertainty prevent meaningful participation by these groups. Considering the types of information that stakeholders and tribes need to be able to participate in the full life cycle of decision making is critical for improving participation and transparency of decision making. Toward this objective, the Consortium for Risk Evaluation with Stakeholder Participation (CRESP) participated in three public processes relating to nuclear waste transportation and disposal in 1997-1998. First, CRESP organized focus groups to identify concerns about nuclear waste transportation. Second, CRESP conducted exit surveys at regional public workshops held by DOE to get input from stakeholders on intersite waste transfer issues. Third, CRESP developed visual tools to synthesize technical information and allow stakeholders and tribes with varying levels of knowledge about nuclear waste to participate in meaningful discussion. In this article we share the results of the CRESP findings, discuss common themes arising from these interactions, and comment on special considerations needed to facilitate stakeholder and tribal participation in similar decision-making processes. PMID:12611653

How Do Stakeholders Engaged in School-University Partnerships Create Value for Their Own Organizations?

ERIC Educational Resources Information Center

Cuppett, Kevin S.

2014-01-01

The purpose of this study was to determine how stakeholders engaged in school-university partnerships, specifically in the work preparing future school administrators, created and captured value for their own organizations. These case studies examined three partnerships that involved three school systems who all partnered with the same college,…

Methodology for fleet deployment decisions. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stremel, J.; Matousek, M.

1995-01-01

In today`s more competitive energy market, selecting investment and operating plans for a generating system, specific plants, and major plant components is becoming increasingly critical and complex. As utilities consider off-system sales, the key factor for fleet deployment decisions is no longer simply minimizing revenue requirements. Rather, system-level value dominates. This is a measure that can be difficult to determine in the context of traditional decision making methods. Selecting the best fleet deployment option requires the ability to account for multiple sources of value under uncertain conditions for multiple utility stakeholders. The object of this paper was to develope andmore » test an approach for assessing the system-wide value of alternative fleet deployment decisions. This was done, and the approach was tested at Consolidated Edison and at Central Illinois Public Service Company.« less

Stakeholder Analysis in Utilizing of Environmental Services and Natural Attractions in Tuk Semuncar Utilization Zone of Gunung Merbabu National Park: A literature review

NASA Astrophysics Data System (ADS)

Setiawan, Muhammad Arif; Muhammad, Fuad

2018-02-01

Many stakeholders in the utilizing of environmental services and natural attraction of Tuk Semuncar Utilization Zone needs to get the attention of the Gunung Merbabu National Park Officer. The existence of natural resources has an important role for the life of the community, making the complexity of the relationship between various parties who have interests in natural resource management. The existence of stakeholders and their interests should receive attention and be considered to be accommodated as an effort to prevent the occurrence of losses to the conservation area of Gunung Merbabu National Park. Every stakeholder's interest can have a positive and negative impact on other stakeholders. Stakeholder analysis can help in understanding the conflict on the utilizing of environmental services and natural attraction that is happening, as well as input strategy in involving stakeholders for the achievement of goals.

Building a Values-Informed Mental Model for New Orleans Climate Risk Management.

PubMed

Bessette, Douglas L; Mayer, Lauren A; Cwik, Bryan; Vezér, Martin; Keller, Klaus; Lempert, Robert J; Tuana, Nancy

2017-10-01

Individuals use values to frame their beliefs and simplify their understanding when confronted with complex and uncertain situations. The high complexity and deep uncertainty involved in climate risk management (CRM) lead to individuals' values likely being coupled to and contributing to their understanding of specific climate risk factors and management strategies. Most mental model approaches, however, which are commonly used to inform our understanding of people's beliefs, ignore values. In response, we developed a "Values-informed Mental Model" research approach, or ViMM, to elicit individuals' values alongside their beliefs and determine which values people use to understand and assess specific climate risk factors and CRM strategies. Our results show that participants consistently used one of three values to frame their understanding of risk factors and CRM strategies in New Orleans: (1) fostering a healthy economy, wealth, and job creation, (2) protecting and promoting healthy ecosystems and biodiversity, and (3) preserving New Orleans' unique culture, traditions, and historically significant neighborhoods. While the first value frame is common in analyses of CRM strategies, the latter two are often ignored, despite their mirroring commonly accepted pillars of sustainability. Other values like distributive justice and fairness were prioritized differently depending on the risk factor or strategy being discussed. These results suggest that the ViMM method could be a critical first step in CRM decision-support processes and may encourage adoption of CRM strategies more in line with stakeholders' values. © 2017 Society for Risk Analysis.

Exploring methods the for selection and integration of stakeholder views in the development of core outcome sets: a case study in reconstructive breast surgery.

PubMed

Potter, Shelley; Brookes, Sara T; Holcombe, Christopher; Ward, Joseph A; Blazeby, Jane M

2016-09-23

The development and use of core outcome sets (COSs) in trials may improve data synthesis and reduce outcome reporting bias. The selection of outcomes in COSs is informed by views of key stakeholders, yet little is known about the role and influence of different stakeholders' views during COS development. We report an exploratory case study examining how stakeholder selection and incorporation of stakeholders' views may influence the selection of outcomes for a COS in reconstructive breast surgery (RBS). We also make recommendations for future considerations. Key stakeholder groups and subgroups were identified from the literature and expert opinion by the COS management group. They included health care professionals, subdivided by profession (breast and plastic surgeons, specialist nurses and psychologists) and patients, subdivided according to type of surgery received, timing of reconstruction, time since surgery and patient age. All participated in a survey in which they were asked to prioritise outcomes. Outcomes were prioritised using a 9-point scale from 1 (not important) to 9 (extremely important). The proportion of (1) all participants, ignoring stakeholder group (single heterogeneous panel analysis), (2) 'professional' and 'patient' groups separately (two heterogeneous panels), ignoring prespecified subgroups and (3) each participant subgroup separately (multiple homogeneous panel analysis) rating each item 'extremely important' was summarised and compared to explore how selection and integration of stakeholder views may influence outcome prioritisation. There were many overlaps between items rated as most important by all groups. Specific stakeholders, however, prioritised specific concerns and a broader range of outcomes were prioritised when the subgroups were considered separately. For example, two additional outcomes were prioritised when patient and professional groups were considered separately and eight additional outcomes were identified when the views of the individual subgroups were explored. In general, patient subgroups preferentially valued additional clinical outcomes, including unplanned surgery, whereas professional subgroups prioritised additional psychosocial issues including body image. Stakeholder groups value different outcomes. Selection of groups, therefore, is important. Our recommendations for robust and transparent stakeholder selection and integration of stakeholder views may aid future COS developers in the design and conduct of their studies and improve the validity and value of future COS.

Stakeholder Engagement in a Patient-Reported Outcomes (PRO) Measure Implementation: A Report from the SAFTINet Practice-based Research Network (PBRN).

PubMed

Kwan, Bethany M; Sills, Marion R; Graham, Deborah; Hamer, Mika K; Fairclough, Diane L; Hammermeister, K E; Kaiser, Alicyn; de Jesus Diaz-Perez, Maria; Schilling, Lisa M

2016-01-01

Patient-reported outcome (PRO) measures offer value for clinicians and researchers, although priorities and value propositions can conflict. PRO implementation in clinical practice may benefit from stakeholder engagement methods to align research and clinical practice stakeholder perspectives. The objective is to demonstrate the use of stakeholder engagement in PRO implementation. Engaged stakeholders represented researchers and clinical practice representatives from the SAFTINet practice-based research network (PBRN). A stakeholder engagement process involving iterative analysis, deliberation, and decision making guided implementation of a medication adherence PRO measure (the Medication Adherence Survey [MAS]) for patients with hypertension and/or hyperlipidemia. Over 9 months, 40 of 45 practices (89%) implemented the MAS, collecting 3,247 surveys (mean = 72, median = 30, range: 0 - 416). Facilitators included: an electronic health record (EHR) with readily modifiable templates; existing staff, tools and workflows in which the MAS could be integrated (e.g., health risk appraisals, hypertension-specific visits, care coordinators); and engaged leadership and quality improvement teams. Stakeholder engagement appeared useful for promoting PRO measure implementation in clinical practice, in a way that met the needs of both researchers and clinical practice stakeholders. Limitations of this approach and opportunities for improving the PRO data collection infrastructure in PBRNs are discussed. © Copyright 2016 by the American Board of Family Medicine.

Identifying and measuring stakeholder preferences for disease prioritisation: A case study of the pig industry in Australia.

PubMed

Brookes, V J; Hernández-Jover, M; Neslo, R; Cowled, B; Holyoake, P; Ward, M P

2014-01-01

We describe stakeholder preference modelling using a combination of new and recently developed techniques to elicit criterion weights to incorporate into a multi-criteria decision analysis framework to prioritise exotic diseases for the pig industry in Australia. Australian pig producers were requested to rank disease scenarios comprising nine criteria in an online questionnaire. Parallel coordinate plots were used to visualise stakeholder preferences, which aided identification of two diverse groups of stakeholders - one group prioritised diseases with impacts on livestock, and the other group placed more importance on diseases with zoonotic impacts. Probabilistic inversion was used to derive weights for the criteria to reflect the values of each of these groups, modelling their choice using a weighted sum value function. Validation of weights against stakeholders' rankings for scenarios based on real diseases showed that the elicited criterion weights for the group who prioritised diseases with livestock impacts were a good reflection of their values, indicating that the producers were able to consistently infer impacts from the disease information in the scenarios presented to them. The highest weighted criteria for this group were attack rate and length of clinical disease in pigs, and market loss to the pig industry. The values of the stakeholders who prioritised zoonotic diseases were less well reflected by validation, indicating either that the criteria were inadequate to consistently describe zoonotic impacts, the weighted sum model did not describe stakeholder choice, or that preference modelling for zoonotic diseases should be undertaken separately from livestock diseases. Limitations of this study included sampling bias, as the group participating were not necessarily representative of all pig producers in Australia, and response bias within this group. The method used to elicit criterion weights in this study ensured value trade-offs between a range of potential impacts, and that the weights were implicitly related to the scale of measurement of disease criteria. Validation of the results of the criterion weights against real diseases - a step rarely used in MCDA - added scientific rigour to the process. The study demonstrated that these are useful techniques for elicitation of criterion weights for disease prioritisation by stakeholders who are not disease experts. Preference modelling for zoonotic diseases needs further characterisation in this context. Copyright © 2013 Elsevier B.V. All rights reserved.

A tall order on a tight timeframe: stakeholder perspectives on comparative effectiveness research using electronic clinical data.

PubMed

Holve, Erin; Lopez, Marianne Hamilton; Scott, Lisa; Segal, Courtney

2012-09-01

BACKGROUND & SIGNIFICANCE: The AcademyHealth Electronic Data Methods Forum aims to advance the national dialogue on the use of electronic clinical data (ECD) for comparative effectiveness research (CER), patient-centered outcomes research, and quality improvement by facilitating exchange and collaboration among eleven research projects and external stakeholders. AcademyHealth conducted a mixed-method needs assessment with the Electronic Data Methods Forum's key stakeholders to assess: stakeholder views on developing new infrastructure for CER using ECD; current gaps in knowledge with respect to CER; and expectations for a learning health system. AcademyHealth conducted 50 stakeholder interviews between August 2011 and November 2011 with participants from the following seven stakeholder groups: government, business/payer, industry, healthcare delivery, patient/consumer, nonprofit/policy and research. With input from key collaborators, AcademyHealth designed a semi-structured interview guide and a short survey. Reviewers used the qualitative data analysis software NVivo to code the transcripts and to identify and manage complex concepts. Quantitative data from the questionnaire has been integrated with the final analysis as relevant. The analysis of recurring concepts in the interviews focus on five central themes: stakeholders have substantial expectations for CER using ECD, both with respect to addressing the limitations of traditional research studies, and generating meaningful evidence for decision-making and improving patient outcomes; stakeholders are aware of many challenges related to implementing CER with ECD, including the need to develop appropriate governance, assess and manage data quality, and develop methods to address confounding in observational data; stakeholders continue to struggle to define 'patient-centeredness' in CER using ECD, adding complexity to attaining this goal; stakeholders express that improving translation and dissemination of CER, and how research can be 'useful' at the point of care, can help mitigate negative perceptions of the CER 'brand'; and stakeholders perceive a need for a substantial 'culture shift' to facilitate collaborative science and new ways of conducting biomedical and outcomes research. Many stakeholders proposed approaches or solutions they felt might address the challenges identified.

Participatory modeling and structured decision making

USGS Publications Warehouse

Robinson, Kelly F.; Fuller, Angela K.

2016-01-01

Structured decision making (SDM) provides a framework for making sound decisions even when faced with uncertainty, and is a transparent, defensible, and replicable method used to understand complex problems. A hallmark of SDM is the explicit incorporation of values and science, which often includes participation from multiple stakeholders, helping to garner trust and ultimately result in a decision that is more likely to be implemented. The core steps in the SDM process are used to structure thinking about natural resources management choices, and include: (1) properly defining the problem and the decision context, (2) determining the objectives that help describe the aspirations of the decision maker, (3) devising management actions or alternatives that can achieve those objectives, (4) evaluating the outcomes or consequences of each alternative on each of the objectives, (5) evaluating trade-offs, and (6) implementing the decision. Participatory modeling for SDM includes engaging stakeholders in some or all of the steps of the SDM process listed above. In addition, participatory modeling often is crucial for creating qualitative and quantitative models of how the system works, providing data for these models, and eliciting expert opinion when data are unavailable. In these ways, SDM provides a framework for decision making in natural resources management that includes participation from stakeholder groups throughout the process, including the modeling phase.

Systems Engineering Applied to the Development of a Wave Energy Farm.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roberts, Jesse D.; Bull, Diana L.; Costello, Ronan Patrick

A motivation for undertaking this stakeholder requirements analysis and Systems Engineering exercise is to document the requirements for successful wave energy farms to facilitate better design and better design assessments. A difficulty in wave energy technology development is the absence to date of a verifiable minimum viable product against which the merits of new products might be measured. A consequence of this absence is that technology development progress, technology value, and technology funding have largely been measured, associated with, and driven by technology readiness, measured in technology readiness levels (TRLs). Originating primarily from the space and defense industries, TRLs focusmore » on procedural implementation of technology developments of large and complex engineering projects, where cost is neither mission critical nor a key design driver. The key deficiency with the TRL approach in the context of wave energy conversion is that WEC technology development has been too focused on commercial readiness and not enough on the stakeholder requirements and particularly economic viability required for market entry.« less

Information and communication technology solutions for outdoor navigation in dementia.

PubMed

Teipel, Stefan; Babiloni, Claudio; Hoey, Jesse; Kaye, Jeffrey; Kirste, Thomas; Burmeister, Oliver K

2016-06-01

Information and communication technology (ICT) is potentially mature enough to empower outdoor and social activities in dementia. However, actual ICT-based devices have limited functionality and impact, mainly limited to safety. What is an ideal operational framework to enhance this field to support outdoor and social activities? Review of literature and cross-disciplinary expert discussion. A situation-aware ICT requires a flexible fine-tuning by stakeholders of system usability and complexity of function, and of user safety and autonomy. It should operate by artificial intelligence/machine learning and should reflect harmonized stakeholder values, social context, and user residual cognitive functions. ICT services should be proposed at the prodromal stage of dementia and should be carefully validated within the life space of users in terms of quality of life, social activities, and costs. The operational framework has the potential to produce ICT and services with high clinical impact but requires substantial investment. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Business analysis for a sustainable, multi-stakeholder ecosystem for leveraging the Electronic Health Records for Clinical Research (EHR4CR) platform in Europe.

PubMed

Dupont, Danielle; Beresniak, Ariel; Sundgren, Mats; Schmidt, Andreas; Ainsworth, John; Coorevits, Pascal; Kalra, Dipak; Dewispelaere, Marc; De Moor, Georges

2017-01-01

The Electronic Health Records for Clinical Research (EHR4CR) technological platform has been developed to enable the trustworthy reuse of hospital electronic health records data for clinical research. The EHR4CR platform can enhance and speed up clinical research scenarios: protocol feasibility assessment, patient identification for recruitment in clinical trials, and clinical data exchange, including for reporting serious adverse events. Our objective was to seed a multi-stakeholder ecosystem to enable the scalable exploitation of the EHR4CR platform in Europe, and to assess its economic sustainability. Market analyses were conducted by a multidisciplinary task force to define an EHR4CR emerging ecosystem and multi-stakeholder value chain. This involved mapping stakeholder groups and defining their unmet needs, incentives, potential barriers for adopting innovative solutions, roles and interdependencies. A comprehensive business model, value propositions, and sustainability strategies were developed accordingly. Using simulation modelling (including Monte Carlo simulations) and a 5-year horizon, the potential financial outcomes of the business model were forecasted from the perspective of an EHR4CR service provider. A business ecosystem was defined to leverage the EHR4CR multi-stakeholder value chain. Value propositions were developed describing the expected benefits of EHR4CR solutions for all stakeholders. From an EHR4CR service provider's viewpoint, the business model simulation estimated that a profitability ratio of up to 1.8 could be achieved at year 1, with potential for growth in subsequent years depending on projected market uptake. By enhancing and speeding up existing processes, EHR4CR solutions promise to transform the clinical research landscape. The ecosystem defined provides the organisational framework for optimising the value and benefits for all stakeholders involved, in a sustainable manner. Our study suggests that the exploitation of EHR4CR solutions appears profitable and sustainable in Europe, with a growth potential depending on the rates of market and hospital adoption. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Respecting Stakeholders and Their Engagement to Decision Making - The Way of Successful Corporate Social Responsibility Strategy

NASA Astrophysics Data System (ADS)

Drieniková, Katarína; Sakál, Peter

2012-12-01

Current world situation characterized by constant dynamic development and changes in all spheres enforced us to view the business not only as a profit creator but as creator of added value to the society. The paper deals with the stakeholders as the integral part of corporate social responsibility (CSR) concept. It mentions the topic of stakeholder theory and stakeholder management in consideration of sustainable development and sustainable competitiveness of business. Within the paper are mentioned outputs of pilot research carried on among Slovak companies focusing on stakeholders and decision making within responsible business.

Business Modeling to Implement an eHealth Portal for Infection Control: A Reflection on Co-Creation With Stakeholders

PubMed Central

Wentzel, Jobke; Sanderman, Robbert; van Gemert-Pijnen, Lisette

2015-01-01

Background It is acknowledged that the success and uptake of eHealth improve with the involvement of users and stakeholders to make technology reflect their needs. Involving stakeholders in implementation research is thus a crucial element in developing eHealth technology. Business modeling is an approach to guide implementation research for eHealth. Stakeholders are involved in business modeling by identifying relevant stakeholders, conducting value co-creation dialogs, and co-creating a business model. Because implementation activities are often underestimated as a crucial step while developing eHealth, comprehensive and applicable approaches geared toward business modeling in eHealth are scarce. Objective This paper demonstrates the potential of several stakeholder-oriented analysis methods and their practical application was demonstrated using Infectionmanager as an example case. In this paper, we aim to demonstrate how business modeling, with the focus on stakeholder involvement, is used to co-create an eHealth implementation. Methods We divided business modeling in 4 main research steps. As part of stakeholder identification, we performed literature scans, expert recommendations, and snowball sampling (Step 1). For stakeholder analyzes, we performed “basic stakeholder analysis,” stakeholder salience, and ranking/analytic hierarchy process (Step 2). For value co-creation dialogs, we performed a process analysis and stakeholder interviews based on the business model canvas (Step 3). Finally, for business model generation, we combined all findings into the business model canvas (Step 4). Results Based on the applied methods, we synthesized a step-by-step guide for business modeling with stakeholder-oriented analysis methods that we consider suitable for implementing eHealth. Conclusions The step-by-step guide for business modeling with stakeholder involvement enables eHealth researchers to apply a systematic and multidisciplinary, co-creative approach for implementing eHealth. Business modeling becomes an active part in the entire development process of eHealth and starts an early focus on implementation, in which stakeholders help to co-create the basis necessary for a satisfying success and uptake of the eHealth technology. PMID:26272510

Subjective experience or objective process: understanding the gap between values and practice for involving patients in designing patient-centred care.

PubMed

Lord, Laura; Gale, Nicola

2014-01-01

Patient-centred care and patient involvement are increasingly central concepts in health policy in the UK and elsewhere. However, there is little consensus regarding their definition or how to achieve "patient-centred" care in everyday practice or how to involve patients in service redesign initiatives. The purpose of this paper is to explore these issues from the perspective of key stakeholders within National Health Service (NHS) hospitals in the UK. Semi-structured interviews, covering a range of topics related to service redesign, were conducted with 77 key stakeholders across three NHS Trusts in the West Midlands. In total, 20 of these stakeholders were re-interviewed 18 months later. Data were managed and analysed using the Framework Method. While patient-centred care and patient involvement were regularly cited as important to the stakeholders, a gap persisted between values and reported practice. This gap is explained through close examination of the ways in which the concepts were used by stakeholders, and identifying the way in which they were adapted to fit other organizational priorities. The value placed on positive subjective experience changed to concerns about objective measurement of the patients as they move through the system. Increased awareness and reflection on the conceptual tensions between objective processes and subjective experiences could highlight reasons why patient-centred values fail to translate into improved practice. The paper describes and explains a previously unarticulated tension in health organisations between values and practice in patient centred care and patient involvement in service redesign.

Action learning across the decades.

PubMed

Eason, Ken

2017-05-02

Purpose The purpose of this paper is to explore how action learning concepts were used in two healthcare projects undertaken many decades apart. The specific purpose in both cases was to examine how action learning can contribute to shared learning across key stakeholders in a complex socio-technical system. In each case study, action learning supported joint design programmes and the sharing of perspectives about the complex system under investigation. Design/methodology/approach Two action learning projects are described: first, the Hospital Internal Communications (HIC) project led by Reg Revans in the 1960s. Senior staff in ten London hospitals formed action learning teams to address communication issues. Second, in the Better Outcomes for People with Learning Disabilities: Transforming Care (BOLDTC) project, videoconferencing equipment enabled people with learning disabilities to increase their opportunities to communicate. A mutual learning process was established to enable stakeholders to explore the potential of the technical system to improve individual care. Findings The HIC project demonstrated the importance of evidence being shared between team members and that action had to engage the larger healthcare system outside the hospital. The BOLDTC project confirmed the continuing relevance of action learning to healthcare today. Mutual learning was achieved between health and social care specialists and technologists. Originality/value This work draws together the socio-technical systems tradition (considering both social and technical issues in organisations) and action learning to demonstrate that complex systems development needs to be undertaken as a learning process in which action provides the fuel for learning and design.

Defining and Negotiating the Social Value of Research in Public Health Facilities: Perceptions of Stakeholders in a Research-Active Province of South Africa.

PubMed

Lutge, Elizabeth; Slack, Catherine; Wassenaar, Douglas

2017-02-01

This article reports on qualitative research conducted in KwaZulu-Natal, South Africa, among researchers and gate-keepers of health facilities in the province. Results suggest disparate but not irreconcilable perceptions of the social value of research in provincial health facilities. This study found that researchers tended to emphasize the contribution of research to the generation of knowledge and to the health of future patients while gate-keepers of health facilities tended to emphasize its contribution to the healthcare system and to current patients. Furthermore, relations between research stakeholders were perceived to be somewhat fragile, making it difficult for stakeholders to achieve consensus about the social value of research, as well as on ways to maximize value. Interventions to negotiate a shared perspective on the social value of research would appear to be warranted, and the findings of this study suggest some focus areas for such intervention. © 2017 John Wiley & Sons Ltd.

DEFINING AND NEGOTIATING THE SOCIAL VALUE OF RESEARCH IN PUBLIC HEALTH FACILITIES: PERCEPTIONS OF STAKEHOLDERS IN A RESEARCH-ACTIVE PROVINCE OF SOUTH AFRICA

PubMed Central

Lutge, Elizabeth; Slack, Catherine; Wassenaar, Douglas

2016-01-01

This paper reports on qualitative research conducted in KwaZulu-Natal, South Africa, among researchers and gate-keepers of health facilities in the province. Results suggest disparate but not irreconcilable perceptions of the social value of research in provincial health facilities. This study found that researchers tended to emphasise the contribution of research to the generation of knowledge and to the health of future patients while gate-keepers of health facilities tended to emphasise its contribution to the healthcare system and to current patients. Furthermore, relations between research stakeholders were perceived to be somewhat fragile, making it difficult for stakeholders to achieve consensus about the social value of research, as well as on ways to maximise value. Interventions to negotiate a shared perspective on the social value of research would appear to be warranted, and the findings of this study suggest some focus areas for such intervention. PMID:28060430

Applications of system dynamics modelling to support health policy.

PubMed

Atkinson, Jo-An M; Wells, Robert; Page, Andrew; Dominello, Amanda; Haines, Mary; Wilson, Andrew

2015-07-09

The value of systems science modelling methods in the health sector is increasingly being recognised. Of particular promise is the potential of these methods to improve operational aspects of healthcare capacity and delivery, analyse policy options for health system reform and guide investments to address complex public health problems. Because it lends itself to a participatory approach, system dynamics modelling has been a particularly appealing method that aims to align stakeholder understanding of the underlying causes of a problem and achieve consensus for action. The aim of this review is to determine the effectiveness of system dynamics modelling for health policy, and explore the range and nature of its application. A systematic search was conducted to identify articles published up to April 2015 from the PubMed, Web of Knowledge, Embase, ScienceDirect and Google Scholar databases. The grey literature was also searched. Papers eligible for inclusion were those that described applications of system dynamics modelling to support health policy at any level of government. Six papers were identified, comprising eight case studies of the application of system dynamics modelling to support health policy. No analytic studies were found that examined the effectiveness of this type of modelling. Only three examples engaged multidisciplinary stakeholders in collective model building. Stakeholder participation in model building reportedly facilitated development of a common 'mental map' of the health problem, resulting in consensus about optimal policy strategy and garnering support for collaborative action. The paucity of relevant papers indicates that, although the volume of descriptive literature advocating the value of system dynamics modelling is considerable, its practical application to inform health policy making is yet to be routinely applied and rigorously evaluated. Advances in software are allowing the participatory model building approach to be extended to more sophisticated multimethod modelling that provides policy makers with more powerful tools to support the design of targeted, effective and equitable policy responses for complex health problems. Building capacity and investing in communication to promote these modelling methods, as well as documenting and evaluating their applications, will be vital to supporting uptake by policy makers.

Caring for one and all - Exploring ethical challenges in an ICU.

PubMed

Jones, Jennifer; Mitchell, Marion; Milligan, Eleanor

2016-08-01

This discussion paper explores some of the complex ethical and moral issues confronting contemporary critical care nurses. In contemporary healthcare discussions, there is an increased appreciation of the complexity of ethical challenges, the multiplicity of stakeholders and that a broad range of possible and practical outcomes exist. Furthermore, many scholars also acknowledge the limitations of principle based ethical frameworks. In seeking to build critical care nurses' capacity to negotiate the complex - and often conflicting - ethical challenges, the authors have adopted a person-centred, values-based approach in this case study. Furthermore, by exploring these complex issues, this paper supports and builds upon critical care nurses' decision making capacities in the clinical area. This case study has been purposefully left open-ended with the aim of inviting the reader to consider the questions posed in a collegial, collaborative manner within the particular context in which she/he is embedded. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Study protocol: developing a decision system for inclusive housing: applying a systematic, mixed-method quasi-experimental design.

PubMed

Zeeman, Heidi; Kendall, Elizabeth; Whitty, Jennifer A; Wright, Courtney J; Townsend, Clare; Smith, Dianne; Lakhani, Ali; Kennerley, Samantha

2016-03-15

Identifying the housing preferences of people with complex disabilities is a much needed, but under-developed area of practice and scholarship. Despite the recognition that housing is a social determinant of health and quality of life, there is an absence of empirical methodologies that can practically and systematically involve consumers in this complex service delivery and housing design market. A rigorous process for making effective and consistent development decisions is needed to ensure resources are used effectively and the needs of consumers with complex disability are properly met. This 3-year project aims to identify how the public and private housing market in Australia can better respond to the needs of people with complex disabilities whilst simultaneously achieving key corporate objectives. First, using the Customer Relationship Management framework, qualitative (Nominal Group Technique) and quantitative (Discrete Choice Experiment) methods will be used to quantify the housing preferences of consumers and their carers. A systematic mixed-method, quasi-experimental design will then be used to quantify the development priorities of other key stakeholders (e.g., architects, developers, Government housing services etc.) in relation to inclusive housing for people with complex disabilities. Stakeholders randomly assigned to Group 1 (experimental group) will participate in a series of focus groups employing Analytical Hierarchical Process (AHP) methodology. Stakeholders randomly assigned to Group 2 (control group) will participate in focus groups employing existing decision making processes to inclusive housing development (e.g., Risk, Opportunity, Cost, Benefit considerations). Using comparative stakeholder analysis, this research design will enable the AHP methodology (a proposed tool to guide inclusive housing development decisions) to be tested. It is anticipated that the findings of this study will enable stakeholders to incorporate consumer housing preferences into commercial decisions. Housing designers and developers will benefit from the creation of a parsimonious set of consumer-led housing preferences by which to make informed investments in future housing and contribute to future housing policy. The research design has not been applied in the Australian research context or elsewhere, and will provide a much needed blueprint for market investment to develop viable, consumer directed inclusive housing options for people with complex disability.

Co-Creating Learning: Insights from Complexity Theory

ERIC Educational Resources Information Center

Desai, Darshan A.

2010-01-01

Purpose: Recent advances in the interactive technologies have transformed the way today's organizations and their different stakeholders learn. Now, because of the increasing learning requirements, neither these organizations nor their stakeholders can afford to be too self-focused while learning; instead, they collaborate and learn together.…

Advancing Sustainable Bioenergy; Evolving Stakeholder Interests and the Relevance of Research

EPA Science Inventory

Sustainable bioenergy production depends on the resolution of both scientific and nontechnical barriers to its development. We focus on the need to recognize and manage stakeholder diversity as an example of the latter. As a complex issue domain, bioenergy involves a disparate se...

Stakeholder Views on Attributes of Scientific Literacy Important for Future Citizens and Employees--A Delphi Study

ERIC Educational Resources Information Center

Post, Aveliis; Rannikmae, Miia; Holbrook, Jack

2011-01-01

This study is based on the creation of a theoretical tool for determining competencies and knowledge in science education which stakeholders value as necessary for students to become productive members of the future work force as well as responsible citizens. Stakeholders' opinions (N = 85) were gathered from persons in different walks of life by…

Evolving the US Army Research Laboratory (ARL) Technical Communication Strategy

DTIC Science & Technology

2016-10-01

of added value and enhanced tech transfer, and strengthened relationships with academic and industry collaborators. In support of increasing ARL’s...communication skills; and Prong 3: Promote a Stakeholder Database to implement a stakeholder database (including names and preferences) and use a...Group, strategic planning, communications strategy, stakeholder database , workforce improvement, science and technology, S&T 16. SECURITY

STakeholder-Objective Risk Model (STORM): Determining the aggregated risk of multiple contaminant hazards in groundwater well catchments

NASA Astrophysics Data System (ADS)

Enzenhoefer, R.; Binning, P. J.; Nowak, W.

2015-09-01

Risk is often defined as the product of probability, vulnerability and value. Drinking water supply from groundwater abstraction is often at risk due to multiple hazardous land use activities in the well catchment. Each hazard might or might not introduce contaminants into the subsurface at any point in time, which then affects the pumped quality upon transport through the aquifer. In such situations, estimating the overall risk is not trivial, and three key questions emerge: (1) How to aggregate the impacts from different contaminants and spill locations to an overall, cumulative impact on the value at risk? (2) How to properly account for the stochastic nature of spill events when converting the aggregated impact to a risk estimate? (3) How will the overall risk and subsequent decision making depend on stakeholder objectives, where stakeholder objectives refer to the values at risk, risk attitudes and risk metrics that can vary between stakeholders. In this study, we provide a STakeholder-Objective Risk Model (STORM) for assessing the total aggregated risk. Or concept is a quantitative, probabilistic and modular framework for simulation-based risk estimation. It rests on the source-pathway-receptor concept, mass-discharge-based aggregation of stochastically occuring spill events, accounts for uncertainties in the involved flow and transport models through Monte Carlo simulation, and can address different stakeholder objectives. We illustrate the application of STORM in a numerical test case inspired by a German drinking water catchment. As one may expect, the results depend strongly on the chosen stakeholder objectives, but they are equally sensitive to different approaches for risk aggregation across different hazards, contaminant types, and over time.

Application of system dynamics and participatory spatial group model building in animal health: A case study of East Coast Fever interventions in Lundazi and Monze districts of Zambia

PubMed Central

Skjerve, Eystein; Rich, Magda; Rich, Karl M.

2017-01-01

East Coast Fever (ECF) is the most economically important production disease among traditional beef cattle farmers in Zambia. Despite the disease control efforts by the government, donors, and farmers, ECF cases are increasing. Why does ECF oscillate over time? Can alternative approaches such as systems thinking contribute solutions to the complex ECF problem, avoid unintended consequences, and achieve sustainable results? To answer these research questions and inform the design and implementation of ECF interventions, we qualitatively investigated the influence of dynamic socio-economic, cultural, and ecological factors. We used system dynamics modelling to specify these dynamics qualitatively, and an innovative participatory framework called spatial group model building (SGMB). SGMB uses participatory geographical information system (GIS) concepts and techniques to capture the role of spatial phenomenon in the context of complex systems, allowing stakeholders to identify spatial phenomenon directly on physical maps and integrate such information in model development. Our SGMB process convened focus groups of beef value chain stakeholders in two distinct production systems. The focus groups helped to jointly construct a series of interrelated system dynamics models that described ECF in a broader systems context. Thus, a complementary objective of this study was to demonstrate the applicability of system dynamics modelling and SGMB in animal health. The SGMB process revealed policy leverage points in the beef cattle value chain that could be targeted to improve ECF control. For example, policies that develop sustainable and stable cattle markets and improve household income availability may have positive feedback effects on investment in animal health. The results obtained from a SGMB process also demonstrated that a “one-size-fits-all” approach may not be equally effective in policing ECF in different agro-ecological zones due to the complex interactions of socio-ecological context with important, and often ignored, spatial patterns. PMID:29244862

Application of system dynamics and participatory spatial group model building in animal health: A case study of East Coast Fever interventions in Lundazi and Monze districts of Zambia.

PubMed

Mumba, Chisoni; Skjerve, Eystein; Rich, Magda; Rich, Karl M

2017-01-01

East Coast Fever (ECF) is the most economically important production disease among traditional beef cattle farmers in Zambia. Despite the disease control efforts by the government, donors, and farmers, ECF cases are increasing. Why does ECF oscillate over time? Can alternative approaches such as systems thinking contribute solutions to the complex ECF problem, avoid unintended consequences, and achieve sustainable results? To answer these research questions and inform the design and implementation of ECF interventions, we qualitatively investigated the influence of dynamic socio-economic, cultural, and ecological factors. We used system dynamics modelling to specify these dynamics qualitatively, and an innovative participatory framework called spatial group model building (SGMB). SGMB uses participatory geographical information system (GIS) concepts and techniques to capture the role of spatial phenomenon in the context of complex systems, allowing stakeholders to identify spatial phenomenon directly on physical maps and integrate such information in model development. Our SGMB process convened focus groups of beef value chain stakeholders in two distinct production systems. The focus groups helped to jointly construct a series of interrelated system dynamics models that described ECF in a broader systems context. Thus, a complementary objective of this study was to demonstrate the applicability of system dynamics modelling and SGMB in animal health. The SGMB process revealed policy leverage points in the beef cattle value chain that could be targeted to improve ECF control. For example, policies that develop sustainable and stable cattle markets and improve household income availability may have positive feedback effects on investment in animal health. The results obtained from a SGMB process also demonstrated that a "one-size-fits-all" approach may not be equally effective in policing ECF in different agro-ecological zones due to the complex interactions of socio-ecological context with important, and often ignored, spatial patterns.

Stakeholder analysis in the management of irrigation in Kampili area

NASA Astrophysics Data System (ADS)

Jumiati; Ali, M. S. S.; Fahmid, I. M.; Mahyuddin

2018-05-01

Irrigation has appreciable contribution in building food security, particularly rice crops. This study aims to analyze the role of stakeholders involved in distributing of irrigation water. The study was conducted in the Kampili Irrigation Area in South Sulawesi Province Indonesia, the data were obtained through observation and interviews with stakeholders involved, and analysed by stakeholder analysis, based on the interests and power held by the actors. This analysis is intended to provide an optimal picture of the expected role of each stakeholder in the management of irrigation resources. The results show that there were many stakeholders involved in irrigation management. In the arrangement of irrigation distribution there was overlapping authority of the stakeholders to its management, every stakeholder had different interests and power between each other. The existence have given positive and negative values in distributing irrigation water management, then in the stakeholder collaboration there was contestation between them. This contestation took place between the agriculture department, PSDA province, the Jeneberang River Region Hall, the Farmers Group and the P3A.

75 FR 47606 - Strategic Plan for Consumer Education via Cooperative Agreement (U18)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-06

... or quantitative research with stakeholders and meetings with stakeholder groups and consumer experts... and resulting from an extensive consumer research process. In 2007, PFSE joined with USDA to create... responsibilities of FDA. B. Research Objectives PFSE supports a large, complex, and multi-faceted consumer food...

The collaboration imperative.

PubMed

Nidumolu, Ram; Ellison, Jib; Whalen, John; Billman, Erin

2014-04-01

Addressing global sustainability challenges--including climate change, resource depletion, and ecosystem loss--is beyond the individual capabilities of even the largest companies. To tackle these threats, and unleash new value, companies and other stakeholders must collaborate in new ways that treat fragile and complex ecosystems as a whole. In this article, the authors draw on cases including the Latin American Water Funds Partnership, the Sustainable Apparel Coalition (led by Nike, Patagonia, and Walmart), and Action to Accelerate Recycling (a partnership between Alcoa, consumer packaged goods companies, and local governments, among others) to describe four new collaboration models that create shared value and address environmental protection across the value stream. Optimal collaborations focus on improving either business processes or outcomes. They start with a small group of key organizations, bring in project management expertise, link self-interest to shared interest, encourage productive competition, create quick wins, and, above all, build and maintain trust.

Stakeholder approach for evaluating organizational change projects.

PubMed

Peltokorpi, Antti; Alho, Antti; Kujala, Jaakko; Aitamurto, Johanna; Parvinen, Petri

2008-01-01

This paper aims to create a model for evaluating organizational change initiatives from a stakeholder resistance viewpoint. The paper presents a model to evaluate change projects and their expected benefits. Factors affecting the challenge to implement change were defined based on stakeholder theory literature. The authors test the model's practical validity for screening change initiatives to improve operating room productivity. Change initiatives can be evaluated using six factors: the effect of the planned intervention on stakeholders' actions and position; stakeholders' capability to influence the project's implementation; motivation to participate; capability to change; change complexity; and management capability. The presented model's generalizability should be explored by filtering presented factors through a larger number of historical cases operating in different healthcare contexts. The link between stakeholders, the change challenge and the outcomes of change projects needs to be empirically tested. The proposed model can be used to prioritize change projects, manage stakeholder resistance and establish a better organizational and professional competence for managing healthcare organization change projects. New insights into existing stakeholder-related understanding of change project successes are provided.

Entering into dialogue about the mathematical value of contextual mathematising tasks

NASA Astrophysics Data System (ADS)

Yoon, Caroline; Chin, Sze Looi; Moala, John Griffith; Choy, Ban Heng

2018-03-01

Our project seeks to draw attention to the rich mathematical thinking that is generated when students work on contextual mathematising tasks. We use a design-based research approach to create ways of reporting that raise the visibility of this rich mathematical thinking while retaining and respecting its complexity. These reports will be aimed for three classroom stakeholders: (1) students, who wish to reflect on and enhance their mathematical learning; (2) teachers, who wish to integrate contextual mathematising tasks into their teaching practice and (3) researchers, who seek rich tasks for generating observable instances of mathematical thinking and learning. We anticipate that these reports and the underlying theoretical framework for creating them will contribute to greater awareness of and appreciation for the mathematical value of contextual mathematising tasks in learning, teaching and research.

Workshop: Economic Research and Policy Concerning Water Use and Watershed Management (1999)

EPA Pesticide Factsheets

Workshop proceedings: Integrating Economic and Physical Models in Water and Watershed Research, Methods for Measuring Stakeholder Values of Water Quality and Watershed Protection, and Applications of Stakeholder Valuation Techniques for Watersheds and WQ

The Need for Social Ethics in Interdisciplinary Environmental Science Graduate Programs: Results from a Nation-Wide Survey in the United States.

PubMed

Hall, Troy E; Engebretson, Jesse; O'Rourke, Michael; Piso, Zach; Whyte, Kyle; Valles, Sean

2017-04-01

Professionals in environmental fields engage with complex problems that involve stakeholders with different values, different forms of knowledge, and contentious decisions. There is increasing recognition of the need to train graduate students in interdisciplinary environmental science programs (IESPs) in these issues, which we refer to as "social ethics." A literature review revealed topics and skills that should be included in such training, as well as potential challenges and barriers. From this review, we developed an online survey, which we administered to faculty from 81 United States colleges and universities offering IESPs (480 surveys were completed). Respondents overwhelmingly agreed that IESPs should address values in applying science to policy and management decisions. They also agreed that programs should engage students with issues related to norms of scientific practice. Agreement was slightly less strong that IESPs should train students in skills related to managing value conflicts among different stakeholders. The primary challenges to incorporating social ethics into the curriculum were related to the lack of materials and expertise for delivery, though challenges such as ethics being marginalized in relation to environmental science content were also prominent. Challenges related to students' interest in ethics were considered less problematic. Respondents believed that social ethics are most effectively delivered when incorporated into existing courses, and they preferred case studies or problem-based learning for delivery. Student competence is generally not assessed, and respondents recognized a need for both curricular materials and assessment tools.

A Mixed-Methods Research Framework for Healthcare Process Improvement.

PubMed

Bastian, Nathaniel D; Munoz, David; Ventura, Marta

2016-01-01

The healthcare system in the United States is spiraling out of control due to ever-increasing costs without significant improvements in quality, access to care, satisfaction, and efficiency. Efficient workflow is paramount to improving healthcare value while maintaining the utmost standards of patient care and provider satisfaction in high stress environments. This article provides healthcare managers and quality engineers with a practical healthcare process improvement framework to assess, measure and improve clinical workflow processes. The proposed mixed-methods research framework integrates qualitative and quantitative tools to foster the improvement of processes and workflow in a systematic way. The framework consists of three distinct phases: 1) stakeholder analysis, 2a) survey design, 2b) time-motion study, and 3) process improvement. The proposed framework is applied to the pediatric intensive care unit of the Penn State Hershey Children's Hospital. The implementation of this methodology led to identification and categorization of different workflow tasks and activities into both value-added and non-value added in an effort to provide more valuable and higher quality patient care. Based upon the lessons learned from the case study, the three-phase methodology provides a better, broader, leaner, and holistic assessment of clinical workflow. The proposed framework can be implemented in various healthcare settings to support continuous improvement efforts in which complexity is a daily element that impacts workflow. We proffer a general methodology for process improvement in a healthcare setting, providing decision makers and stakeholders with a useful framework to help their organizations improve efficiency. Published by Elsevier Inc.

European Pharmaceutical Pricing and Reimbursement--SMi's 21st Annual Meeting (October 5-6, 2015--London, UK).

PubMed

Kibble, A; D'Souza, P

2015-10-01

Translating perceived market value for pharmaceutical products into a willingness to pay remains the key factor in ensuring market access and return on investment. How price is managed in the context of new market entrants or new approval settings can create complex challenges, and further complexity is added through diverse global reimbursement structures and the myriad of stakeholders involved at every step of value identification. SMi's 21st Annual Meeting on European Pricing and Reimbursement presented a program focused on the measures being taken by European healthcare systems as they seek to facilitate access to the latest treatments while delivering value for payers and patients. Supporting patient access to life-changing medicines is a challenge, and funders are responding in many different ways; however, while the pharma industry continues to focus its efforts on high cost drugs that treat diseases of the few, the disconnect will be not be resolved. The speakers and delegates at the annual meeting believe success is possible by focusing on value for patients, driven by provider experience, scale and learning. Instead of simply lowering costs, companies, providers and payers can more adequately contribute to the goals of funders as well as the treatment needs of patients. Copyright 2015 Prous Science, S.A.U. or its licensors. All rights reserved.

Emerging Lessons From Regional and State Innovation in Value-Based Payment Reform: Balancing Collaboration and Disruptive Innovation

PubMed Central

Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

2014-01-01

Policy Points: Public and private purchasersmust create a "burning bridge" of countervailing pressure that signals "no turning back" to fee-for-service in order to sustain the momentum for value-based payment. Multi-stakeholder coalitions must establish a defined set of quality, outcomes, and cost performance measures and the interoperable information systems to support data collection and reporting of value-based payment schemes. Anti-trust vigilance is necessary to find the "sweet spot" of competition and cooperation among health plans and health care providers. Provider and health plan transparency of price and quality, supported by all-payer claims data, are critical in driving value-based payment innovation and cost constraint. Context In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. Methods As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. Findings The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers’ limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. Conclusions From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected “honest broker” that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder engagement and priorities shift over time. Another significant facilitator of value-based payment reform is outside investment that enables increased investment in human resources, information infrastructure, and care management by provider organizations and their collaborators. Supportive community and social service networks that enhance population health management also are important enablers of value-based payment reform. External pressure from public and private payers is fueling a “burning bridge” between the past of fee-for-service payment models and the future of payments based on value. Robust competition in local health plan and provider markets, coupled with an appropriate mix of multistakeholder governance, pressure from organized purchasers, and regulatory oversight, has the potential to spur value-based payment innovation that combines elements of “reformed” fee-for-service with bundled payments and global payments. PMID:25199900

Stakeholders' perceptions of ways to support decisions about health insurance marketplace enrollment: a qualitative study.

PubMed

Housten, A J; Furtado, K; Kaphingst, K A; Kebodeaux, C; McBride, T; Cusanno, B; Politi, M C

2016-11-08

Approximately 29 million individuals are expected to enroll in health insurance using the Patient Protection and Affordable Care Act (ACA) Marketplace by 2022. Those seeking health insurance struggle to understand insurance options and choose a plan that best suits their needs. We interviewed stakeholders to identify the challenges associated with the ACA Marketplace health insurance enrollment and elicited feedback about what to include in health insurance decision support tools. Interviews were transcribed and themes were identified using inductive thematic analysis. Stakeholders stated that consumers felt frustrated by unclear terminology, high plan costs, and complex calculations required to assess costs. Consumers felt anxious about making the wrong choice and being unable to change plans within a calendar year. Stakeholders recommended using plain language tables defining complex terms, grouping information, and using engaging graphics to communicate information about health insurance. Stakeholders thought that narratives of how others made decisions about insurance might be helpful to consumers, but recommended that they be tailored to the needs of specific consumers. Strategies that clarify health insurance terms using plain language and graphics, acknowledge concern associated with making the wrong choice, calculate and enable cost comparison, and tailor information to consumers' unique needs could benefit those enrolling in ACA Marketplace plans, Narratives developed should be simple and inclusive enough for diverse populations.

Collaborative Visual Analytics: A Health Analytics Approach to Injury Prevention.

PubMed

Al-Hajj, Samar; Fisher, Brian; Smith, Jennifer; Pike, Ian

2017-09-12

Background : Accurate understanding of complex health data is critical in order to deal with wicked health problems and make timely decisions. Wicked problems refer to ill-structured and dynamic problems that combine multidimensional elements, which often preclude the conventional problem solving approach. This pilot study introduces visual analytics (VA) methods to multi-stakeholder decision-making sessions about child injury prevention; Methods : Inspired by the Delphi method, we introduced a novel methodology-group analytics (GA). GA was pilot-tested to evaluate the impact of collaborative visual analytics on facilitating problem solving and supporting decision-making. We conducted two GA sessions. Collected data included stakeholders' observations, audio and video recordings, questionnaires, and follow up interviews. The GA sessions were analyzed using the Joint Activity Theory protocol analysis methods; Results : The GA methodology triggered the emergence of ' common g round ' among stakeholders. This common ground evolved throughout the sessions to enhance stakeholders' verbal and non-verbal communication, as well as coordination of joint activities and ultimately collaboration on problem solving and decision-making; Conclusion s : Understanding complex health data is necessary for informed decisions. Equally important, in this case, is the use of the group analytics methodology to achieve ' common ground' among diverse stakeholders about health data and their implications.

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol

PubMed Central

Pluye, Pierre; Légaré, France; Haggerty, Jeannie; Gore, Genevieve C; Sherif, Reem El; Poitras, Marie-Ève; Beaulieu, Marie-Claude; Beaulieu, Marie-Dominique; Bush, Paula L; Couturier, Yves; Débarges, Béatrice; Gagnon, Justin; Giguère, Anik; Grad, Roland; Granikov, Vera; Goulet, Serge; Hudon, Catherine; Kremer, Bernardo; Kröger, Edeltraut; Kudrina, Irina; Lebouché, Bertrand; Loignon, Christine; Lussier, Marie-Thérèse; Martello, Cristiano; Nguyen, Quynh; Pratt, Rebekah; Rihoux, Benoit; Rosenberg, Ellen; Samson, Isabelle; Senn, Nicolas; Li Tang, David; Tsujimoto, Masashi; Vedel, Isabelle; Ventelou, Bruno; Wensing, Michel; Bigras, Magali

2017-01-01

Introduction Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). Methods and analysis This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs’ qualitative decisional need assessment (semistructured interviews and focus group with stakeholders). Ethics and dissemination This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs’ decisional needs (practical contribution). We will adapt the IP-SDM model, normally dealing with a single decision, for PCCNs who experience cascade of decisions involving different stakeholders (theoretical contribution). Knowledge users will facilitate dissemination of the results in the Canadian primary care network. PROSPERO registration number CRD42015020558. PMID:29133314

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol.

PubMed

Bujold, Mathieu; Pluye, Pierre; Légaré, France; Haggerty, Jeannie; Gore, Genevieve C; Sherif, Reem El; Poitras, Marie-Eve; Beaulieu, Marie-Claude; Beaulieu, Marie-Dominique; Bush, Paula L; Couturier, Yves; Débarges, Beatrice; Gagnon, Justin; Giguère, Anik; Grad, Roland; Granikov, Vera; Goulet, Serge; Hudon, Catherine; Kremer, Bernardo; Kröger, Edeltraut; Kudrina, Irina; Lebouché, Bertrand; Loignon, Christine; Lussier, Marie-Therese; Martello, Cristiano; Nguyen, Quynh; Pratt, Rebekah; Rihoux, Benoit; Rosenberg, Ellen; Samson, Isabelle; Senn, Nicolas; Li Tang, David; Tsujimoto, Masashi; Vedel, Isabelle; Ventelou, Bruno; Wensing, Michel

2017-11-12

Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs' qualitative decisional need assessment (semistructured interviews and focus group with stakeholders). This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs' decisional needs (practical contribution). We will adapt the IP-SDM model, normally dealing with a single decision, for PCCNs who experience cascade of decisions involving different stakeholders (theoretical contribution). Knowledge users will facilitate dissemination of the results in the Canadian primary care network. CRD42015020558. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Value Frameworks in Oncology: Comparative Analysis and Implications to the Pharmaceutical Industry.

PubMed

Slomiany, Mark; Madhavan, Priya; Kuehn, Michael; Richardson, Sasha

2017-07-01

As the cost of oncology care continues to rise, composite value models that variably capture the diverse concerns of patients, physicians, payers, policymakers, and the pharmaceutical industry have begun to take shape. To review the capabilities and limitations of 5 of the most notable value frameworks in oncology that have emerged in recent years and to compare their relative value and application among the intended stakeholders. We compared the methodology of the American Society of Clinical Oncology (ASCO) Value Framework (version 2.0), the National Comprehensive Cancer Network Evidence Blocks, Memorial Sloan Kettering Cancer Center DrugAbacus, the Institute for Clinical and Economic Review Value Assessment Framework, and the European Society for Medical Oncology Magnitude of Clinical Benefit Scale, using a side-by-side comparative approach in terms of the input, scoring methodology, and output of each framework. In addition, we gleaned stakeholder insights about these frameworks and their potential real-world applications through dialogues with physicians and payers, as well as through secondary research and an aggregate analysis of previously published survey results. The analysis identified several framework-specific themes in their respective focus on clinical trial elements, breadth of evidence, evidence weighting, scoring methodology, and value to stakeholders. Our dialogues with physicians and our aggregate analysis of previous surveys revealed a varying level of awareness of, and use of, each of the value frameworks in clinical practice. For example, although the ASCO Value Framework appears nascent in clinical practice, physicians believe that the frameworks will be more useful in practice in the future as they become more established and as their outputs are more widely accepted. Along with patients and payers, who bear the burden of treatment costs, physicians and policymakers have waded into the discussion of defining value in oncology care, as well as pharmaceutical companies that seek to understand the impact of these value frameworks on each stakeholder, as they model the value and financial threshold of innovative, high-cost drugs.

A Futures Study of Internationalization of the Carlson School of Management: Diverse Perspectives of Key Stakeholders

ERIC Educational Resources Information Center

D'Angelo, Anne Marie

2010-01-01

Internationalization is a multi-faceted, multi-dimensional and complex concept described most notably as a higher educational process that integrates an international perspective into its organizational leadership, vision, and curricular goals. Success is dependent upon ongoing engagement of a multitude of internal and external stakeholders with…

The Quest for Autonomy: A Foucauldian Perspective on Work-Based Research

ERIC Educational Resources Information Center

Siebert, Sabina; Mills, Vince

2007-01-01

The relationship between the workplace, the researcher and the university is of a complex nature and all three stakeholders have their own influences on work-based learning. Defining the relationship between the stakeholders provokes a consideration of the issue of power, since power relations within a workplace can affect the reliability of…

Interactive modelling with stakeholders in two cases in flood management

NASA Astrophysics Data System (ADS)

Leskens, Johannes; Brugnach, Marcela

2013-04-01

New policies on flood management called Multi-Level Safety (MLS), demand for an integral and collaborative approach. The goal of MLS is to minimize flood risks by a coherent package of protection measures, crisis management and flood resilience measures. To achieve this, various stakeholders, such as water boards, municipalities and provinces, have to collaborate in composing these measures. Besides the many advances this integral and collaborative approach gives, the decision-making environment becomes also more complex. Participants have to consider more criteria than they used to do and have to take a wide network of participants into account, all with specific perspectives, cultures and preferences. In response, sophisticated models are developed to support decision-makers in grasping this complexity. These models provide predictions of flood events and offer the opportunity to test the effectiveness of various measures under different criteria. Recent model advances in computation speed and model flexibility allow stakeholders to directly interact with a hydrological hydraulic model during meetings. Besides a better understanding of the decision content, these interactive models are supposed to support the incorporation of stakeholder knowledge in modelling and to support mutual understanding of different perspectives of stakeholders To explore the support of interactive modelling in integral and collaborate policies, such as MLS, we tested a prototype of an interactive flood model (3Di) with respect to a conventional model (Sobek) in two cases. The two cases included the designing of flood protection measures in Amsterdam and a flood event exercise in Delft. These case studies yielded two main results. First, we observed that in the exploration phase of a decision-making process, stakeholders participated actively in interactive modelling sessions. This increased the technical understanding of complex problems and the insight in the effectiveness of various integral measures. Second, when measures became more concrete, the model played a minor role, as stakeholders were still bounded to goals, responsibilities and budgets of their own organization. Model results in this phase are mainly used in a political way to maximize the goals of particular organizations.

Tinamit: Making coupled system dynamics models accessible to stakeholders

NASA Astrophysics Data System (ADS)

Malard, Julien; Inam Baig, Azhar; Rojas Díaz, Marcela; Hassanzadeh, Elmira; Adamowski, Jan; Tuy, Héctor; Melgar-Quiñonez, Hugo

2017-04-01

Model coupling is increasingly used as a method of combining the best of two models when representing socio-environmental systems, though barriers to successful model adoption by stakeholders are particularly present with the use of coupled models, due to their high complexity and typically low implementation flexibility. Coupled system dynamics - physically-based modelling is a promising method to improve stakeholder participation in environmental modelling while retaining a high level of complexity for physical process representation, as the system dynamics components are readily understandable and can be built by stakeholders themselves. However, this method is not without limitations in practice, including 1) inflexible and complicated coupling methods, 2) difficult model maintenance after the end of the project, and 3) a wide variety of end-user cultures and languages. We have developed the open-source Python-language software tool Tinamit to overcome some of these limitations to the adoption of stakeholder-based coupled system dynamics - physically-based modelling. The software is unique in 1) its inclusion of both a graphical user interface (GUI) and a library of available commands (API) that allow users with little or no coding abilities to rapidly, effectively, and flexibly couple models, 2) its multilingual support for the GUI, allowing users to couple models in their preferred language (and to add new languages as necessary for their community work), and 3) its modular structure allowing for very easy model coupling and modification without the direct use of code, and to which programming-savvy users can easily add support for new types of physically-based models. We discuss how the use of Tinamit for model coupling can greatly increase the accessibility of coupled models to stakeholders, using an example of a stakeholder-built system dynamics model of soil salinity issues in Pakistan coupled with the physically-based soil salinity and water flow model SAHYSMOD. Different socioeconomic and environmental policies for soil salinity remediation are tested within the coupled model, allowing for the identification of the most efficient actions from an environmental and a farmer economy standpoint while taking into account the complex feedbacks between socioeconomics and the physical environment.

Costing in Radiology and Health Care: Rationale, Relativity, Rudiments, and Realities.

PubMed

Rubin, Geoffrey D

2017-02-01

Costs direct decisions that influence the effectiveness of radiology in the care of patients on a daily basis. Yet many radiologists struggle to harness the power of cost measurement and cost management as a critical path toward establishing their value in patient care. When radiologists cannot articulate their value, they risk losing control over how imaging is delivered and supported. In the United States, recent payment trends directing value-based payments for bundles of care advance the imperative for radiology providers to articulate their value. This begins with the development of an understanding of the providers' own costs, as well as the complex interrelationships and imaging-associated costs of other participants across the imaging value chain. Controlling the costs of imaging necessitates understanding them at a procedural level and quantifying the costs of delivering specific imaging services. Effective product-level costing is dependent on a bottom-up approach, which is supported through recent innovations in time-dependent activity-based costing. Once the costs are understood, they can be managed. Within the high fixed cost and high overhead cost environment of health care provider organizations, stakeholders must understand the implications of misaligned top-down cost management approaches that can both paradoxically shift effort from low-cost workers to much costlier professionals and allocate overhead costs counterproductively. Radiology's engagement across a broad spectrum of care provides an excellent opportunity for radiology providers to take a leading role within the health care organizations to enhance value and margin through principled and effective cost management. Following a discussion of the rationale for measuring costs, this review contextualizes costs from the perspectives of a variety of stakeholders (relativity), discusses core concepts in how costs are classified (rudiments), presents common and improved methods for measuring costs in health care, and discusses how cost management strategies can either improve or hinder high-value health care (realities). © RSNA, 2017 Online supplemental material is available for this article.

Dynamic simulation modelling of policy responses to reduce alcohol-related harms: rationale and procedure for a participatory approach.

PubMed

Atkinson, Jo-An; O'Donnell, Eloise; Wiggers, John; McDonnell, Geoff; Mitchell, Jo; Freebairn, Louise; Indig, Devon; Rychetnik, Lucie

2017-02-15

Development of effective policy responses to address complex public health problems can be challenged by a lack of clarity about the interaction of risk factors driving the problem, differing views of stakeholders on the most appropriate and effective intervention approaches, a lack of evidence to support commonly implemented and acceptable intervention approaches, and a lack of acceptance of effective interventions. Consequently, political considerations, community advocacy and industry lobbying can contribute to a hotly contested debate about the most appropriate course of action; this can hinder consensus and give rise to policy resistance. The problem of alcohol misuse and its associated harms in New South Wales (NSW), Australia, provides a relevant example of such challenges. Dynamic simulation modelling is increasingly being valued by the health sector as a robust tool to support decision making to address complex problems. It allows policy makers to ask 'what-if' questions and test the potential impacts of different policy scenarios over time, before solutions are implemented in the real world. Participatory approaches to modelling enable researchers, policy makers, program planners, practitioners and consumer representatives to collaborate with expert modellers to ensure that models are transparent, incorporate diverse evidence and perspectives, are better aligned to the decision-support needs of policy makers, and can facilitate consensus building for action. This paper outlines a procedure for embedding stakeholder engagement and consensus building in the development of dynamic simulation models that can guide the development of effective, coordinated and acceptable policy responses to complex public health problems, such as alcohol-related harms in NSW.

Planning a multi-site, complex intervention for homeless people with mental illness: the relationships between the national team and local sites in Canada's At Home/Chez Soi project.

PubMed

Nelson, Geoffrey; Macnaughton, Eric; Goering, Paula; Dudley, Michael; O'Campo, Patricia; Patterson, Michelle; Piat, Myra; Prévost, Natasha; Strehlau, Verena; Vallée, Catherine

2013-06-01

This research focused on the relationships between a national team and five project sites across Canada in planning a complex, community intervention for homeless people with mental illness called At Home/Chez Soi, which is based on the Housing First model. The research addressed two questions: (a) what are the challenges in planning? and (b) what factors that helped or hindered moving project planning forward? Using qualitative methods, 149 national, provincial, and local stakeholders participated in key informant or focus group interviews. We found that planning entails not only intervention and research tasks, but also relational processes that occur within an ecology of time, local context, and values. More specifically, the relationships between the national team and the project sites can be conceptualized as a collaborative process in which national and local partners bring different agendas to the planning process and must therefore listen to, negotiate, discuss, and compromise with one another. A collaborative process that involves power-sharing and having project coordinators at each site helped to bridge the differences between these two stakeholder groups, to find common ground, and to accomplish planning tasks within a compressed time frame. While local context and culture pushed towards unique adaptations of Housing First, the principles of the Housing First model provided a foundation for a common approach across sites and interventions. The implications of the findings for future planning and research of multi-site, complex, community interventions are noted.

Exploring stakeholders' views of medical education research priorities: a national survey.

PubMed

Dennis, Ashley A; Cleland, Jennifer A; Johnston, Peter; Ker, Jean S; Lough, Murray; Rees, Charlotte E

2014-11-01

Setting research priorities is important when exploring complex issues with limited resources. Only two countries (Canada and New Zealand) have previously conducted priority-setting exercises for medical education research (MER). This study aimed to identify the views of multiple stakeholders on MER priorities in Scotland. This study utilised a two-stage design to explore the views of stakeholders across the medical education continuum using online questionnaires. In Stage 1, key informants outlined their top three MER priorities and justified their choices. In Stage 2, participants rated 21 topics generated in Stage 1 according to importance and identified or justified their top priorities. A combination of qualitative (i.e. framework analysis) and quantitative (e.g. exploratory factor analysis) data analyses were employed. Views were gathered from over 1300 stakeholders. A total of 21 subthemes (or priority areas) identified in Stage 1 were explored further in Stage 2. The 21 items loaded onto five factors: the culture of learning together in the workplace; enhancing and valuing the role of educators; curriculum integration and innovation; bridging the gap between assessment and feedback, and building a resilient workforce. Within Stage 2, the top priority subthemes were: balancing conflicts between service and training; providing useful feedback; promoting resiliency and well-being; creating an effective workplace learning culture; selecting and recruiting doctors to reflect need, and ensuring that curricula prepare trainees for practice. Participant characteristics were related to the perceived importance of the factors. Finally, five themes explaining why participants prioritised items were identified: patient safety; quality of care; investing for the future; policy and political agendas, and evidence-based education. This study indicates that, across the spectrum of stakeholders and geography, certain MER priorities are consistently identified. These priority areas are in harmony with a range of current drivers in UK medical education. They provide a platform of evidence on which to base decisions about MER programmes in Scotland and beyond. © 2014 John Wiley & Sons Ltd.

Developing rural community health risk assessments for climate change: a Tasmanian pilot study.

PubMed

Bell, Erica J; Turner, Paul; Meinke, Holger; Holbrook, Neil J

2015-01-01

This article examines the development and pilot implementation of an approach to support local community decision-makers to plan health adaptation responses to climate change. The approach involves health and wellbeing risk assessment supported through the use of an electronic tool. While climate change is a major foreseeable public health threat, the extent to which health services are prepared for, or able to adequately respond to, climate change impact-related risks remains unclear. Building health decision-support mechanisms in order to involve and empower local stakeholders to help create the basis for agreement on these adaptive actions is an important first step. The primary research question was 'What can be learned from pilot implementation of a community health and well-being risk assessment (CHWRA) information technology-based tool designed to support understanding of, and decision-making on, local community challenges and opportunities associated with health risks posed by climate change? The article examines the complexity of climate change science to adaptation translational processes, with reference to existing research literature on community development. This is done in the context of addressing human health risks for rural and remote communities in Tasmania, Australia. This process is further examined through the pilot implementation of an electronic tool designed to support the translation of physically based climate change impact information into community-level assessments of health risks and adaptation priorities. The procedural and technical nature of the CHWRA tool is described, and the implications of the data gathered from stakeholder workshops held at three rural Tasmanian local government sites are considered and discussed. Bushfire, depression and waterborne diseases were identified by community stakeholders as being potentially 'catastrophic' health effects 'likely' to 'almost certain' to occur at one or more Tasmanian rural sites - based on an Intergovernmental Panel on Climate Change style of assessment. Consensus statements from stakeholders also suggested concern with health sector adaptation capacity and community resilience, and what community stakeholders defined as 'last straw' climate effects in already stressed communities. Preventative action and community engagement were also seen as important, especially with regard to managing the ways that climate change can multiply socioeconomic and health outcome inequality. Above all, stakeholder responses emphasised the importance of an applied, complexity-oriented understanding of how climate and climate change impacts affect local communities and local services to compromise the overall quality of human health in these communities. Complex community-level assessments about climate change and related health risks and responses can be captured electronically in ways that offer potentially actionable information about priorities for health sector adaptation, as a first step in planning. What is valuable about these community judgements is the creation of shared values and commitments. Future iteration of the IT tool could include decision-support modules to support best practice health sector adaptation scenarios, providing participants with opportunities to develop their know-how about health sector adaptation to climate change. If managed carefully, such tools could work within a balanced portfolio of measures to help reduce the rising health burden from climate change.

The International Finance Facility for Immunisation: stakeholders' perspectives.

PubMed

Crocker-Buque, Tim; Mounier-Jack, Sandra

2016-09-01

To evaluate stakeholders' understanding and opinions of the International Finance Facility for Immunisation (IFFIm); to identify factors affecting funding levels; and to explore the future use of IFFIm. Between July and September 2015, we interviewed 33 individuals from 25 organizations identified as stakeholders in IFFIm. In total 22.5 hours of semi-structured interviews were recorded, transcribed and analysed using a framework method. Stakeholders' understanding of IFFIm's financing mechanism and its outcomes varied and many stakeholders wanted more information. Participants highlighted that the change in the macro-economic environment following the 2008 financial crisis affected national policy in donor countries and subsequently the number of new commitments IFFIm received. Since Gavi is now seen as a successful and mature organization, participants stated that donors prefer to donate directly to Gavi. The pharmaceutical industry valued IFFIm for providing funding stability and flexibility. Other stakeholders valued IFFIm's ability to access funds early and enable Gavi to increase vaccine coverage. Overall, stakeholders thought IFFIm was successful, but they had divergent views about IFFIm's on-going role. Participants listed two issues where bond financing mechanisms may be suitable: emergency preparedness and outcome-based time-limited interventions. The benefit of pledging funds through IFFIm needs to be re-evaluated. There are potential uses for bond financing to raise funds for other global health issues, but these must be carefully considered against criteria to establish effectiveness, with quantifiable pre-defined outcome indicators to evaluate performance.

Stakeholder Dialogue as Deliberation for Decision Making in Health Policy and Systems: The Approach from Argumentation Theory.

PubMed

Rubinelli, Sara; von Groote, Per Maximilian

2017-02-01

The literature on knowledge translation and dissemination in health care highlights the value of the stakeholder dialogue, namely, a structured process where stakeholders interact to identify the best solution to a given problem. By analyzing the stakeholder dialogue as a form of deliberative argumentation, this article identifies those factors that may hinder or facilitate reaching agreement among stakeholders on options to target problems. Conceptual analysis based on the descriptive and evaluation methods of argumentation theory. When stakeholders have a difference of opinion, confrontation alone does not lead to agreement. A normative model of critical discussion is needed to facilitate stakeholders in reaching this agreement and to prevent barriers to it that can result from personal factors (e.g., attitude and beliefs) or communication moves. This type of dialogue requires a training of stakeholders about the preconditions of argumentation and its different stages. The figure of the moderator is crucial in ensuring that the dialogue fulfills standards of reasonableness. This article offers a reading of the stakeholder dialogue rooted in the tradition of critical thinking. It instructs on how to promote a collaborative exchange among stakeholders as a way to go beyond any expression of views.

Improving Management of Green Retrofits from a Stakeholder Perspective: A Case Study in China.

PubMed

Liang, Xin; Shen, Geoffrey Qiping; Guo, Li

2015-10-28

Green retrofits, which improve the environment and energy efficiency of buildings, are considered a potential solution for reducing energy consumption as well as improving human health and productivity. They represent some of the riskiest, most complex, and most uncertain projects to manage. As the foundation of project management, critical success factors (CSFs) have been emphasized by previous research. However, most studies identified and prioritized CSFs independently of stakeholders. This differs from the reality, where the success of green retrofits is tightly interrelated to the stakeholders of projects. To improve the analysis from a stakeholder perspective, the present study proposed an innovative method based on a two-mode social network analysis to integrate CSF analysis with stakeholders. The results of this method can provide further understanding of the interactions between stakeholders and CSFs, and the underlying relationship among CSFs through stakeholders. A pilot study was conducted to apply the proposed method and assess the CSFs for green retrofits in China. The five most significant CSFs are identified in the management of green retrofit. Furthermore, the interrelations between stakeholders and CSFs, coefficient and clusters of CSFs are likewise discussed.

Improving Management of Green Retrofits from a Stakeholder Perspective: A Case Study in China

PubMed Central

Liang, Xin; Shen, Geoffrey Qiping; Guo, Li

2015-01-01

Green retrofits, which improve the environment and energy efficiency of buildings, are considered a potential solution for reducing energy consumption as well as improving human health and productivity. They represent some of the riskiest, most complex, and most uncertain projects to manage. As the foundation of project management, critical success factors (CSFs) have been emphasized by previous research. However, most studies identified and prioritized CSFs independently of stakeholders. This differs from the reality, where the success of green retrofits is tightly interrelated to the stakeholders of projects. To improve the analysis from a stakeholder perspective, the present study proposed an innovative method based on a two-mode social network analysis to integrate CSF analysis with stakeholders. The results of this method can provide further understanding of the interactions between stakeholders and CSFs, and the underlying relationship among CSFs through stakeholders. A pilot study was conducted to apply the proposed method and assess the CSFs for green retrofits in China. The five most significant CSFs are identified in the management of green retrofit. Furthermore, the interrelations between stakeholders and CSFs, coefficient and clusters of CSFs are likewise discussed. PMID:26516897

Business Model Design from an ANT Perspective: Contributions and Insights of an Open and Living Theory

NASA Astrophysics Data System (ADS)

Costa, Cristina Chuva; da Cunha, Paulo Rupino

The way the Internet has connected millions of users at negligible costs has changed playing field for companies. Several stakeholders can now come together in virtual networks to create innovative business models that would be unfeasible in the physical world. However, the more radical the departure from the established models of value creation, the bigger the complexity in ensuring the sustained interest of the involved parties and the stability of the bonds. To address this problem, we sought inspiration in the Actor-Network Theory (ANT), which is capable of providing insights into socio-technical settings where human and non-human agents interact. We describe how several of its principles, ideas, and concepts were adapted and embedded in our approach for complex business model design or analysis. A simple illustration is provided. Our iterative approach helps systematically scrutinize and tune the contributions and returns of the various actors, ensuring that all end up with an attractive value proposal, thus promoting the robustness of the network. Guidelines for the services that an underlying information system must provide are also derived from the results.

An exploratory study of healthcare strategic planning in two metropolitan areas.

PubMed

Begun, James W; Kaissi, Amer A

2005-01-01

Little is known about empirical variation in the extent to which healthcare organizations conduct formal strategic planning or the extent to which strategic planning affects performance. Structural contingency and complexity science theory offer differing interpretations of the value of strategic planning. Structural contingency theory emphasizes adaptation to achieve organizational fit with a changing environment and views strategic planning as a way to chart the organization's path. Complexity science argues that planning is largely futile in changing environments. Interviews of leaders in 20 healthcare organizations in the metropolitan areas of Minneapolis/St. Paul, Minnesota, and San Antonio, Texas, reveal that strategic planning is a common and valued function in healthcare organizations. Respondents emphasized the need to continuously update strategic plans, involve physicians and the governing board, and integrate strategic plans with other organizational plans. Most leaders expressed that strategic planning contributes to organizational focus, fosters stakeholder participation and commitment, and leads to achievement of strategic goals. Because the widespread belief in strategic planning is based largely on experience, intuition, and faith, we present recommendations for developing an evidence base for healthcare strategic planning.

Stakeholder Participation in System Change: A New Conceptual Model.

PubMed

O'Rourke, Tammy; Higuchi, Kathryn S; Hogg, William

2016-08-01

A recent change in Canada's primary care system led to the introduction of Nurse Practitioner-Led clinics. The literature suggests that stakeholders can influence system change initiatives. However, very little is known about healthcare stakeholder motivations, particularly stakeholders who are seen as resistors to change. To examine stakeholder participation in the system change process that led to the introduction of the first Nurse Practitioner-Led clinic in Ontario. This single case study included two site visits, semistructured individual tape-recorded interviews, and the examination of relevant public documents. Qualitative content analysis was used to analyze the data. Sixteen individuals from different healthcare sectors and professions participated in the interviews and 20 documents were reviewed. Six key themes emerged from the data. Linking Evidence to Action The findings from the study present a new perspective on stakeholder participation that includes both those who supported the proposed change and those who advocated for a different change. The findings identify stakeholder activities used to shape, share, and protect their visions for system change. The conceptual model presented in this study adds to the understanding of challenges and complexities involved in healthcare system change. Understanding why and how stakeholders participate in change can help healthcare leaders in planning activities to enhance stakeholder involvement in healthcare system change. © 2016 Sigma Theta Tau International.

Negotiating multisectoral evidence: a qualitative study of knowledge exchange at the intersection of transport and public health.

PubMed

Guell, Cornelia; Mackett, Roger; Ogilvie, David

2017-01-05

For the prevention and control of chronic diseases, two strategies are frequently highlighted: that public health should be evidence based, and that it should develop a multisectoral approach. At the end of a natural experimental study of the health impacts of new transport infrastructure, we took the opportunity of a knowledge exchange forum to explore how stakeholders assessed, negotiated and intended to apply multisectoral evidence in policy and practice at the intersection of transport and health. We aimed to better understand the challenges they faced in knowledge exchange, as well as their everyday experiences with working in multisectoral remits. In 2015, we conducted participant observation during an interactive event with 41 stakeholders from national and local government, the third sector and academia in Cambridge, UK. Formal and informal interactions between stakeholders were recorded in observational field notes. We also conducted 18 semistructured interviews reflecting on the event and on knowledge exchange in general. We found that stakeholders negotiated a variety of challenges. First, stakeholders had to negotiate relatively new formal and informal multisectoral remits; and how to reconcile the differing expectations of transport specialists, who tended to emphasise the importance of precedence in guiding action, and health specialists' concern for the rigour and synthesis of research evidence. Second, research in this field involved complex study designs, and often produced evidence with uncertain transferability to other settings. Third, health outcomes of transport schemes had political traction and were used strategically but not easily translated into cost-benefit ratios. Finally, knowledge exchange meant multiple directions of influence. Stakeholders were concerned that researchers did not always have skills to translate their findings into understandable evidence, and some stakeholders would welcome opportunities to influence research agendas. This case study of stakeholders' experiences indicates that multisectoral research, practice and policymaking requires the ability and capacity to locate, understand and communicate complex evidence from a variety of disciplines, and integrate different types of evidence into clear business cases beyond sectoral boundaries.

Systems, Stakeholders, and Students: Including Students in School Reform

ERIC Educational Resources Information Center

Zion, Shelley D.

2009-01-01

The education system in the United States is under pressure from a variety of sources to reform and improve the delivery of educational services to students. Change across a system as complex and dynamic as the educational system requires a systemic approach and requires the participation or buy-in of all participants and stakeholders. This…

A watershed-based adaptive knowledge system for developing ecosystem stakeholder partnerships

NASA Astrophysics Data System (ADS)

Lin, Hebin; Thornton, Jeffrey A.; Shadrin, Nickolai

2015-11-01

This study proposes a Watershed-based Adaptive Knowledge System (WAKES) to consistently coordinate multiple stakeholders in developing sustainable partnerships for ecosystem management. WAKES is extended from the institutional mechanism of Payments for Improving Ecosystem Services at the Watershed-scale (PIES-W). PIES-W is designed relating to the governance of ecosystem services fl ows focused on a lake as a resource stock connecting its infl owing and outfl owing rivers within its watershed. It explicitly realizes the values of conservation services provided by private land managers and incorporates their activities into the public organizing framework for ecosystem management. It implicitly extends the "upstream-to-downstream" organizing perspective to a broader vision of viewing the ecosystems as comprised of both "watershed landscapes" and "marine landscapes". Extended from PIES-W, WAKES specifies two corresponding feedback: Framework I and II. Framework I is a relationship matrix comprised of three input-output structures of primary governance factors intersecting three subsystems of a watershed with regard to ecosystem services and human stakeholders. Framework II is the Stakeholder-and-Information structure channeling five types of information among four stakeholder groups in order to enable the feedbacks mechanism of Framework I. WAKES identifies the rationales behind three fundamental information transformations, illustrated with the Transboundary Diagnostic Analysis and the Strategic Action Program of the Bermejo River Binational Basin. These include (1) translating scientific knowledge into public information within the Function-and-Service structure corresponding to the ecological subsystem, (2) incorporating public perceptions into political will within the Service- and- Value structure corresponding to the economic subsystem, and (3) integrating scientific knowledge, public perceptions and political will into management options within the Value-and-Stakeholder structure corresponding to the social subsystem. This study seeks to share a vision of social adaptation for a global sustainable future through developing a network to adopt contributions from and forming partnerships among all ecosystem stakeholders.

Mind the gap! Lessons from science-based stakeholder dialogue in climate-adapted management of wetlands.

PubMed

Grygoruk, Mateusz; Rannow, Sven

2017-01-15

Effective stakeholder involvement is crucial for the management of protected areas, especially when new challenges like adaptation to climate change need to be addressed. Under these circumstances, science-based stakeholder involvement is required. However, there is often a gap between the information produced by science and the need for information from stakeholders. Along with the design and implementation of adaptive management strategies and policies, efforts must be taken to adjust messages about conservation and adaptation issues, to make them easier to understand, relevant and acceptable for stakeholders. In this paper, the experience of closing the gap between scientific information and the user needs of stakeholders in the Biebrza Valley is documented. The requirements of efficient stakeholder dialogue and the raising of awareness are then indicated. We conclude that many attempts to raise awareness of environmental conservation require improvements. Messages often need to be adjusted for different stakeholders and their various perception levels to efficiently anticipate the potential impacts of the changing climate on ecosystem management. We also revealed that the autonomous adaptation measures implemented by stakeholders to mitigate impacts of climatic change often contradict adaptive management planned and implemented by environmental authorities. We conclude that there is a demand for boundary spanners that can build a bridge between complex scientific outputs and stakeholder needs. Copyright © 2016 Elsevier Ltd. All rights reserved.

'Hot particles' in the cold light of day: principles for a stakeholder and public engagement architecture relating to historic liabilities in the marine environment.

PubMed

Wylie, Rick

2007-09-01

This paper discusses issues in stakeholder relations, focusing on the challenges of liabilities management associated with small fragments of irradiated nuclear fuel hereafter termed particles (and sometimes termed 'hot particles' in the public domain, from which this paper gets its title), produced over a number of decades from now ceased operations at Dounreay. It describes key problems confronting the nuclear industry in developing a stakeholder-relations strategy. Drawing upon examples of the stakeholder activity at Dounreay, and using an ecological metaphor, an innovative architecture for stakeholder engagement relating to nuclear issues is outlined. This is based upon the view that the solution of the stakeholder issue must reflect the complexity and connectivity of influences and interests within the stakeholder environment. It is argued that the lay public should be visualised as the stakeholder if an effective stakeholder-relations strategy is to be achieved. The importance of creating trust in a context of scientific uncertainty is highlighted. This will, it is argued, become an increasingly salient issue in the thrust for openness and transparency, two key drivers of nuclear industry public and stakeholder relations, which could make the limits of scientific knowledge and control more widely appreciated, and bring to the fore the role of lay conceptions of perceived risk.

Integrating Collaboration, Adaptive Management, and Scenario-Planning to Address Rapid Change: Experiences at Las Cienegas National Conservation Area

NASA Astrophysics Data System (ADS)

Caves, J. K.; Bodner, G.; Simms, K.; Fisher, L.; Robertson, T.

2012-12-01

There is growing recognition that public lands cannot be managed as islands; rather, land management must address the ecological, social, and temporal complexity that often spans jurisdictions and traditional planning horizons. Collaborative decision-making and adaptive management (CAM) have been promoted as methods to reconcile competing societal demands and respond to complex ecosystem dynamics. We present the experiences of land managers and stakeholders in using CAM at Las Cienegas National Conservation Area (LCNCA), a highly valued site under the jurisdiction of the Bureau of Land Management (BLM). The CAM process at Las Cienegas is marked by strong stakeholder engagement, with four core elements: 1) shared watershed goals with measurable resource objectives; 2) mechanisms to incorporate new information into decision-making; 3) efforts to make information increasingly relevant and reliable; and 4) shared learning to improve both the process and management actions. The combination of stakeholder engagement and adaptive management has led to agreement on contentious issues, more innovative solutions, and more effective land management. Yet the region is now experiencing rapid changes outside managers' control—including climate change, human population growth, and reduced federal budgets—with large but unpredictable impacts on natural resources. While CAM experience provides a strong foundation for making the difficult and contentious management decisions that such changes are likely to require, neither collaboration nor adaptive management provides a sufficient structure for addressing uncontrollable and unpredictable change. As a result, LCNCA is exploring two specific modifications to CAM that may better address emerging challenges, including: 1) Creating nested resource objectives to distinguish between those objectives which may be crucial from those which may hinder a flexible response to climate change, and 2) Incorporating scenario planning into CAM to explore how climate change may interact with other drivers and alter options for the future, to identify robust management, and to prioritize ecological monitoring efforts. The experiences at LCNCA demonstrate how collaboration and adaptive management can be used to improve social and environmental outcomes and, with a few modifications, may help address the complexity and change that threatens to overwhelm even the best efforts to sustain public lands.

Comprehensive Plans for a Culture-Driven Local Development: Emergence as a Tool for Understanding Social Impacts of Projects on Built Cultural Heritage

NASA Astrophysics Data System (ADS)

Torre, Stefano Della; Canziani, Andrea

Cultural Heritage is comprehensible within an integrated vision, involving economic, cultural and ethic values, typical of not renewable resources. It is an open system that doesn't correspond just to monuments but is made by the complex interactions of a built environment. The systemic relationships between cultural goods (object, building, landscape), and their environmental context have to be considered of the same importance of the systemic relations established with stakeholders/observers. A first partial answer to Cultural Heritage systemic nature has been the creation of "networks" of cultural institutions, that afterwards have been evolving in "cultural systems" and have been recently followed by "cultural districts". The Cultural District model put forward a precise application for the theory of emergence. But its systemic nature presents also some problematical identifications. For Cultural Heritage the point is not any more limited to "direct" actions. We must consider stakeholders/observers, feedback circuits, emergence of activation of social/cultural/human capital, more than that linked to the architectural design process.

Taking stock of current societal, political and academic stakeholders in the Canadian healthcare knowledge translation agenda

PubMed Central

Newton, Mandi S; Scott-Findlay, Shannon

2007-01-01

Background In the past 15 years, knowledge translation in healthcare has emerged as a multifaceted and complex agenda. Theoretical and polemical discussions, the development of a science to study and measure the effects of translating research evidence into healthcare, and the role of key stakeholders including academe, healthcare decision-makers, the public, and government funding bodies have brought scholarly, organizational, social, and political dimensions to the agenda. Objective This paper discusses the current knowledge translation agenda in Canadian healthcare and how elements in this agenda shape the discovery and translation of health knowledge. Discussion The current knowledge translation agenda in Canadian healthcare involves the influence of values, priorities, and people; stakes which greatly shape the discovery of research knowledge and how it is or is not instituted in healthcare delivery. As this agenda continues to take shape and direction, ensuring that it is accountable for its influences is essential and should be at the forefront of concern to the Canadian public and healthcare community. This transparency will allow for scrutiny, debate, and improvements in health knowledge discovery and health services delivery. PMID:17916256

What makes a good home-based nocturnal seizure detector? A value sensitive design.

PubMed

van Andel, Judith; Leijten, Frans; van Delden, Hans; van Thiel, Ghislaine

2015-01-01

A device for the in-home detection of nocturnal seizures is currently being developed in the Netherlands, to improve care for patients with severe epilepsy. It is recognized that the design of medical technology is not value neutral: perspectives of users and developers are influential in design, and design choices influence these perspectives. However, during development processes, these influences are generally ignored and value-related choices remain implicit and poorly argued for. In the development process of the seizure detector we aimed to take values of all stakeholders into consideration. Therefore, we performed a parallel ethics study, using "value sensitive design." Analysis of stakeholder communication (in meetings and e-mail messages) identified five important values, namely, health, trust, autonomy, accessibility, and reliability. Stakeholders were then asked to give feedback on the choice of these values and how they should be interpreted. In a next step, the values were related to design choices relevant for the device, and then the consequences (risks and benefits) of these choices were investigated. Currently the process of design and testing of the device is still ongoing. The device will be validated in a trial in which the identified consequences of design choices are measured as secondary endpoints. Value sensitive design methodology is feasible for the development of new medical technology and can help designers substantiate the choices in their design.

Using serious games and virtual worlds in pesticides transport teaching

NASA Astrophysics Data System (ADS)

Payraudeau, Sylvain; Alvarez-Zaldivar, Pablo; van Dijk, Paul; Imfeld, Gwenaël

2017-04-01

Teaching environmental scenarios, such as the availability and transport of pesticides in catchments, may fail with traditional lectures and tutorials due to the complex and synergic interplay of soil, landuse, compounds properties, hydroclimatic forcing and biogeochemical processes. To tackle and pedagogically enter into this complexity, virtual worlds (i.e. computer-based simulated environment) and serious games (i.e. applied games with added pedagogical value) can efficiently improve knowledge and know-how of the future water management stakeholders and scientists. We have developed an e-learning teaching unit using virtual catchments and serious games by gradually adapting the level of complexity depending of the targeted public. The first targeted group is farmers in continuing education centers. We developed a distributed pesticide transport tool in a virtual agricultural catchment to highlight the specific risks of off-site pesticide transport along crop growing season. Students of this first group can interactively define and combine climatic, land-use and soil type scenarios with different pesticides to experiment the components of worst-case situations and to propose best-management practices depending of the involved environmental compartments, i.e. atmosphere, soil, surface water or groundwater. For Master's degree students, we added a level of complexity by adding a specific module focusing on pesticide degradation using cutting-edge approaches. With the compound-specific isotope analysis (CSIA) module students are able to link the 13C/12C signature of pesticides to the ongoing dissipation processes within the catchment. By using and interpreting CSIA data, students can thus efficiently understand the difference between non-destructive (e.g. sorption) and destructive (e.g. bio and abiotic degradation) processes occurring in a catchment. This CSIA tool applied to a virtual agricultural catchment will also allow to distinguish the dilution effect from the degradation effect in complex agricultural catchments receiving pesticides. We anticipate our e-learning teaching unit based on serious game and virtual catchments will help future scientists and stakeholders to better understand and manage pesticides transport within catchments.

Understanding global health governance as a complex adaptive system.

PubMed

Hill, Peter S

2011-01-01

The transition from international to global health reflects the rapid growth in the numbers and nature of stakeholders in health, as well as the constant change embodied in the process of globalisation itself. This paper argues that global health governance shares the characteristics of complex adaptive systems, with its multiple and diverse players, and their polyvalent and constantly evolving relationships, and rich and dynamic interactions. The sheer quantum of initiatives, the multiple networks through which stakeholders (re)configure their influence, the range of contexts in which development for health is played out - all compound the complexity of this system. This paper maps out the characteristics of complex adaptive systems as they apply to global health governance, linking them to developments in the past two decades, and the multiple responses to these changes. Examining global health governance through the frame of complexity theory offers insight into the current dynamics of governance, and while providing a framework for making meaning of the whole, opens up ways of accessing this complexity through local points of engagement.

Emerging lessons from regional and state innovation in value-based payment reform: balancing collaboration and disruptive innovation.

PubMed

Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

2014-09-01

In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder engagement and priorities shift over time. Another significant facilitator of value-based payment reform is outside investment that enables increased investment in human resources, information infrastructure, and care management by provider organizations and their collaborators. Supportive community and social service networks that enhance population health management also are important enablers of value-based payment reform. External pressure from public and private payers is fueling a "burning bridge" between the past of fee-for-service payment models and the future of payments based on value. Robust competition in local health plan and provider markets, coupled with an appropriate mix of multistakeholder governance, pressure from organized purchasers, and regulatory oversight, has the potential to spur value-based payment innovation that combines elements of "reformed" fee-for-service with bundled payments and global payments. © 2014 Milbank Memorial Fund.

Value driven innovation in medical device design: a process for balancing stakeholder voices.

PubMed

de Ana, F J; Umstead, K A; Phillips, G J; Conner, C P

2013-09-01

The innovation process has often been represented as a linear process which funnels customer needs through various business and process filters. This method may be appropriate for some consumer products, but in the medical device industry there are some inherent limitations to the traditional innovation funnel approach. In the medical device industry, there are a number of stakeholders who need to have their voices heard throughout the innovation process. Each stakeholder has diverse and unique needs relating to the medical device, the needs of one may highly affect the needs of another, and the relationships between stakeholders may be tenuous. This paper describes the application of a spiral innovation process to the development of a medical device which considers three distinct stakeholder voices: the Voice of the Customer, the Voice of the Business and the Voice of the Technology. The process is presented as a case study focusing on the front-end redesign of a class III medical device for an orthopedics company. Starting from project initiation and scope alignment, the process describes four phases, Discover, Envision, Create, and Refine, and concludes with value assessment of the final design features.

Multiple Aims in the Development of a Major Reform of the National Curriculum for Science in England

NASA Astrophysics Data System (ADS)

Ryder, Jim; Banner, Indira

2011-03-01

In the context of a major reform of the school science curriculum for 14-16-year-olds in England, we examine the aims ascribed to the reform, the stakeholders involved, and the roles of differing values and authority in its development. This reform includes an emphasis on socioscientific issues and the nature of science; curriculum trends of international relevance. Our analysis identifies largely 'instrumental' aims, with little emphasis on 'intrinsic' aims and associated values. We identify five broad categories of stakeholders focusing on different aims with, for example, a social, individual, political, or economic emphasis. We suggest that curriculum development projects reflecting largely social and individual aims were appropriated by other stakeholders to serve political and economic aims. We argue that a curriculum reform body representing all stakeholder interests is needed to ensure that multiple aims are considered throughout the curriculum reform process. Within such a body, the differentiated character of the science teaching community would need to be represented.

Interactive Cumulative Burden Assessment: Engaging Stakeholders in an Adaptive, Participatory and Transdisciplinary Approach

PubMed Central

Shrestha, Rehana; van Maarseveen, Martin

2018-01-01

Cumulative burden assessment (CuBA) has the potential to inform planning and decision-making on health disparities related to multiple environmental burdens. However, scholars have raised concerns about the social complexity to be dealt with while conducting CuBA, suggesting that it should be addressed in an adaptive, participatory and transdisciplinary (APT) approach. APT calls for deliberation among stakeholders by engaging them in a process of social learning and knowledge co-production. We propose an interactive stakeholder-based approach that facilitates a science-based stakeholder dialogue as an interface for combining different knowledge domains and engendering social learning in CuBA processes. Our approach allows participants to interact with each other using a flexible and auditable CuBA model implemented within a shared workspace. In two workshops we explored the usefulness and practicality of the approach. Results show that stakeholders were enabled to deliberate on cumulative burdens collaboratively, to learn about the technical uncertainties and social challenges associated with CuBA, and to co-produce knowledge in a realm of both technical and societal challenges. The paper identifies potential benefits relevant for responding to social complexity in the CuBA and further recommends exploration of how our approach can enable or constraint social learning and knowledge co-production in CuBA processes under various institutional, social and political contexts. PMID:29401676

Cultural context of school communities in rural Hawaii to inform youth violence prevention.

PubMed

Affonso, Dyanne D; Mayberry, Linda; Shibuya, June Y; Archambeau, Olga G; Correa, Mary; Deliramich, Aimee N; Frueh, B Christopher

2010-03-01

Escalation of youth violence within a large geographic school-complex area in southeastern rural Hawaii became a major problem in 2006. How cultural forces impact the problem was an impetus to examine youth violence from perspectives of adults and children in rural communities. Gathering these data was an essential first step toward school-based youth violence prevention program development. Eight focus groups involving 86 community stakeholders included 51 adults (parent, teachers, school staff, community leaders) and 35 children aged 8-15 years old (3rd- to 10-th grade). Qualitative narrative analysis elicited major themes. Five themes emerged: (1) School-community violence takes on many forms that become entrenched in local culture. (2) Disintegration of community resources and a sense of learned helplessness underlie the escalation of youth violence. (3) Inadequate role modeling coupled with behavioral ambivalence among adults has sustained a climate of local cultural acceptance with youth violence. (4) Connection to cultural values has diminished, leading to a sense of loss in cultural identity among students. (5) Cultural values and practices are potential strategies for youth violence prevention. Cultural and community contextual factors contributed to youth violence in rural Hawaiian communities. Study implications include the need to further investigate the impact of vigilant, community involvement of stakeholders in school-based youth violence prevention program development. Cultural revitalization at family, school, and community levels may be critical success factors of such programs.

The Regional Advisory Councils: what is their potential to incorporate stakeholder knowledge into fisheries governance?

PubMed

Linke, Sebastian; Dreyer, Marion; Sellke, Piet

2011-03-01

The protection of the Baltic Sea ecosystem is exacerbated by the social, environmental and economic complexities of governing European fisheries. Increased stakeholder participation and knowledge integration are suggested to improve the EU's Common Fisheries Policy (CFP), suffering from legitimacy, credibility and compliance problems. As a result, the CFP was revised in 2002 to involve fisheries representatives, NGOs and other stakeholders through so called Regional Advisory Councils (RACs) in the policy process. We address the RAC's task to incorporate stakeholder knowledge into the EU's fisheries governance system in empirical and theoretical perspectives. Drawing on a four-stage governance concept we subsequently suggest that a basic problem is a mismatch between participation purpose (knowledge inclusion) and the governance stage at which RACs are formally positioned (evaluation of management proposals). We conclude that, if the aim is to broaden the knowledge base of fisheries management, stakeholders need to be included earlier in the governance process.

Stakeholders' views on the ethical challenges of pragmatic trials investigating pharmaceutical drugs.

PubMed

Kalkman, Shona; van Thiel, Ghislaine J M W; Grobbee, Diederick E; Meinecke, Anna-Katharina; Zuidgeest, Mira G P; van Delden, Johannes J M

2016-08-22

We explored the views of key stakeholders to identify the ethical challenges of pragmatic trials investigating pharmaceutical drugs. A secondary aim was to capture stakeholders' attitudes towards the implementation of pragmatic trials in the drug development process. We conducted semistructured, in-depth interviews among individuals from different key stakeholder groups (academia and independent research institutions, the pharmaceutical industry, regulators, Health Technology Assessment (HTA) agencies and patients' organizations) through telephone or face-to-face sessions. Interviews were structured around the question "what challenges were experienced or perceived during the design, conduct and/or review of pragmatic trials." Respondents were additionally asked about their views on implementation of pragmatic trials in the drug development process. Thematic analysis was used to identify the ethically relevant features across data sets. We interviewed 34 stakeholders in 25 individual sessions and four group sessions. The four perceived challenges of ethical relevance were: (1) less controlled conditions creating safety concerns, (2) comparison with usual care potentially compromising clinical equipoise, (3) tailored or waivers of informed consent affecting patient autonomy, and (4) minimal interference with "real-world" practice reducing the knowledge value of trial results. We identified stakeholder concerns regarding risk assessment, use of suboptimal usual care as a comparator, tailoring of informed consent procedures and ensuring the social value of pragmatic trials. These concerns increased when respondents were asked about pragmatic trials conducted before market authorization.

A framework for stakeholder identification in concept mapping and health research: a novel process and its application to older adult mobility and the built environment.

PubMed

Schiller, Claire; Winters, Meghan; Hanson, Heather M; Ashe, Maureen C

2013-05-02

Stakeholders, as originally defined in theory, are groups or individual who can affect or are affected by an issue. Stakeholders are an important source of information in health research, providing critical perspectives and new insights on the complex determinants of health. The intersection of built and social environments with older adult mobility is an area of research that is fundamentally interdisciplinary and would benefit from a better understanding of stakeholder perspectives. Although a rich body of literature surrounds stakeholder theory, a systematic process for identifying health stakeholders in practice does not exist. This paper presents a framework of stakeholders related to older adult mobility and the built environment, and further outlines a process for systematically identifying stakeholders that can be applied in other health contexts, with a particular emphasis on concept mapping research. Informed by gaps in the relevant literature we developed a framework for identifying and categorizing health stakeholders. The framework was created through a novel iterative process of stakeholder identification and categorization. The development entailed a literature search to identify stakeholder categories, representation of identified stakeholders in a visual chart, and correspondence with expert informants to obtain practice-based insight. The three-step, iterative creation process progressed from identifying stakeholder categories, to identifying specific stakeholder groups and soliciting feedback from expert informants. The result was a stakeholder framework comprised of seven categories with detailed sub-groups. The main categories of stakeholders were, (1) the Public, (2) Policy makers and governments, (3) Research community, (4) Practitioners and professionals, (5) Health and social service providers, (6) Civil society organizations, and (7) Private business. Stakeholders related to older adult mobility and the built environment span many disciplines and realms of practice. Researchers studying this issue may use the detailed stakeholder framework process we present to identify participants for future projects. Health researchers pursuing stakeholder-based projects in other contexts are encouraged to incorporate this process of stakeholder identification and categorization to ensure systematic consideration of relevant perspectives in their work.

A framework for stakeholder identification in concept mapping and health research: a novel process and its application to older adult mobility and the built environment

PubMed Central

2013-01-01

Background Stakeholders, as originally defined in theory, are groups or individual who can affect or are affected by an issue. Stakeholders are an important source of information in health research, providing critical perspectives and new insights on the complex determinants of health. The intersection of built and social environments with older adult mobility is an area of research that is fundamentally interdisciplinary and would benefit from a better understanding of stakeholder perspectives. Although a rich body of literature surrounds stakeholder theory, a systematic process for identifying health stakeholders in practice does not exist. This paper presents a framework of stakeholders related to older adult mobility and the built environment, and further outlines a process for systematically identifying stakeholders that can be applied in other health contexts, with a particular emphasis on concept mapping research. Methods Informed by gaps in the relevant literature we developed a framework for identifying and categorizing health stakeholders. The framework was created through a novel iterative process of stakeholder identification and categorization. The development entailed a literature search to identify stakeholder categories, representation of identified stakeholders in a visual chart, and correspondence with expert informants to obtain practice-based insight. Results The three-step, iterative creation process progressed from identifying stakeholder categories, to identifying specific stakeholder groups and soliciting feedback from expert informants. The result was a stakeholder framework comprised of seven categories with detailed sub-groups. The main categories of stakeholders were, (1) the Public, (2) Policy makers and governments, (3) Research community, (4) Practitioners and professionals, (5) Health and social service providers, (6) Civil society organizations, and (7) Private business. Conclusions Stakeholders related to older adult mobility and the built environment span many disciplines and realms of practice. Researchers studying this issue may use the detailed stakeholder framework process we present to identify participants for future projects. Health researchers pursuing stakeholder-based projects in other contexts are encouraged to incorporate this process of stakeholder identification and categorization to ensure systematic consideration of relevant perspectives in their work. PMID:23639179

Development of a comprehensive model for stakeholder management in mental healthcare.

PubMed

Bierbooms, Joyce; Van Oers, Hans; Rijkers, Jeroen; Bongers, Inge

2016-06-20

Purpose - Stakeholder management is not yet incorporated into the standard practice of most healthcare providers. The purpose of this paper is to assess the applicability of a comprehensive model for stakeholder management in mental healthcare organization for more evidence-based (stakeholder) management. Design/methodology/approach - The assessment was performed in two research parts: the steps described in the model were executed in a single case study at a mental healthcare organization in the Netherlands; and a process and effect evaluation was done to find the supporting and impeding factors with regard to the applicability of the model. Interviews were held with managers and directors to evaluate the effectiveness of the model with a view to stakeholder management. Findings - The stakeholder analysis resulted in the identification of eight stakeholder groups. Different expectations were identified for each of these groups. The analysis on performance gaps revealed that stakeholders generally find the collaboration with a mental healthcare provider "sufficient." Finally a prioritization showed that five stakeholder groups were seen as "definite" stakeholders by the organization. Practical implications - The assessment of the model showed that it generated useful knowledge for more evidence-based (stakeholder) management. Adaptation of the model is needed to increase its feasibility in practice. Originality/value - Provided that the model is properly adapted for the specific field, the analysis can provide more knowledge on stakeholders and can help integrate stakeholder management as a comprehensive process in policy planning.

Regional Charging Infrastructure for Plug-In Electric Vehicles: A Case Study of Massachusetts

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wood, Eric; Raghavan, Sesha; Rames, Clement

Given the complex issues associated with plug-in electric vehicle (PEV) charging and options in deploying charging infrastructure, there is interest in exploring scenarios of future charging infrastructure deployment to provide insight and guidance to national and regional stakeholders. The complexity and cost of PEV charging infrastructure pose challenges to decision makers, including individuals, communities, and companies considering infrastructure installations. The value of PEVs to consumers and fleet operators can be increased with well-planned and cost-effective deployment of charging infrastructure. This will increase the number of miles driven electrically and accelerate PEV market penetration, increasing the shared value of charging networksmore » to an expanding consumer base. Given these complexities and challenges, the objective of the present study is to provide additional insight into the role of charging infrastructure in accelerating PEV market growth. To that end, existing studies on PEV infrastructure are summarized in a literature review. Next, an analysis of current markets is conducted with a focus on correlations between PEV adoption and public charging availability. A forward-looking case study is then conducted focused on supporting 300,000 PEVs by 2025 in Massachusetts. The report concludes with a discussion of potential methodology for estimating economic impacts of PEV infrastructure growth.« less

Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition

PubMed Central

O'Brien, Nicola; Heaven, Ben; Teal, Gemma; Evans, Elizabeth H; Cleland, Claire; Moffatt, Suzanne; Sniehotta, Falko F; White, Martin; Mathers, John C

2016-01-01

Background Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders. Objective The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example. Methods Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation. Results The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process. Conclusions Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible. PMID:27489143

Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition.

PubMed

O'Brien, Nicola; Heaven, Ben; Teal, Gemma; Evans, Elizabeth H; Cleland, Claire; Moffatt, Suzanne; Sniehotta, Falko F; White, Martin; Mathers, John C; Moynihan, Paula

2016-08-03

Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders. The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example. Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation. The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process. Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible.

A Multivariate Model of Stakeholder Preference for Lethal Cat Management

PubMed Central

Wald, Dara M.; Jacobson, Susan K.

2014-01-01

Identifying stakeholder beliefs and attitudes is critical for resolving management conflicts. Debate over outdoor cat management is often described as a conflict between two groups, environmental advocates and animal welfare advocates, but little is known about the variables predicting differences among these critical stakeholder groups. We administered a mail survey to randomly selected stakeholders representing both of these groups (n = 1,596) in Florida, where contention over the management of outdoor cats has been widespread. We used a structural equation model to evaluate stakeholder intention to support non-lethal management. The cognitive hierarchy model predicted that values influenced beliefs, which predicted general and specific attitudes, which in turn, influenced behavioral intentions. We posited that specific attitudes would mediate the effect of general attitudes, beliefs, and values on management support. Model fit statistics suggested that the final model fit the data well (CFI = 0.94, RMSEA = 0.062). The final model explained 74% of the variance in management support, and positive attitudes toward lethal management (humaneness) had the largest direct effect on management support. Specific attitudes toward lethal management and general attitudes toward outdoor cats mediated the relationship between positive (p<0.05) and negative cat-related impact beliefs (p<0.05) and support for management. These results supported the specificity hypothesis and the use of the cognitive hierarchy to assess stakeholder intention to support non-lethal cat management. Our findings suggest that stakeholders can simultaneously perceive both positive and negative beliefs about outdoor cats, which influence attitudes toward and support for non-lethal management. PMID:24736744

The Right Tree for the Job? Perceptions of Species Suitability for the Provision of Ecosystem Services

NASA Astrophysics Data System (ADS)

Smaill, Simeon J.; Bayne, Karen M.; Coker, Graham W. R.; Paul, Thomas S. H.; Clinton, Peter W.

2014-04-01

Stakeholders in plantation forestry are increasingly aware of the importance of the ecosystem services and non-market values associated with forests. In New Zealand, there is significant interest in establishing species other than Pinus radiata D. Don (the dominant plantation species) in the belief that alternative species are better suited to deliver these services. Significant risk is associated with this position as there is little objective data to support these views. To identify which species were likely to be planted to deliver ecosystem services, a survey was distributed to examine stakeholder perceptions. Stakeholders were asked which of 15 tree attributes contributed to the provision of five ecosystem services (amenity value, bioenergy production, carbon capture, the diversity of native habitat, and erosion control/water quality) and to identify which of 22 candidate tree species possessed those attributes. These data were combined to identify the species perceived most suitable for the delivery of each ecosystem service. Sequoia sempervirens (D.Don) Endl. closely matched the stakeholder derived ideotypes associated with all five ecosystem services. Comparisons to data from growth, physiological and ecological studies demonstrated that many of the opinions held by stakeholders were inaccurate, leading to erroneous assumptions regarding the suitability of most candidate species. Stakeholder perceptions substantially influence tree species selection, and plantations established on the basis of inaccurate opinions are unlikely to deliver the desired outcomes. Attitudinal surveys associated with engagement campaigns are essential to improve stakeholder knowledge, advancing the development of fit-for-purpose forest management that provides the required ecosystem services.

A multivariate model of stakeholder preference for lethal cat management.

PubMed

Wald, Dara M; Jacobson, Susan K

2014-01-01

Identifying stakeholder beliefs and attitudes is critical for resolving management conflicts. Debate over outdoor cat management is often described as a conflict between two groups, environmental advocates and animal welfare advocates, but little is known about the variables predicting differences among these critical stakeholder groups. We administered a mail survey to randomly selected stakeholders representing both of these groups (n=1,596) in Florida, where contention over the management of outdoor cats has been widespread. We used a structural equation model to evaluate stakeholder intention to support non-lethal management. The cognitive hierarchy model predicted that values influenced beliefs, which predicted general and specific attitudes, which in turn, influenced behavioral intentions. We posited that specific attitudes would mediate the effect of general attitudes, beliefs, and values on management support. Model fit statistics suggested that the final model fit the data well (CFI=0.94, RMSEA=0.062). The final model explained 74% of the variance in management support, and positive attitudes toward lethal management (humaneness) had the largest direct effect on management support. Specific attitudes toward lethal management and general attitudes toward outdoor cats mediated the relationship between positive (p<0.05) and negative cat-related impact beliefs (p<0.05) and support for management. These results supported the specificity hypothesis and the use of the cognitive hierarchy to assess stakeholder intention to support non-lethal cat management. Our findings suggest that stakeholders can simultaneously perceive both positive and negative beliefs about outdoor cats, which influence attitudes toward and support for non-lethal management.

The right tree for the job? perceptions of species suitability for the provision of ecosystem services.

PubMed

Smaill, Simeon J; Bayne, Karen M; Coker, Graham W R; Paul, Thomas S H; Clinton, Peter W

2014-04-01

Stakeholders in plantation forestry are increasingly aware of the importance of the ecosystem services and non-market values associated with forests. In New Zealand, there is significant interest in establishing species other than Pinus radiata D. Don (the dominant plantation species) in the belief that alternative species are better suited to deliver these services. Significant risk is associated with this position as there is little objective data to support these views. To identify which species were likely to be planted to deliver ecosystem services, a survey was distributed to examine stakeholder perceptions. Stakeholders were asked which of 15 tree attributes contributed to the provision of five ecosystem services (amenity value, bioenergy production, carbon capture, the diversity of native habitat, and erosion control/water quality) and to identify which of 22 candidate tree species possessed those attributes. These data were combined to identify the species perceived most suitable for the delivery of each ecosystem service. Sequoia sempervirens (D.Don) Endl. closely matched the stakeholder derived ideotypes associated with all five ecosystem services. Comparisons to data from growth, physiological and ecological studies demonstrated that many of the opinions held by stakeholders were inaccurate, leading to erroneous assumptions regarding the suitability of most candidate species. Stakeholder perceptions substantially influence tree species selection, and plantations established on the basis of inaccurate opinions are unlikely to deliver the desired outcomes. Attitudinal surveys associated with engagement campaigns are essential to improve stakeholder knowledge, advancing the development of fit-for-purpose forest management that provides the required ecosystem services.

Practical perspectives of personalized healthcare in oncology.

PubMed

Hodgson, Darren R; Wellings, Robert; Harbron, Christopher

2012-09-15

There is an increasing prevalence of drug-diagnostic combinations in oncology. This has placed diagnostic stakeholders directly into the complex benefit-risk, cost, value and uncertainty-driven development paradigm traditionally the preserve of the drug development community. In this review we focus on the delivery of the clinical data required to advance such drug-diagnostic combination development programmes and ultimately satisfy regulators and payors of the value of contemporaneous changes in diagnostic and treatment practice. Ideally all stakeholders would like to initially estimate, and ultimately specify, the comparative benefit-risk for a new treatment option with and without changing diagnostic practice. Hence, in an ideal world clinical trial design is focused on acquiring biomarker treatment interaction data. In this review we describe the key scientific and feasibility inputs required to design and deliver such trials and the drivers, advantages and disadvantages associated with departing from this model. We do not discuss the discovery of new biomarkers nor the analytical validation and marketing of diagnostic products. Following on from trial design we describe how subsequent success then depends upon the concepts that guide trial design being driven into the complex world of large, multinational clinical trial delivery. For every aspect of a traditional clinical drug trial such as supply, recruitment and adherence, there is a corresponding concept for the diagnostic element. In practice, this means that each patient's contribution to the decision making data-set is subject to double jeopardy (attrition on clinical outcome and biomarker status). Historically, this has led to significantly reduced power for detecting biomarker-treatment interactions, reduced decision making confidence and a waste of valuable human and financial resources. We describe recent practice changes and experience that have led to the successful delivery of such trials focusing on both pre- and on trial aspects. The former includes the pivotal role of tissue banks in accurate estimation of evaluability and prevalence for biomarker assays and the latter several practices designed to engage and incentivize key stakeholders particularly CRAs and pathologists. The result is that in the new world of developing personalized treatments for cancer patients the real-time acquisition and monitoring of biomarker data receives similar support to that traditionally reserved for clinical outcome data and far more patients contribute to the testing of personalized medicine hypotheses. Copyright © 2012 Elsevier B.V. All rights reserved.

Talk, trust and time: a longitudinal study evaluating knowledge translation and exchange processes for research on violence against women

PubMed Central

2011-01-01

Background Violence against women (VAW) is a major public health problem. Translation of VAW research to policy and practice is an area that remains understudied, but provides the opportunity to examine knowledge translation and exchange (KTE) processes in a complex, multi-stakeholder context. In a series of studies including two randomized trials, the McMaster University VAW Research Program studied one key research gap: evidence about the effectiveness of screening women for exposure to intimate partner violence. This project developed and evaluated KTE strategies to share research findings with policymakers, health and community service providers, and women's advocates. Methods A longitudinal cross-sectional design, applying concurrent mixed data collection methods (surveys, interviews, and focus groups), was used to evaluate the utility of specific KTE strategies, including a series of workshops and a day-long Family Violence Knowledge Exchange Forum, on research sharing, uptake, and use. Results Participants valued the opportunity to meet with researchers, provide feedback on key messages, and make personal connections with other stakeholders. A number of factors specific to the knowledge itself, stakeholders' contexts, and the nature of the knowledge gap being addressed influenced the uptake, sharing, and use of the research. The types of knowledge use changed across time, and were specifically related to both the types of decisions being made, and to stage of decision making; most reported use was conceptual or symbolic, with few examples of instrumental use. Participants did report actively sharing the research findings with their own networks. Further examination of these second-order knowledge-sharing processes is required, including development of appropriate methods and measures for its assessment. Some participants reported that they would not use the research evidence in their decision making when it contradicted professional experiences, while others used it to support apparently contradictory positions. The online wiki-based 'community of interest' requested by participants was not used. Conclusions Mobilizing knowledge in the area of VAW practice and policy is complex and resource-intensive, and must acknowledge and respect the values of identified knowledge users, while balancing the objectivity of the research and researchers. This paper provides important lessons learned about these processes, including attending to the potential unintended consequences of knowledge sharing. PMID:21896170

Talk, trust and time: a longitudinal study evaluating knowledge translation and exchange processes for research on violence against women.

PubMed

Wathen, C Nadine; Sibbald, Shannon L; Jack, Susan M; Macmillan, Harriet L

2011-09-06

Violence against women (VAW) is a major public health problem. Translation of VAW research to policy and practice is an area that remains understudied, but provides the opportunity to examine knowledge translation and exchange (KTE) processes in a complex, multi-stakeholder context. In a series of studies including two randomized trials, the McMaster University VAW Research Program studied one key research gap: evidence about the effectiveness of screening women for exposure to intimate partner violence. This project developed and evaluated KTE strategies to share research findings with policymakers, health and community service providers, and women's advocates. A longitudinal cross-sectional design, applying concurrent mixed data collection methods (surveys, interviews, and focus groups), was used to evaluate the utility of specific KTE strategies, including a series of workshops and a day-long Family Violence Knowledge Exchange Forum, on research sharing, uptake, and use. Participants valued the opportunity to meet with researchers, provide feedback on key messages, and make personal connections with other stakeholders. A number of factors specific to the knowledge itself, stakeholders' contexts, and the nature of the knowledge gap being addressed influenced the uptake, sharing, and use of the research. The types of knowledge use changed across time, and were specifically related to both the types of decisions being made, and to stage of decision making; most reported use was conceptual or symbolic, with few examples of instrumental use. Participants did report actively sharing the research findings with their own networks. Further examination of these second-order knowledge-sharing processes is required, including development of appropriate methods and measures for its assessment. Some participants reported that they would not use the research evidence in their decision making when it contradicted professional experiences, while others used it to support apparently contradictory positions. The online wiki-based 'community of interest' requested by participants was not used. Mobilizing knowledge in the area of VAW practice and policy is complex and resource-intensive, and must acknowledge and respect the values of identified knowledge users, while balancing the objectivity of the research and researchers. This paper provides important lessons learned about these processes, including attending to the potential unintended consequences of knowledge sharing.

Lay and professional stakeholder involvement in scoping palliative care issues: Methods used in seven European countries.

PubMed

Brereton, Louise; Ingleton, Christine; Gardiner, Clare; Goyder, Elizabeth; Mozygemba, Kati; Lysdahl, Kristin Bakke; Tummers, Marcia; Sacchini, Dario; Leppert, Wojciech; Blaževičienė, Aurelija; van der Wilt, Gert Jan; Refolo, Pietro; De Nicola, Martina; Chilcott, James; Oortwijn, Wija

2017-02-01

Stakeholders are people with an interest in a topic. Internationally, stakeholder involvement in palliative care research and health technology assessment requires development. Stakeholder involvement adds value throughout research (from prioritising topics to disseminating findings). Philosophies and understandings about the best ways to involve stakeholders in research differ internationally. Stakeholder involvement took place in seven countries (England, Germany, Italy, Lithuania, the Netherlands, Norway and Poland). Findings informed a project that developed concepts and methods for health technology assessment and applied these to evaluate models of palliative care service delivery. To report on stakeholder involvement in the INTEGRATE-HTA project and how issues identified informed project development. Using stakeholder consultation or a qualitative research design, as appropriate locally, stakeholders in seven countries acted as 'advisors' to aid researchers' decision making. Thematic analysis was used to identify key issues across countries. A total of 132 stakeholders (82 professionals and 50 'lay' people) aged ⩾18 participated in individual face-to-face or telephone interviews, consultation meetings or focus groups. Different stakeholder involvement methods were used successfully to identify key issues in palliative care. A total of 23 issues common to three or more countries informed decisions about the intervention and comparator of interest, sub questions and specific assessments within the health technology assessment. Stakeholders, including patients and families undergoing palliative care, can inform project decision making using various involvement methods according to the local context. Researchers should consider local understandings about stakeholder involvement as views of appropriate and feasible methods vary. Methods for stakeholder involvement, especially consultation, need further development.

Systems thinking and ethics in public health: a necessary and mutually beneficial partnership.

PubMed

Silva, Diego S; Smith, Maxwell J; Norman, Cameron D

2018-06-13

Systems thinking has emerged as a means of conceptualizing and addressing complex public health problems, thereby challenging more commonplace understanding of problems and corresponding solutions as straightforward explanations of cause and effect. Systems thinking tries to address the complexity of problems through qualitative and quantitative modeling based on a variety of systems theories, each with their own assumptions and, more importantly, implicit and unexamined values. To date, however, there has been little engagement between systems scientists and those working in bioethics and public health ethics. The goal of this paper is to begin to consider what it might mean to combine systems thinking with public health ethics to solve public health challenges. We argue that there is a role for ethics in systems thinking in public health as a means of elucidating implicit assumptions and facilitating ethics debate and dialogue with key stakeholders.

Empowerment through public involvement functional interactive planning (PIFIP)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beck, J. E.; Davidson, S. A.

1993-05-01

This paper constructs a planning process that will enable private industries, government, and public interest organizations to actualize their visions. The public involvement functional interactive planning (PIFIP) model can facilitate these groups in actualizing their visions by forcing them to recognize their stakeholder`s values, interests and expectations.

Education Stakeholders' Translation and Sense-Making of Accountability Policies

ERIC Educational Resources Information Center

Werts, Amanda B.; Della Sala, Matt; Lindle, Jane; Horace, Jennifer M.; Brewer, Curtis; Knoeppel, Robert

2013-01-01

Scholars of education policy have consistently found that the capacity, beliefs, and values of local actors affect the relative success or failure of policy implementation. This article examines stakeholders' perceptions of education policy in South Carolina to consider the relationship between interpretations of education policy and attitudes of…

Linking Ecosystem Services Supply to Stakeholder Values in Guanica Bay Watershed, Puerto Rico

EPA Science Inventory

Policies to protect coastal resources will be more effective when they account for the social and economic concerns of stakeholders in the coastal zone and watershed, and are responsive to potential tradeoffs between benefits offered by both land and sea. We focus on the Gu&aacu...

The Stakeholder Model of voice research: Acknowledging barriers to human rights of all stakeholders in a communicative exchange.

PubMed

Madill, Catherine; Warhurst, Samantha; McCabe, Patricia

2018-02-01

The act of communication is a complex, transient and often abstract phenomenon that involves many stakeholders, each of whom has their own perspective: the speaker, the listener, the observer and the researcher. Current research practices in voice disorder are frequently framed through a single lens - that of the researcher/clinician or their participant/patient. This single lens approach risks overlooking significant barriers to the basic human right of freedom of expression for those with a voice disorder as it omits consideration of the impact of voice disorder on the listener, and consideration of the wider impact of the voice in the occupational context. Recent research in the area of voice has developed a multiple lens and subsequent Stakeholder Model that acknowledges the experience and reality of multiple stakeholders viewing the same phenomenon, the voice. This research paradigm is built on Article 19 of the Universal Declaration of Human Rights as it considers the realities of all stakeholders in forming a deeper understanding of the causality, impact and aspects of communication disorder. The Stakeholder Model will be presented as a suggestion for future investigations of communication disorders more widely.

Using canonical correlation analysis to identify environmental attitude groups: considerations for national forest planning in the southwestern U.S.

PubMed

Prera, Alejandro J; Grimsrud, Kristine M; Thacher, Jennifer A; McCollum, Dan W; Berrens, Robert P

2014-10-01

As public land management agencies pursue region-specific resource management plans, with meaningful consideration of public attitudes and values, there is a need to characterize the complex mix of environmental attitudes in a diverse population. The contribution of this investigation is to make use of a unique household, mail/internet survey data set collected in 2007 in the Southwestern United States (Region 3 of the U.S. Forest Service). With over 5,800 survey responses to a set of 25 Public Land Value statements, canonical correlation analysis is able to identify 7 statistically distinct environmental attitudinal groups. We also examine the effect of expected changes in regional demographics on overall environmental attitudes, which may help guide in the development of socially acceptable long-term forest management policies. Results show significant support for conservationist management policies and passive environmental values, as well as a greater role for stakeholder groups in generating consensus for current and future forest management policies.

Prioritizing strategies for comprehensive liver cancer control in Asia: a conjoint analysis.

PubMed

Bridges, John F P; Dong, Liming; Gallego, Gisselle; Blauvelt, Barri M; Joy, Susan M; Pawlik, Timothy M

2012-10-30

Liver cancer is a complex and burdensome disease, with Asia accounting for 75% of known cases. Comprehensive cancer control requires the use of multiple strategies, but various stakeholders may have different views as to which strategies should have the highest priority. This study identified priorities across multiple strategies for comprehensive liver cancer control (CLCC) from the perspective of liver cancer clinical, policy, and advocacy stakeholders in China, Japan, South Korea and Taiwan. Concordance of priorities was assessed across the region and across respondent roles. Priorities for CLCC were examined as part of a cross-sectional survey of liver cancer experts. Respondents completed several conjoint-analysis choice tasks to prioritize 11 strategies. In each task, respondents judged which of two competing CLCC plans, consisting of mutually exclusive and exhaustive subsets of the strategies, would have the greatest impact. The dependent variable was the chosen plan, which was then regressed on the strategies of different plans. The restricted least squares (RLS) method was utilized to compare aggregate and stratified models, and t-tests and Wald tests were used to test for significance and concordance, respectively. Eighty respondents (69.6%) were eligible and completed the survey. Their primary interests were hepatitis (26%), hepatocellular carcinoma (HCC) (58%), metastatic liver cancer (10%) and transplantation (6%). The most preferred strategies were monitoring at-risk populations (p<0.001), clinician education (p<0.001), and national guidelines (p<0.001). Most priorities were concordant across sites except for three strategies: transplantation infrastructure (p=0.009) was valued lower in China, measuring social burden (p=0.037) was valued higher in Taiwan, and national guidelines (p=0.025) was valued higher in China. Priorities did not differ across stakeholder groups (p=0.438). Priorities for CLCC in Asia include monitoring at-risk populations, clinician education, national guidelines, multidisciplinary management, public awareness and centers of excellence. As most priorities are relatively concordant across the region, multilateral approaches to addressing comprehensive liver cancer would be beneficial. However, where priorities are discordant among sites, such as transplantation infrastructure, strategies should be tailored to local needs.

Stakeholder engagement in dredged material management decisions.

PubMed

Collier, Zachary A; Bates, Matthew E; Wood, Matthew D; Linkov, Igor

2014-10-15

Dredging and disposal issues often become controversial with local stakeholders because of their competing interests. These interests tend to manifest themselves in stakeholders holding onto entrenched positions, and deadlock can result without a methodology to move the stakeholder group past the status quo. However, these situations can be represented as multi-stakeholder, multi-criteria decision problems. In this paper, we describe a case study in which multi-criteria decision analysis was implemented in a multi-stakeholder setting in order to generate recommendations on dredged material placement for Long Island Sound's Dredged Material Management Plan. A working-group of representatives from various stakeholder organizations was formed and consulted to help prioritize sediment placement sites for each dredging center in the region by collaboratively building a multi-criteria decision model. The resulting model framed the problem as several alternatives, criteria, sub-criteria, and metrics relevant to stakeholder interests in the Long Island Sound region. An elicitation of values, represented as criteria weights, was then conducted. Results show that in general, stakeholders tended to agree that all criteria were at least somewhat important, and on average there was strong agreement on the order of preferences among the diverse groups of stakeholders. By developing the decision model iteratively with stakeholders as a group and soliciting their preferences, the process sought to increase stakeholder involvement at the front-end of the prioritization process and lead to increased knowledge and consensus regarding the importance of site-specific criteria. Published by Elsevier B.V.

Visualization-based decision support for value-driven system design

NASA Astrophysics Data System (ADS)

Tibor, Elliott

In the past 50 years, the military, communication, and transportation systems that permeate our world, have grown exponentially in size and complexity. The development and production of these systems has seen ballooning costs and increased risk. This is particularly critical for the aerospace industry. The inability to deal with growing system complexity is a crippling force in the advancement of engineered systems. Value-Driven Design represents a paradigm shift in the field of design engineering that has potential to help counteract this trend. The philosophy of Value-Driven Design places the desires of the stakeholder at the forefront of the design process to capture true preferences and reveal system alternatives that were never previously thought possible. Modern aerospace engineering design problems are large, complex, and involve multiple levels of decision-making. To find the best design, the decision-maker is often required to analyze hundreds or thousands of combinations of design variables and attributes. Visualization can be used to support these decisions, by communicating large amounts of data in a meaningful way. Understanding the design space, the subsystem relationships, and the design uncertainties is vital to the advancement of Value-Driven Design as an accepted process for the development of more effective, efficient, robust, and elegant aerospace systems. This research investigates the use of multi-dimensional data visualization tools to support decision-making under uncertainty during the Value-Driven Design process. A satellite design system comprising a satellite, ground station, and launch vehicle is used to demonstrate effectiveness of new visualization methods to aid in decision support during complex aerospace system design. These methods are used to facilitate the exploration of the feasible design space by representing the value impact of system attribute changes and comparing the results of multi-objective optimization formulations with a Value-Driven Design formulation. The visualization methods are also used to assist in the decomposition of a value function, by representing attribute sensitivities to aid with trade-off studies. Lastly, visualization is used to enable greater understanding of the subsystem relationships, by displaying derivative-based couplings, and the design uncertainties, through implementation of utility theory. The use of these visualization methods is shown to enhance the decision-making capabilities of the designer by granting them a more holistic view of the complex design space.

Health impact assessment of industrial development projects: a spatio-temporal visualization.

PubMed

Winkler, Mirko S; Krieger, Gary R; Divall, Mark J; Singer, Burton H; Utzinger, Jürg

2012-05-01

Development and implementation of large-scale industrial projects in complex eco-epidemiological settings typically require combined environmental, social and health impact assessments. We present a generic, spatio-temporal health impact assessment (HIA) visualization, which can be readily adapted to specific projects and key stakeholders, including poorly literate communities that might be affected by consequences of a project. We illustrate how the occurrence of a variety of complex events can be utilized for stakeholder communication, awareness creation, interactive learning as well as formulating HIA research and implementation questions. Methodological features are highlighted in the context of an iron ore development in a rural part of Africa.

Global change impact on water resources at the regional scale - a reflection on participatory modeling

NASA Astrophysics Data System (ADS)

Barthel, Roland; Büttner, Hannah; Nickel, Darla; Seidl, Roman

2015-04-01

Participatory modeling (PM) has become an essential part of environmental impact assessment and planning in the field of water resources research and management. This is mainly because of the notion that models developed by scientists for scientific purposes are often not suitable for practical management for several reasons, such as (too) high complexity, low user-friendliness and lack of problem/solution orientation. Participation is seen as a key concept for bridging the gap between modelers and stakeholders. In this submission we focus on the PM-process in the GLOWA-Danube (GD) project (German Ministry of Education and Research, 2001-2011). GD was carried out by an interdisciplinary consortium of 17 research organizations. The main goal was to develop and to use the integrated modelling system DANUBIA as a tool to evaluate the impact of global change on the Upper Danube Catchment (Southern Germany, 77,000 km^2) and to discuss the implications with relevant stakeholders. An intensive stakeholder dialoged was carried out to include the perspective of stakeholders and end-users in the model and scenario development - with the final goal of facilitating implementation of DANUBIA in practical management after termination of the scientific project. This contribution looks at the specific conditions for PM in the field of global change scenarios and complex integrated models. The different phases of the PM process in GD are presented along with a discussion of the respective results. Overall, the impact of stakeholder interaction on the model development was much lower than expected. The ultimate goal of using the PM process to develop DANUBIA as a tool used in practical management after termination of the scientific project was not reached. However, implications of climate change and modelling could be discussed with the stakeholders involved and relevant learning processes on both sides (scientists and stakeholders) were facilitated in the final phase. In the discussion we therefore focus on the following three questions: • Can a stakeholder dialogue be successfully used to support the development of new, complex modelling systems, in particular at the regional scale? • What is the right timing for stakeholder interaction in the case of unclear problem definition - i.e. global (climate) change impact on regions where climate is not (yet) a threat to water or land use related demands and activities? • To what degree can scientists be motivated to carry out participatory research at all? We conclude that the PM process in GD was only partly successful because the project set overambitious goals, including the application of fundamentally new approaches to interdisciplinary science, the use of new modelling technologies, the focus upon and evaluation of potential and therefore characteristically uncertain future problems, including stakeholder demands, and the development of a ready-to-use, user-friendly tool. Furthermore, GD also showed that an externally and professionally moderated stakeholder dialogue is an absolute necessity to achieve successful participation of stakeholders in model development. The modelers themselves neither had the time, the skills and the ambitions to do this. Furthermore, there is a lack of incentives for scientists, particularly natural scientists, to commit to PM activities. Given the fact that the outcomes of PM are supposed to be relevant for societal decision making, this issue needs further attention.

Providing guidance for genomics-based cancer treatment decisions: insights from stakeholder engagement for post-prostatectomy radiation therapy.

PubMed

Abe, James; Lobo, Jennifer M; Trifiletti, Daniel M; Showalter, Timothy N

2017-08-24

Despite the emergence of genomics-based risk prediction tools in oncology, there is not yet an established framework for communication of test results to cancer patients to support shared decision-making. We report findings from a stakeholder engagement program that aimed to develop a framework for using Markov models with individualized model inputs, including genomics-based estimates of cancer recurrence probability, to generate personalized decision aids for prostate cancer patients faced with radiation therapy treatment decisions after prostatectomy. We engaged a total of 22 stakeholders, including: prostate cancer patients, urological surgeons, radiation oncologists, genomic testing industry representatives, and biomedical informatics faculty. Slides were at each meeting to provide background information regarding the analytical framework. Participants were invited to provide feedback during the meeting, including revising the overall project aims. Stakeholder meeting content was reviewed and summarized by stakeholder group and by theme. The majority of stakeholder suggestions focused on aspects of decision aid design and formatting. Stakeholders were enthusiastic about the potential value of using decision analysis modeling with personalized model inputs for cancer recurrence risk, as well as competing risks from age and comorbidities, to generate a patient-centered tool to assist decision-making. Stakeholders did not view privacy considerations as a major barrier to the proposed decision aid program. A common theme was that decision aids should be portable across multiple platforms (electronic and paper), should allow for interaction by the user to adjust model inputs iteratively, and available to patients both before and during consult appointments. Emphasis was placed on the challenge of explaining the model's composite result of quality-adjusted life years. A range of stakeholders provided valuable insights regarding the design of a personalized decision aid program, based upon Markov modeling with individualized model inputs, to provide a patient-centered framework to support for genomic-based treatment decisions for cancer patients. The guidance provided by our stakeholders may be broadly applicable to the communication of genomic test results to patients in a patient-centered fashion that supports effective shared decision-making that represents a spectrum of personal factors such as age, medical comorbidities, and individual priorities and values.

Addressing the Evidence Gap in Stroke Rehabilitation for Complex Patients: A Preliminary Research Agenda.

PubMed

Nelson, Michelle L; McKellar, Kaileah A; Munce, Sarah; Kelloway, Linda; Hans, Parminder Kaur; Fortin, Martin; Lyons, Renee; Bayley, Mark

2018-06-01

Evidence suggests that a stroke occurs in isolation (no comorbid conditions) in less than 6% of patients. Multimorbidity, compounded by psychosocial issues, makes treatment and recovery for stroke increasingly complex. Recent research and health policy documents called for a better understanding of the needs of this patient population, and for the development and testing of models of care that meet their needs. A research agenda specific to complexity is required. The primary objective of the think tank was to identify and prioritize research questions that meet the information needs of stakeholders, and to develop a research agenda specific to stroke rehabilitation and patient complexity. A modified Delphi and World Café approach underpinned the think tank meeting, approaches well recognized to foster interaction, dialogue, and collaboration between stakeholders. Forty-three researchers, clinicians, and policymakers attended a 2-day meeting. Initial question-generating activities resulted in 120 potential research questions. Sixteen high-priority research questions were identified, focusing on predetermined complexity characteristics-multimorbidity, social determinants, patient characteristics, social supports, and system factors. The final questions are presented as a prioritized research framework. An emergent result of this activity is the development of a complexity and stroke rehabilitation research network. The research agenda reflects topics of importance to stakeholders working with stroke patients with increasingly complex care needs. This robust process resulted in a preliminary research agenda that could provide policymakers with the evidence needed to make improvements toward better-organized services, better coordination between settings, improved patient outcomes, and lower system costs. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Informing Hospital Change Processes through Visualization and Simulation: A Case Study at a Children's Emergency Clinic.

PubMed

Persson, Johanna; Dalholm, Elisabeth Hornyánszky; Johansson, Gerd

2014-01-01

To demonstrate the use of visualization and simulation tools in order to involve stakeholders and inform the process in hospital change processes, illustrated by an empirical study from a children's emergency clinic. Reorganization and redevelopment of a hospital is a complex activity that involves many stakeholders and demands. Visualization and simulation tools have proven useful for involving practitioners and eliciting relevant knowledge. More knowledge is desired about how these tools can be implemented in practice for hospital planning processes. A participatory planning process including practitioners and researchers was executed over a 3-year period to evaluate a combination of visualization and simulation tools to involve stakeholders in the planning process and to elicit knowledge about needs and requirements. The initial clinic proposal from the architect was discarded as a result of the empirical study. Much general knowledge about the needs of the organization was extracted by means of the adopted tools. Some of the tools proved to be more accessible than others for the practitioners participating in the study. The combination of tools added value to the process by presenting information in alternative ways and eliciting questions from different angles. Visualization and simulation tools inform a planning process (or other types of change processes) by providing the means to see beyond present demands and current work structures. Long-term involvement in combination with accessible tools is central for creating a participatory setting where the practitioners' knowledge guides the process. © 2014 Vendome Group, LLC.

A strategy for human factors/ergonomics: developing the discipline and profession.

PubMed

Dul, Jan; Bruder, Ralph; Buckle, Peter; Carayon, Pascale; Falzon, Pierre; Marras, William S; Wilson, John R; van der Doelen, Bas

2012-01-01

Human factors/ergonomics (HFE) has great potential to contribute to the design of all kinds of systems with people (work systems, product/service systems), but faces challenges in the readiness of its market and in the supply of high-quality applications. HFE has a unique combination of three fundamental characteristics: (1) it takes a systems approach (2) it is design driven and (3) it focuses on two closely related outcomes: performance and well-being. In order to contribute to future system design, HFE must demonstrate its value more successfully to the main stakeholders of system design. HFE already has a strong value proposition (mainly well-being) and interactivity with the stakeholder group of 'system actors' (employees and product/service users). However, the value proposition (mainly performance) and relationships with the stakeholder groups of 'system experts' (experts fromtechnical and social sciences involved in system design), and 'system decision makers' (managers and other decision makers involved in system design, purchase, implementation and use), who have a strong power to influence system design, need to be developed. Therefore, the first main strategic direction is to strengthen the demand for high-quality HFE by increasing awareness among powerful stakeholders of the value of high-quality HFE by communicating with stakeholders, by building partnerships and by educating stakeholders. The second main strategic direction is to strengthen the application of high-quality HFE by promoting the education of HFE specialists, by ensuring high-quality standards of HFE applications and HFE specialists, and by promoting HFE research excellence at universities and other organisations. This strategy requires cooperation between the HFE community at large, consisting of the International Ergonomics Association (IEA), local (national and regional) HFE societies, and HFE specialists. We propose a joint world-wide HFE development plan, in which the IEA takes a leadership role. Human factors/ergonomics (HFE) has much to offer by addressing major business and societal challenges regarding work and product/service systems. HFE potential, however, is underexploited. This paper presents a strategy for the HFE community to strengthen demand and application of high-quality HFE, emphasising its key elements: systems approach, design driven, and performance and well-being goals.

Investigating the role of Clinical Nurse Consultants in one health district from multiple stakeholder perspectives: a cooperative inquiry.

PubMed

Walsh, Kenneth; Bothe, Janine; Edgar, Denise; Beaven, Geraldine; Burgess, Bernadette; Dickson, Vhari; Dunn, Stephen; Horning, Lynda; Jensen, Janice; Kandl, Bronia; Nonu, Miriam; Owen, Fran; Moss, Cheryle

2015-01-01

The impetus for this research came from a group of 11 Clinical Nurse Consultants (CNCs) within a health service in NSW, Australia, who wanted to investigate the CNC role from multiple stakeholder perspectives. With support from academic researchers, the CNCs designed and implemented the study. The aim of this research project was to investigate the role of the CNC from the multiple perspectives of CNCs and other stakeholders who work with CNCs in the Health District. This was a co-operative inquiry that utilised qualitative descriptive research approach. Co-operative inquiry methods enabled 11 CNCs to work as co-researchers and to conduct the investigation. The co-researchers implemented a qualitative descriptive design for the research and used interviews (7) and focus groups (16) with CNC stakeholders (n = 103) to gather sufficient data to investigate the role of the CNC in the organisation. Thematic analysis was undertaken to obtain the results. The CNC role is invaluable to all stakeholders and it was seen as the "glue" which holds teams together. Stakeholder expectations of the CNC role were multiple and generally agreed. Five themes derived from the data are reported as "clinical leadership as core", "making a direct difference to patient care", "service development as an outcome", "role breadth or narrowness and boundaries", and "career development". There was clear appreciation of the work that CNCs do in their roles, and the part that the CNC role plays in achieving quality health outcomes. The role of the CNC is complex and the CNCs themselves often negotiate these complexities to ensure beneficial outcomes for the patient and organisation. For the wider audience this study has given further insights into the role of these nurses and the perspectives of those with whom they work.

Information needs related to extension service and community outreach.

PubMed

Bottcher, Robert W

2003-06-01

Air quality affects everyone. Some people are affected by air quality impacts, regulations, and technological developments in several ways. Stakeholders include the medical community, ecologists, government regulators, industries, technology providers, academic professionals, concerned citizens, the news media, and elected officials. Each of these groups may perceive problems and opportunities differently, but all need access to information as it is developed. The diversity and complexity of air quality problems contribute to the challenges faced by extension and outreach professionals who must communicate with stakeholders having diverse backgrounds. Gases, particulates, biological aerosols, pathogens, and odors all require expensive and relatively complex technology to measure and control. Economic constraints affect the ability of regulators and others to measure air quality, and industry and others to control it. To address these challenges, while communicating air quality research results and concepts to stakeholders, three areas of information needs are evident. (1) A basic understanding of the fundamental concepts regarding air pollutants and their measurement and control is needed by all stakeholders; the Extension Specialist, to be effective, must help people move some distance up the learning curve. (2) Each problem or set of problems must be reasonably well defined since comprehensive solution of all problems simultaneously may not be feasible; for instance, the solution of an odor problem associated with animal production may not address atmospheric effects due to ammonia emissions. (3) The integrity of the communication process must be preserved by avoiding prejudice and protectionism; although stakeholders may seek to modify information to enhance their interests, extension and outreach professionals must be willing to present unwelcome information or admit to a lack of information. A solid grounding in fundamental concepts, careful and fair problem definition, and a resolute commitment to integrity and credibility will enable effective communication of air quality information to and among diverse stakeholders.

Physical Activity and Exercise Interventions in the Workplace Impacting Work Outcomes: A Stakeholder-Centered Best Evidence Synthesis of Systematic Reviews.

PubMed

White, M I; Dionne, C E; Wärje, O; Koehoorn, M; Wagner, S L; Schultz, I Z; Koehn, C; Williams-Whitt, K; Harder, H G; Pasca, R; Hsu, V; McGuire, L; Schulz, W; Kube, D; Wright, M D

2016-04-01

The prevention of work disability is beneficial to employees and employers, and mitigates unnecessary societal costs associated with social welfare. Many service providers and employers have initiated workplace interventions designed to reduce unnecessary work disability. To conduct a best-evidence synthesis of systematic reviews on workplace interventions that address physical activities or exercise and their impact on workplace absence, work productivity or financial outcomes. Using a participatory research approach, academics and stakeholders identified inclusion and exclusion criteria, built an abstraction table, evaluated systematic review quality and relevance, and interpreted the combined findings. A minimum of two scientists participated in a methodological review of the literature followed by a consensus process. Stakeholders and researchers participated as a collaborative team. 3363 unique records were identified, 115 full text articles and 46 systematic reviews were included, 18 assessed the impact of physical fitness or exercise interventions. 11 focused on general workers rather than workers who were absent from work at baseline; 16 of the reviews assessed work absence, 4 assessed productivity and 6 assessed financial impacts. The strongest evidence supports the use of short, simple exercise or fitness programs for both workers at work and those absent from work at baseline. For workers at work, simple exercise programs (1-2 modal components) appear to provide similar benefits to those using more complex multimodal interventions. For workers off-work with subacute low back pain, there is evidence that some complex exercise programs may be more effective than simple exercise interventions, especially if they involve workplace stakeholder engagement, communication and coordination with employers and other stakeholders. The development and utilization of standardized definitions, methods and measures and blinded evaluation would improve research quality and strengthen stakeholder-centered guidance.

Serious-game for water resources management adaptation training to climatic changes

NASA Astrophysics Data System (ADS)

Leroy, Eve; Saulnier, Georges-Marie

2013-04-01

Water resources access is a main issue for territorial development to ensure environmental and human well-being. Indeed, sustainable development is vulnerable to water availability and climate change may affect the quantity and temporality of available water resources for anthropogenic water uses. How then to adapt, how to change water management rules and practices and how to involve stakeholders is such process? To prevent water scarcity situations, which may generate conflicts and impacts on ecosystems, it is important to think about a sustainable development where anthropogenic water uses are in good balance with forecasted water resources availability. This implies to raise awareness and involve stakeholders for a sustainable water management. Stakeholders have to think about future territorial development taking into account climate change impacts on water resources. Collaboration between scientists and stakeholders is essential to insure consistent climate change knowledge, well identification of anthropogenic uses, tensions and stakes of the territory. However sharing information on complex questions such as climate change, hydro-meteorological modeling and practical constraints may be a difficult task. Therefore to contribute to an easier debate and to the global training of all the interested actors, a serious game about water management was built. The serious game uses scientist complex models with real data but via a simple and playful web-game interface. The advantage of this interface is that it may help stakeholders, citizen or the target group to raise their understandings of impacts of climate change on water resources and to raise their awareness to the need for a sustainable water management while using state-of-the-art knowledge. The principle of the game is simple. The gamer is a mayor of a city and has to manage the water withdrawals from hydro systems, water distribution and consumption, water retreatment etc. In the same time, a clock is running and climate change occurs on the territory which impacts the water resources. The gamer has to deal with this evolution and try to help its municipality in growing. If the water management plays well the city can develop. At the opposite, wrong player decisions may generate water, energy or food scarcities, which lead the city to decrease. A first version of this game still under development was built. It makes uses of data from a famous French ski resort: Megève municipality. A demo of this game will be presented. Under a playful approach the serious game helps to discuss essential but strained topics between stakeholders, scientists and citizens. It may be considered as a useful tool for decision support and explanation of a complex topic. It is also hoped that this approach offers new ways of collaboration with stakeholders to approach complex situations in order to find the best paths for future water management.

A Collaborative Approach for Scoping Ecosystem Services with Stakeholders: The Case of Arrábida Natural Park.

PubMed

Lopes, Rita; Videira, Nuno

2016-08-01

This paper presents an innovative approach for conducting collaborative scoping processes aiming to elicit multiple values of ecosystem services. The proposed methodology rests on three steps combining different participatory tools that promote a comprehensive examination of the perceptions hold by relevant stakeholder groups. The first step consists of an institutional and stakeholder analysis developed in the study area. The second includes a participatory workshop, where a sequence of scoping exercises is conducted with the active collaboration of the invited stakeholders. The final step aims to validate scoping results and develop dependency networks between organizations and the identified ecosystem services. The approach was tested in the Arrábida Natural Park, a marine and coastal protected area in Portugal. Invited participants were able to identify an extensive list of ecosystem services in the natural area, establish linkages between those services and human wellbeing, identify drivers of change and perform a preliminary screening of the associated ecological, social, and economic values. The case study evaluation provided positive feedback on the usefulness of the approach, which advances the existing set of methods for participatory identification of ecosystem services and sets the scene for involvement of stakeholder groups in assessment and management processes.

A Collaborative Approach for Scoping Ecosystem Services with Stakeholders: The Case of Arrábida Natural Park

NASA Astrophysics Data System (ADS)

Lopes, Rita; Videira, Nuno

2016-08-01

This paper presents an innovative approach for conducting collaborative scoping processes aiming to elicit multiple values of ecosystem services. The proposed methodology rests on three steps combining different participatory tools that promote a comprehensive examination of the perceptions hold by relevant stakeholder groups. The first step consists of an institutional and stakeholder analysis developed in the study area. The second includes a participatory workshop, where a sequence of scoping exercises is conducted with the active collaboration of the invited stakeholders. The final step aims to validate scoping results and develop dependency networks between organizations and the identified ecosystem services. The approach was tested in the Arrábida Natural Park, a marine and coastal protected area in Portugal. Invited participants were able to identify an extensive list of ecosystem services in the natural area, establish linkages between those services and human wellbeing, identify drivers of change and perform a preliminary screening of the associated ecological, social, and economic values. The case study evaluation provided positive feedback on the usefulness of the approach, which advances the existing set of methods for participatory identification of ecosystem services and sets the scene for involvement of stakeholder groups in assessment and management processes.

Economic evaluation of pharmacogenomics: a value-based approach to pragmatic decision making in the face of complexity.

PubMed

Snyder, Susan R; Mitropoulou, Christina; Patrinos, George P; Williams, Marc S

2014-01-01

Evidence of the value of pharmacogenomic testing is needed to inform policymakers and clinicians for decision making related to adoption and coverage, and to facilitate prioritization for research and development. Pharmacogenomics has an important role in creating a more efficient healthcare system, and this article addresses how economic evaluation can strategically target evidence gaps for public health priorities with examples from pharmacogenomic medicine. This article begins with a review of the need for and use of economic evaluations in value-based decision making for pharmacogenomic testing. Three important gaps are described with examples demonstrating how they can be addressed: (1) projected impact of hypothetical new technology, (2) pre-implementation assessment of a specific technology, and (3) post-implementation assessment from relevant analytical stakeholder perspectives. Additional needs, challenges and approaches specific to pharmacogenomic economic evaluation in the developing world are also identified. These pragmatic approaches can provide much needed evidence to support real-world value-based decision making for pharmacogenomic-based screening and treatment strategies. © 2014 S. Karger AG, Basel.

Commercial viability of CNS drugs: balancing the risk/reward profile.

PubMed

Johnson, Ginger S

2014-01-01

CNS has historically been a formidable therapeutic area in which to innovate owing to biological (e.g., complex neurobiology, difficulty reaching the target), as well as clinical (e.g., subjective clinical endpoints, high placebo response, lack of biomarkers) challenges. In the current market where many of the larger diseases are dominated by a generic standard of care, commercial challenges now make the triple threat of scientific-clinical-commercial risk too much for many players to tackle. However, opportunities do exist for smaller biotech companies to concentrate on narrowly focused patient populations associated with high unmet need for which risk can be tightly defined. In CNS, there are two major areas to balance the risk/reward profile and create commercially viable opportunities: To realize value, all companies (start-ups and big players) must define, measure and quantify clear and meaningful value to all stakeholders: physicians, patients, caregivers and payers. © 2013.

Planning that works: Empowerment through stakeholder focused interactive planning (SFIP)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beck, J.E.; Ison, S.A.

1994-12-31

This paper describes a powerful planning tool that can enable government, private industries, and public interest organizations to actualize their visions through sound decision making. The stakeholder focused interactive planning model is designed to integrate and ultimately gain stakeholder investment in the success of attainment of their vision. The only concessions required of the planning organization using this process is the acceptance of the premise that sustained vision success requires the support of both internal and external stakeholders and that each step in the process must be used as a validation of the previous step and essential to the completionmore » of the next step. What is stakeholder/public involvement? It is the process in which the stakeholders (both internal and external) values, interests and expectations are included in decision-making processes. The primary goal of public involvement efforts is to include all those who have a stake in the decision, whether or not they have already been identified. Stakeholders are individuals, contractors, clients, suppliers, public organizations, state and local governments, Indian tribes, federal agencies, and other parties affected by decisions.« less

Navigating complexity through knowledge coproduction: Mainstreaming ecosystem services into disaster risk reduction.

PubMed

Reyers, Belinda; Nel, Jeanne L; O'Farrell, Patrick J; Sitas, Nadia; Nel, Deon C

2015-06-16

Achieving the policy and practice shifts needed to secure ecosystem services is hampered by the inherent complexities of ecosystem services and their management. Methods for the participatory production and exchange of knowledge offer an avenue to navigate this complexity together with the beneficiaries and managers of ecosystem services. We develop and apply a knowledge coproduction approach based on social-ecological systems research and assess its utility in generating shared knowledge and action for ecosystem services. The approach was piloted in South Africa across four case studies aimed at reducing the risk of disasters associated with floods, wildfires, storm waves, and droughts. Different configurations of stakeholders (knowledge brokers, assessment teams, implementers, and bridging agents) were involved in collaboratively designing each study, generating and exchanging knowledge, and planning for implementation. The approach proved useful in the development of shared knowledge on the sizable contribution of ecosystem services to disaster risk reduction. This knowledge was used by stakeholders to design and implement several actions to enhance ecosystem services, including new investments in ecosystem restoration, institutional changes in the private and public sector, and innovative partnerships of science, practice, and policy. By bringing together multiple disciplines, sectors, and stakeholders to jointly produce the knowledge needed to understand and manage a complex system, knowledge coproduction approaches offer an effective avenue for the improved integration of ecosystem services into decision making.

Navigating complexity through knowledge coproduction: Mainstreaming ecosystem services into disaster risk reduction

PubMed Central

Reyers, Belinda; Nel, Jeanne L.; O’Farrell, Patrick J.; Sitas, Nadia; Nel, Deon C.

2015-01-01

Achieving the policy and practice shifts needed to secure ecosystem services is hampered by the inherent complexities of ecosystem services and their management. Methods for the participatory production and exchange of knowledge offer an avenue to navigate this complexity together with the beneficiaries and managers of ecosystem services. We develop and apply a knowledge coproduction approach based on social–ecological systems research and assess its utility in generating shared knowledge and action for ecosystem services. The approach was piloted in South Africa across four case studies aimed at reducing the risk of disasters associated with floods, wildfires, storm waves, and droughts. Different configurations of stakeholders (knowledge brokers, assessment teams, implementers, and bridging agents) were involved in collaboratively designing each study, generating and exchanging knowledge, and planning for implementation. The approach proved useful in the development of shared knowledge on the sizable contribution of ecosystem services to disaster risk reduction. This knowledge was used by stakeholders to design and implement several actions to enhance ecosystem services, including new investments in ecosystem restoration, institutional changes in the private and public sector, and innovative partnerships of science, practice, and policy. By bringing together multiple disciplines, sectors, and stakeholders to jointly produce the knowledge needed to understand and manage a complex system, knowledge coproduction approaches offer an effective avenue for the improved integration of ecosystem services into decision making. PMID:26082541

Stakeholder-focused evaluation of an online course for health care providers.

PubMed

Dunet, Diane O; Reyes, Michele

2006-01-01

Different people who have a stake or interest in a training course (stakeholders) may have markedly different definitions of what constitutes "training success" and how they will use evaluation results. Stakeholders at multiple levels within and outside of the organization guided the development of an evaluation plan for a Web-based training course on hemochromatosis. Stakeholder interests and values were reflected in the type, level, and rigor of evaluation methods selected. Our mixed-method evaluation design emphasized small sample sizes and repeated measures. Limited resources for evaluation were leveraged by focusing on the data needs of key stakeholders, understanding how they wanted to use evaluation results, and collecting data needed for stakeholder decision making. Regular feedback to key stakeholders provided opportunities for updating the course evaluation plan to meet emerging needs for new or different information. Early and repeated involvement of stakeholders in the evaluation process also helped build support for the final product. Involving patient advocacy groups, managers, and representative course participants improved the course and enhanced product dissemination. For training courses, evaluation planning is an opportunity to tailor methods and data collection to meet the information needs of particular stakeholders. Rigorous evaluation research of every training course may be infeasible or unwarranted; however, course evaluations can be improved by good planning. A stakeholder-focused approach can build a picture of the results and impact of training while fostering the practical use of evaluation data.

Complexity in Vocational Education and Training Governance

ERIC Educational Resources Information Center

Oliver, Damian

2010-01-01

Complexity is a feature common to all vocational education and training (VET) governance arrangements, due to the wide range of students VET systems caters for, and the number of stakeholders involved in both decision making and funding and financing. In this article, Pierre and Peter's framework of governance is used to examine complexity in VET…

Enhancing School Asthma Action Plans: Qualitative Results from Southeast Minnesota Beacon Stakeholder Groups

ERIC Educational Resources Information Center

Egginton, Jason S.; Textor, Lauren; Knoebel, Erin; McWilliams, Deborah; Aleman, Marty; Yawn, Barbara

2013-01-01

Background: This study explores ways southeast Minnesota schools currently address asthma problems, identifies areas for improvement, and assesses the potential value of asthma action plans (AAPs) in schools. Methods: Focus groups were used to query stakeholder groups on asthma care in schools. Groups were held separately for elementary school…

Collecting and Analyzing Stakeholder Feedback for Signing at Complex Interchanges

DOT National Transportation Integrated Search

2014-10-01

The purpose of this project was to identify design constraints related to signing, markings, and geometry for complex interchanges, and then to identify useful topics for future research that will yield findings that can address those design issues. ...

Stakeholder involvement: how to do it right: article 9 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Cluzeau, Françoise; Wedzicha, Jadwiga A; Kelson, Marcia; Corn, Judy; Kunz, Regina; Walsh, John; Schünemann, Holger J

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that healthcare recommendations are informed by the best available research evidence with input from appropriate stakeholders. This is the ninth of a series of 14 articles that were prepared by an international panel to advise guideline developers in respiratory and other diseases on approaches for guideline development. We updated a review of the literature on stakeholder involvement, focusing on six key questions. In this review we addressed the following questions. (1) What are "stakeholders"? (2) Why involve stakeholders in guidelines? (3) At what stage should stakeholders contribute to guidelines? (4) What are the potential barriers to integrating stakeholder involvement? (5) How can stakeholders be involved effectively? (6) Should anyone be excluded from the process? We searched PubMed and other databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct our own systematic reviews. Our conclusions are based on available evidence, the experience of guideline developers, and workshop discussions. Stakeholders are all those who have a legitimate interest in a guideline. They include healthcare professionals, patients and caregivers, public and private funding bodies, managers, employers, and manufacturers. Their engagement is justified for several reasons, including limitations of evidence, principles of transparency and democracy, ownership, and potential policy implications. They have a role to play at different points of guideline development, but their involvement can be complex. To be successful, stakeholder engagement needs to be inclusive, equitable, and adequately resourced.

Anatomy of a value proposition for laboratory medicine.

PubMed

Price, Christopher P; St John, Andrew

2014-09-25

Value is now becoming a key driver in the ongoing development of healthcare delivery; key facets include the identification of what is valuable and how that value can be identified, leveraged, and delivered. The concept of a value proposition is widely used in business but can be used in healthcare as a statement of the benefits, costs and value that an organization can deliver to its customers. The foundation of this statement in laboratory medicine is evidence of clinical and cost effectiveness, not only for the patient, but also for other stakeholders involved in the delivery of healthcare, e.g., the carer, service provider, commissioner, purchaser, and the supplier of the test or device, as well as society as a whole. However the value of any laboratory medicine investigation is only achieved if the output (the test result(s)), is acted upon by the initiator of the investigation. Laboratory medicine is one part of a complex intervention, and so the value proposition should encompass the breadth of that intervention - from addressing the unmet need through the generation of clinical, operational and economic outcomes. A value proposition in laboratory medicine is central to successful innovation and quality improvement in healthcare. Copyright © 2014 Elsevier B.V. All rights reserved.

Collaborative development of an educational resource on rehabilitation for people living with HIV.

PubMed

Solomon, Patricia; Salbach, Nancy M; O'Brien, Kelly K; Nixon, Stephanie; Worthington, Catherine; Baxter, Larry; Tattle, Stephen; Gervais, Nicole

2017-07-12

The objective of this study is to describe the collaborative development of a rehabilitation guide for people living with human immunodeficiency virus (HIV) which was adapted from an online resource for clinicians. We adapted a comprehensive evidence-informed online clinical resource for people living with HIV using a three-phase participatory process. In Phase 1, we interviewed 26 clinicians and 16 people living with HIV to gather recommendations on how to adapt and format the content to benefit people living with HIV. In Phase 2, we adapted the patient education resource using the recommendations that emerged from Phase 1. Phase 3 consisted of comprehensive stakeholder review of the revised resource on the adaptability, usability, communicability, and relevance of the information. Stakeholders participated in an interview to obtain in-depth information on their perspectives. Transcribed interviews underwent qualitative content analysis. Stakeholders indicated that the e-guide had utility for people living with HIV, community HIV service organizations, and care providers. Engaging people living with HIV resulted in a more relevant and meaningful resource that incorporated patients' values, needs, and preferences. Involving multiple stakeholders and user groups in the adaptation and evaluation of online patient education resources can assist in meeting patients' needs through increasing the relevance, organization and presentation of the content, and incorporating patients' values and needs. Implications for Rehabilitation Online patient education resources should be adapted in order to maximize relevance and meaningfulness to patients. Involving multiple stakeholders in the adaptation and evaluation of online patient education resources can assist in meeting patients' needs. Involving multiple stakeholders increases the relevance, organization and presentation of the content and allows the incorporation of patient values and needs. This collaborative approach with an emphasis on meaningful participation of patients and community may be of interest to others interested in promoting knowledge translation.

Using an innovative criteria weighting tool for stakeholders involvement to rank MSW facility sites with the AHP.

PubMed

De Feo, Giovanni; De Gisi, Sabino

2010-11-01

The main aim of this study was to verify the efficacy of using an innovative criteria weighting tool (the "priority scale") for stakeholders involvement to rank a list of suitable municipal solid waste (MSW) facility sites with the multi-criteria decision-making (MCDM) technique known as analytic hierarchy process (AHP). One of the main objectives of the study was to verify the behaviour of the "priority scale" with both technical and non-technical decision-makers. All over the world, the siting of MSW treatment or disposal plants is a complex process involving politicians, technicians as well as citizens, where stakeholders who are not effectively involved strongly oppose (or even obstruct) the realization of new facilities. In this study, in order to pursue both the technical (select the best site) and social aims (all the stakeholders have to give their aware contribution), the use of the "priority scale" is suggested as a tool to easily collect non-contradictory criteria preferences by the various decision-makers. Every decision-maker filled in "priority scale", which was subsequently uploaded in the AHP tool in order to indirectly calculate the individual priority of alternatives given by each stakeholder (not using group aggregation techniques). The proposed method was applied to the siting of a composting plant in an area suffering from a serious MSW emergency, which has lasted for over 15 years, in the Campania Region, in Southern Italy. The best site (the "first choice") was taken as the one that appeared the most times at the first place of each decision-maker ranking list. The involved technical and non-technical decision-makers showed the same behaviour in (indirectly) selecting the best site as well as in terms of the most appraised criteria ("absence of areas of the highest value for natural habitats and species of plants and animals"). Moreover, they showed the same AHP inconsistency ratio as well as the same behaviour in comparison with a "balanced decision-maker" (who assigns identical weights to all the considered criteria). Therefore, the proposed criteria weighting tool could be widely as well as easily used for stakeholders involvement to rank MSW facility sites (or other kinds of alternatives) with the AHP or with other MCDM techniques, taking or not into consideration group aggregation methods. Copyright © 2010 Elsevier Ltd. All rights reserved.

AMCP Partnership Forum: Improving Quality, Value, and Outcomes with Patient-Reported Outcomes.

PubMed

2018-03-01

Patient-reported outcomes (PROs), which provide a direct measure of a patient's health status or treatment preferences, represent a key component of the shift toward patient-centered health care. PROs can measure the state of a patient's disease-specific and overall health throughout the care continuum, enabling them to have a variety of uses for key health care stakeholders. Currently, PROs are used in drug development, aligning patient and clinician goals in care, quality-of-care measures, and coverage and reimbursement decisions. While there have been significant strides by key health care stakeholders to further the development and use of PROs, there are a number of challenges limiting more widespread use. In light of these current challenges and the potential for PROs to improve health care quality and value, on October 19, 2017, the Academy of Managed Care Pharmacy convened a forum of key stakeholders representing patients, payers, providers, government, and pharmaceutical companies to discuss and identify solutions to the current challenges and barriers to further use of PROs. These discussions informed the development of participants' ideal future state in which PROs maximize the goals of all health care stakeholders and the actionable steps required to make the future state a reality. While stakeholders shared unique perspectives throughout the forum, they had consensus on 2 overarching issues: the importance of PROs in defining value, improving patient care, and implementing value-based payment models and the need for strong organizational and operational systems to achieve optimal adoption and use. Participants identified several key challenges in PRO use and adoption: achieving a representative patient population, inclusion of PRO data in medication labels, the necessity for both standardized and customizable PROs, and operational and organizational barriers to collecting and analyzing PROs. To overcome these challenges, participants recommended that manufacturers should engage key stakeholders early and throughout the drug development process to ensure the most valid and representative PROs and patient populations will be included. To streamline the PRO collection process, participants suggested engaging pharmacists and other providers who may have more frequent interaction with patients. Participants also recommended that PRO collection and analysis should use common technology platforms, streamline components of clinician care to reduce workflow, and be integrated with claims data to provider payers a better understanding of patient health in real time. Finally, additional work should be done to develop patient-reported outcome measures that contain relevant measures for all healthcare stakeholders. While significant challenges remain in PRO development and adoption, participants agreed that greater use can only be achieved through collaboration and patient-centered care. The AMCP Partnership Forum titled "Improving Quality, Value, and Outcomes with Patient-Reported Outcomes" and the development of this proceedings report were supported by Amgen, Boehringer Ingelheim Pharmaceuticals, Genentech, GlaxoSmithKline, Novartis Pharmaceuticals, Novo Nordisk, Precision for Value, Premier, Sanofi, Takeda Pharmaceuticals USA, and Xcenda.

Stakeholder analysis: a review.

PubMed

Brugha, R; Varvasovszky, Z

2000-09-01

The growing popularity of stakeholder analysis reflects an increasing recognition of how the characteristics of stakeholders--individuals, groups and organizations--influence decision-making processes. This paper reviews the origins and uses of stakeholder analysis, as described in the policy, health care management and development literature. Its roots are in the political and policy sciences, and in management theory where it has evolved into a systematic tool with clearly defined steps and applications for scanning the current and future organizational environment. Stakeholder analysis can be used to generate knowledge about the relevant actors so as to understand their behaviour, intentions, interrelations, agendas, interests, and the influence or resources they have brought--or could bring--to bear on decision-making processes. This information can then be used to develop strategies for managing these stakeholders, to facilitate the implementation of specific decisions or organizational objectives, or to understand the policy context and assess the feasibility of future policy directions. Policy development is a complex process which frequently takes place in an unstable and rapidly changing context, subject to unpredictable internal and external factors. As a cross-sectional view of an evolving picture, the utility of stakeholder analysis for predicting and managing the future is time-limited and it should be complemented by other policy analysis approaches.

An analysis of stakeholder views on children's mental health services.

PubMed

Rodríguez, Adriana; Southam-Gerow, Michael A; O'Connor, Mary Katherine; Allin, Robert B

2014-01-01

The purpose was to examine the perspectives of mental health stakeholders as a means to guide the adaptation of evidence-based treatments. The Mental Health System Ecological (MHSE) model was used to organize therapist, administrator, and parent perspectives gathered using qualitative methods. The MHSE model posits the influences of client-level, provider-level, intervention-specific, service delivery, organizational, and service system characteristics on implementation. Focus groups and interviews were conducted with community mental health stakeholders and included parents, therapists, and administrators (N = 21). Participants included 11 primarily Caucasian (90.48%) female participants, ranging in ages between 31 and 57 years. Data were analyzed according to the MHSE model. Frequency counts were tabulated for each theme and stakeholder group differences were determined using the Mann-Whitney test. Stakeholder groups mentioned needs at each level of the MHSE model. Stakeholder group differences most notably emerged with child and family themes, which included complexity of mental health issues, parenting differences, and family stressors. Stakeholders identified challenges for optimal mental health services for children across multiple levels of an ecological model. Implications of the findings are discussed, including the continued relevance of adapting mental health interventions by increasing their flexible application across multiple target problems and the promise of partnership approaches.

Social shaping of food intervention initiatives at worksites: canteen takeaway schemes at two Danish hospitals.

PubMed

Poulsen, Signe; Jørgensen, Michael Søgaard

2011-09-01

The aim of this article is to analyse the social shaping of worksite food interventions at two Danish worksites. The overall aims are to contribute first, to the theoretical frameworks for the planning and analysis of food and health interventions at worksites and second, to a foodscape approach to worksite food interventions. The article is based on a case study of the design of a canteen takeaway (CTA) scheme for employees at two Danish hospitals. This was carried out as part of a project to investigate the shaping and impact of schemes that offer employees meals to buy, to take home or to eat at the worksite during irregular working hours. Data collection was carried out through semi-structured interviews with stakeholders within the two change processes. Two focus group interviews were also carried out at one hospital and results from a user survey carried out by other researchers at the other hospital were included. Theoretically, the study was based on the social constitution approach to change processes at worksites and a co-evolution approach to problem-solution complexes as part of change processes. Both interventions were initiated because of the need to improve the food supply for the evening shift and the work-life balance. The shaping of the schemes at the two hospitals became rather different change processes due to the local organizational processes shaped by previously developed norms and values. At one hospital the change process challenged norms and values about food culture and challenged ideas in the canteen kitchen about working hours. At the other hospital, the change was more of a learning process that aimed at finding the best way to offer a CTA scheme. Worksite health promotion practitioners should be aware that the intervention itself is an object of negotiation between different stakeholders at a worksite based on existing norms and values. The social contextual model and the setting approach to worksite health interventions lack reflections about how such norms and values might influence the shaping of the intervention. It is recommended that future planning and analyses of worksite health promotion interventions apply a combination of the social constitution approach to worksites and an integrated food supply and demand perspective based on analyses of the co-evolution of problem-solution complexes.

Disinvestment policy and the public funding of assisted reproductive technologies: outcomes of deliberative engagements with three key stakeholder groups.

PubMed

Hodgetts, Katherine; Hiller, Janet E; Street, Jackie M; Carter, Drew; Braunack-Mayer, Annette J; Watt, Amber M; Moss, John R; Elshaug, Adam G

2014-05-05

Measures to improve the quality and sustainability of healthcare practice and provision have become a policy concern. In addition, the involvement of stakeholders in health policy decision-making has been advocated, as complex questions arise around the structure of funding arrangements in a context of limited resources. Using a case study of assisted reproductive technologies (ART), deliberative engagements with a range of stakeholder groups were held on the topic of how best to structure the distribution of Australian public funding in this domain. Deliberative engagements were carried out with groups of ART consumers, clinicians and community members. The forums were informed by a systematic review of ART treatment safety and effectiveness (focusing, in particular, on maternal age and number of treatment cycles), as well as by international policy comparisons, and ethical and cost analyses. Forum discussions were transcribed and subject to thematic analysis. Each forum demonstrated stakeholders' capacity to understand concepts of choice under resource scarcity and disinvestment, and to countenance options for ART funding not always aligned with their interests. Deliberations in each engagement identified concerns around 'equity' and 'patient responsibility', culminating in a broad preference for (potential) ART subsidy restrictions to be based upon individual factors rather than maternal age or number of treatment cycles. Community participants were open to restrictions based upon measures of body mass index (BMI) and smoking status, while consumers and clinicians saw support to improve these factors as part of an ART treatment program, as distinct from a funding criterion. All groups advocated continued patient co-payments, with measures in place to provide treatment access to those unable to pay (namely, equity of access). Deliberations yielded qualitative, socially-negotiated evidence required to inform ethical, accountable policy decisions in the specific area of ART and health care more broadly. Notably, reductionist, deterministic characterizations of stakeholder 'self-interest' proved unfounded as each group sought to prioritise universal values (in particular, 'equity' and 'responsibility') over specific, within-group concerns. Our results--from an emotive case study in ART--highlight that evidence-informed disinvestment decision-making is feasible, and potentially less controversial than often presumed.

The role of stakeholders in developing an international regulatory framework for carbon capture and storage

NASA Astrophysics Data System (ADS)

Augustin, C. M.; Broad, K.; Swart, P. K.

2011-12-01

It is estimated that carbon capture and storage (CCS) could be used to achieve between 15% and 55% of the carbon emission reductions necessary to avoid dangerous levels of climate change. It is also believed that achieving emission reduction goals will be less costly with CCS than without it. The expansion of active CCS sites over the past decade, from three to 53 demonstrates the value that industry sees in CCS as a transition technology for governments seeking to reduce their CO2 emissions. However, to continue developing CCS for industry scale implementation, it is essential to provide the regulatory certainty needed to foster energy industry wide adoption of CCS. Existing CCS regulatory regimes are inadequate, fragmented and contradictory. There is a need for comprehensive, unifying regulations for CCS that are flexible enough to adapt as the technology develops. Governments are limited by the fact that carbon capture and storage is a multidisciplinary issue that touches on the fields of oil drilling, groundwater quality, greenhouse gas management, air quality, and risk management. Though it is in part a technological, environmental and management issue there is also a complex political element to tackling the CCS problem. Due to its cross-cutting nature, CCS regulations should be based off the best practices and standards developed by industry stakeholders. Industry standards are stakeholder developed and consensus based, created through a democratic and collaborative process by bodies such as the International Standards Organization, the National Institutes of Standards and Testing (USA), ASTM International, and the Canadian Standards Organization. Standards can typically be broken down into six general categories: test methods, specifications, classifications, practices, guides, and terminology. These standards are created by stakeholders across the industry and across geographic boundaries to create an trade-wide, rather than nationwide, consensus and ensuring that the standards are international in scope. This paper examines regulatory issues post-capture, particularly the transport and geological storage of carbon dioxide and seeks to identify areas where relevant stakeholders should collaborate to develop a comprehensive list of industry standards and provides several case study examples.

Evaluating the value and impact of the Victorian Audit of Surgical Mortality.

PubMed

Retegan, Claudia; Russell, Colin; Harris, Darren; Andrianopoulos, Nick; Beiles, C Barry

2013-10-01

Since the Victorian Audit of Surgical Mortality (VASM) commenced in 2007, 95% of Victorian Fellows have agreed to participate and have provided data on the deaths of patients receiving surgical care. All public, and the majority of private, hospitals involved in the delivery of surgical services in Victoria have been submitting data on deaths associated with surgery. De-identified reports on this data are distributed in regular annual reports and case note review booklets. Although informal feedback on the perceived value of the audit was encouraging, a formal review of all aspects of the audit was felt necessary. An independent formal review of VASM governance, documentation, datasets and data analysis was performed, in addition to a survey of 257 individuals (surgeons and other stakeholders) on the perceived impact of VASM. The review confirmed increasing participation and acceptance by surgeons since the inception of the project. Governance mechanisms were found to be effective and acknowledged by stakeholders and collaborators. Robust participation rates have been achieved, and stakeholders were generally satisfied with the quality of feedback. Suggestions for improvement were provided by some surgeons and hospitals. External review of VASM processes and procedures confirmed that the audit was operating effectively, with robust quality control and achieving the trust of stakeholders. The educational value of the audit to the surgical community was acknowledged and areas for future improvement have been identified. © 2013 Royal Australasian College of Surgeons.

Determinants of public attitudes to genetically modified salmon.

PubMed

Amin, Latifah; Azad, Md Abul Kalam; Gausmian, Mohd Hanafy; Zulkifli, Faizah

2014-01-01

The objective of this paper is to assess the attitude of Malaysian stakeholders to genetically modified (GM) salmon and to identify the factors that influence their acceptance of GM salmon using a structural equation model. A survey was carried out on 434 representatives from various stakeholder groups in the Klang Valley region of Malaysia. Public attitude towards GM salmon was measured using self-developed questionnaires with seven-point Likert scales. The findings of this study have confirmed that public attitudes towards GM salmon is a complex issue and should be seen as a multi-faceted process. The most important direct predictors for the encouragement of GM salmon are the specific application-linked perceptions about religious acceptability of GM salmon followed by perceived risks and benefits, familiarity, and general promise of modern biotechnology. Encouragement of GM salmon also involves the interplay among other factors such as general concerns of biotechnology, threatening the natural order of things, the need for labeling, the need for patenting, confidence in regulation, and societal values. The research findings can serve as a database that will be useful for understanding the social construct of public attitude towards GM foods in a developing country.

Teaching the Ethical Aspects of Environmental Science

NASA Astrophysics Data System (ADS)

Palinkas, C. M.

2014-12-01

Environmental and societal issues are often inherently linked, especially in coastal and estuarine environments, and science and social values must often be balanced in ecosystem management and decision-making. A new seminar course has been developed for the Marine Estuarine and Environmental Science (MEES) graduate program, an inter-institutional program within the University System of Maryland, to examine these issues. This 1-credit course, offered for the first time in Spring 2015, takes a complex systems perspective on major environmental and societal challenges to examine these linked issues in a variety of contexts. After a brief introduction to the emerging field of "geoethics," students develop a list of issues to examine throughout the seminar. Example topics could include fracking, offshore wind technology, dam removal, and iron fertilization, among others. A case-study approach is taken, with each class meeting focusing on one issue. For each case study, students are asked to 1) identify relevant scientific principles and major knowledge gaps, 2) predict potential outcomes, 3) identify stakeholders and likely viewpoints, and 4) construct communication plans to disseminate findings to these stakeholders. At the end of the semester, students give a brief presentation of the ethical aspects of their own research topics.

Preparing future fisheries professionals to make good decisions

USGS Publications Warehouse

Colvin, Michael E.; Peterson, James T.

2017-01-01

Future fisheries professionals will face decision-making challenges in an increasingly complex field of fisheries management. Though fisheries students are well trained in the use of the scientific method to understand the natural world, they are rarely exposed to structured decision making (SDM) as part of an undergraduate or graduate education. Specifically, SDM encourages users (e.g., students, managers) to think critically and communicate the problem and then identify specific, measurable objectives as they relate to the problem. Next, users must think critically and creatively about management alternatives that can be used to meet the objectives—there must be more than one alternative or there is no decision to be made. Lastly, the management alternatives are evaluated with regard to how likely they are to succeed in terms of multiple, possibly completing, objectives, such as how stakeholder groups value outcomes of management actions versus monetary cost. We believe that exposure to SDM and its elements is an important part of preparing future fisheries professional to meet the challenges they may face. These challenges include reduced budgets, the growth of potentially competing natural resource interest groups, and stakeholder desire to be involved in management decisions affecting public trust resources, just to name a few.

Road map to a patient-centered research agenda at the intersection of hospital medicine and geriatric medicine.

PubMed

Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O

2014-06-01

As the United States ages, the patient population in acute care hospitals is increasingly older and more medically complex. Despite evidence of a high burden of disease, high costs, and often poor outcomes of care, there is limited understanding of the presentation, diagnostic strategies, and management of acute illness in older adults. In this paper, we present a strategy for the development of a research agenda at the intersection of hospital and geriatric medicine. This approach is informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, emphasizing input from patients and caregivers. The framework's four components are: 1) Topic generation, 2) Gap Analysis in Systematic Review, 3) Value of information (VOI) analysis, and 4) Peer Review. An inclusive process for topic generation requiring the systematic engagement of multiple stakeholders, especially patients, is emphasized. In subsequent steps, researchers and stakeholders prioritize research topics in order to identify areas that optimize patient-centeredness, population impact, impact on clinical decision making, ease of implementation, and durability. Finally, next steps for dissemination of the research agenda and evaluation of the impact of the patient-centered research prioritization process are described.

Determinants of Public Attitudes to Genetically Modified Salmon

PubMed Central

Amin, Latifah; Azad, Md. Abul Kalam; Gausmian, Mohd Hanafy; Zulkifli, Faizah

2014-01-01

The objective of this paper is to assess the attitude of Malaysian stakeholders to genetically modified (GM) salmon and to identify the factors that influence their acceptance of GM salmon using a structural equation model. A survey was carried out on 434 representatives from various stakeholder groups in the Klang Valley region of Malaysia. Public attitude towards GM salmon was measured using self-developed questionnaires with seven-point Likert scales. The findings of this study have confirmed that public attitudes towards GM salmon is a complex issue and should be seen as a multi-faceted process. The most important direct predictors for the encouragement of GM salmon are the specific application-linked perceptions about religious acceptability of GM salmon followed by perceived risks and benefits, familiarity, and general promise of modern biotechnology. Encouragement of GM salmon also involves the interplay among other factors such as general concerns of biotechnology, threatening the natural order of things, the need for labeling, the need for patenting, confidence in regulation, and societal values. The research findings can serve as a database that will be useful for understanding the social construct of public attitude towards GM foods in a developing country. PMID:24489695

Liberating the potential: the role of non-nurses in adding value to nurse education.

PubMed

Dickinson, Julie

2006-01-01

In this paper, I have attempted to explore the role of non-nurse lecturers in adding value to nurse education programmes. In measuring "added-value" in higher education, I have embraced a more comprehensive approach including investigating the views of "Experts"; including the nurse and non-nurse lecturers themselves, and various United Kingdom stakeholders such as the Government, the Nursing and Midwifery Council and the Quality Assurance Agency. The students' views are also taken into account, when considering both the content of the programmes and how they are delivered. The complexity of "objective measurement" is considered, and the requirements of a "good" teaching experience. The potential areas for adding value include: health and social care policy priorities which encourage partnership working, the blurring of professional boundaries, and inter-professional working. Professional-specific changes embracing extended and enhanced roles and the concepts of specialist and assistant practitioners. Other areas include the Higher Education agendas including transferable skills and adult and student-centred learning. I conclude by discussing the latest policy changes and suggest that the role of the non-nurse lecturer needs more exploration to provide the best value for all.

A Critical Look at the Policy Environment for Opening up Public Higher Education in Rwanda

ERIC Educational Resources Information Center

Nkuyubwatsi, Bernard

2016-01-01

Policies play a critical role in the implementation of open, distance education and opening up higher education. To encourage participation of different stakeholders in related practices, policies may need to embody values and benefits for those stakeholders. It is in this perspective that this study was conducted to investigate the policy…

Core Clinical Data Elements for Cancer Genomic Repositories: A Multi-stakeholder Consensus.

PubMed

Conley, Robert B; Dickson, Dane; Zenklusen, Jean Claude; Al Naber, Jennifer; Messner, Donna A; Atasoy, Ajlan; Chaihorsky, Lena; Collyar, Deborah; Compton, Carolyn; Ferguson, Martin; Khozin, Sean; Klein, Roger D; Kotte, Sri; Kurzrock, Razelle; Lin, C Jimmy; Liu, Frank; Marino, Ingrid; McDonough, Robert; McNeal, Amy; Miller, Vincent; Schilsky, Richard L; Wang, Lisa I

2017-11-16

The Center for Medical Technology Policy and the Molecular Evidence Development Consortium gathered a diverse group of more than 50 stakeholders to develop consensus on a core set of data elements and values essential to understanding the clinical utility of molecularly targeted therapies in oncology. Copyright © 2017 Elsevier Inc. All rights reserved.

Risk communication and the Precautionary Principle.

PubMed

Biocca, Marco

2004-01-01

The perception of risks for environment and health deriving from globalization processes and an uncontrolled use of modern technologies is growing everywhere. The greater the capacity of controlling living conditions, the larger is the possibility of misusing this power. In environmental and occupational health research we tend to reduce the complexity of the observed phenomena in order to facilitate conclusions. In social and political sciences complexity is an essential element of the context, which needs to be continuously considered. The Precautionary Principle is a tool for facing complexity and uncertainty in health risk management. This paper is aimed at demonstrating that this is not only a problem of technical risk assessment. Great attention should also be paid to improve risk communication. Communication between the stakeholders (experts, decision makers, political and social leaders, media, groups of interest and people involved) is possibly the best condition to be successful in health risk management. Nevertheless, this process usually runs up against severe obstacles. These are not only caused by existing conflicts of interest. Differences in values, languages, perceptions, resources to have access to information, and to express one's own point of view are other key aspects.

Setting Priorities in Global Child Health Research Investments: Addressing Values of Stakeholders

PubMed Central

Kapiriri, Lydia; Tomlinson, Mark; Gibson, Jennifer; Chopra, Mickey; El Arifeen, Shams; Black, Robert E.; Rudan, Igor

2007-01-01

Aim To identify main groups of stakeholders in the process of health research priority setting and propose strategies for addressing their systems of values. Methods In three separate exercises that took place between March and June 2006 we interviewed three different groups of stakeholders: 1) members of the global research priority setting network; 2) a diverse group of national-level stakeholders from South Africa; and 3) participants at the conference related to international child health held in Washington, DC, USA. Each of the groups was administered different version of the questionnaire in which they were asked to set weights to criteria (and also minimum required thresholds, where applicable) that were a priori defined as relevant to health research priority setting by the consultants of the Child Health and Nutrition Research initiative (CHNRI). Results At the global level, the wide and diverse group of respondents placed the greatest importance (weight) to the criterion of maximum potential for disease burden reduction, while the most stringent threshold was placed on the criterion of answerability in an ethical way. Among the stakeholders’ representatives attending the international conference, the criterion of deliverability, answerability, and sustainability of health research results was proposed as the most important one. At the national level in South Africa, the greatest weight was placed on the criterion addressing the predicted impact on equity of the proposed health research. Conclusions Involving a large group of stakeholders when setting priorities in health research investments is important because the criteria of relevance to scientists and technical experts, whose knowledge and technical expertise is usually central to the process, may not be appropriate to specific contexts and in accordance with the views and values of those who invest in health research, those who benefit from it, or wider society as a whole. PMID:17948948

Assisted-living spaces for end-users with complex needs: a proposed implementation and delivery model.

PubMed

Linskell, Jeremy; Bouamrane, Matt-Mouley

2012-09-01

An assisted living space (ALS) is a technology-enabled environment designed to allow people with complex health or social care needs to remain, and live independently, in their own home for longer. However, many challenges remain in order to deliver usable systems acceptable to a diverse range of stakeholders, including end-users, and their families and carers, as well as health and social care services. ALSs need to support activities of daily-living while allowing end-users to maintain important social connections. They must be dynamic, flexible and adaptable living environments. In this article, we provide an overview of the technological landscape of assisted-living technology (ALT) and recent policies to promote an increased adoption of ALT in Scotland. We discuss our experiences in implementing technology-supported ALSs and emphasise key lessons. Finally, we propose an iterative and pragmatic user-centred implementation model for delivering ALSs in complex-needs scenarios. This empirical model is derived from our past ALS implementations. The proposed model allows project stakeholders to identify requirements, allocate tasks and responsibilities, and identify appropriate technological solutions for the delivery of functional ALS systems. The model is generic and makes no assumptions on needs or technology solutions, nor on the technical knowledge, skills and experience of the stakeholders involved in the ALS design process.

A Value Analysis of Lean Processes in Target Value Design and Integrated Project Delivery.

PubMed

Nanda, Upali; K Rybkowski, Zofia; Pati, Sipra; Nejati, Adeleh

2017-04-01

To investigate what key stakeholders consider to be the advantages and the opportunities for improvement in using lean thinking and tools in the integrated project delivery (IPD) process. A detailed literature review was followed by case study of a Lean-IPD project. Interviews with members of the project leadership team, focus groups with the integrated team as well as the design team, and an online survey of all stakeholders were conducted. Statistical analysis and thematic content analysis were used to analyze the data, followed by a plus-delta analysis. (1) Learning is a large, implicit benefit of Lean-IPD that is not currently captured by any success metric; (2) the cardboard mock-up was the most successful lean strategy; (3) although a collaborative project, the level of influence of different stakeholder groups was perceived to be different by different stakeholders; (4) overall, Lean-IPD was rated as better than traditional design-bid-build methods; and (5) opportunities for improvement reported were increase in accurate cost estimating, more efficient use of time, perception of imbalance of control/influence, and need for facilitation (which represents different points of view). While lean tools and an IPD method are preferred to traditional design-bid-build methods, the perception of different stakeholders varies and more work needs to be done to allow a truly shared decision-making model. Learning was identified as one of the biggest advantages.

Patterns of Success in Systems Engineering: Acquisition of IT-Intensive Government Systems

DTIC Science & Technology

2011-11-01

supply web, with all that entails. (See Section 4.1.1.) Stakeholders are aware of the different viewpoints and equities that they carry, and they are...Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a...interdependencies among enterprise stakeholders who have different equities in the capability being developed. ?Harnessing Technical Complexity? addresses the

Environmental policy beliefs of stakeholders in protected area management.

PubMed

Hovardas, Tasos; Poirazidis, Kostas

2007-04-01

Although the importance of understanding stakeholder beliefs regarding environmental policy has been noted by many authors, research focusing on the heterogeneity of stakeholder views is still very scarce and concentrated on a product-oriented definition of stakeholders. The aim of the present study is to address this gap by examining environmental policy beliefs of stakeholder groups engaged in protected area management. Questionnaires containing 73 five-point Likert scale items were administered to eight different stakeholder groups involved in the management of Greek protected areas. Items referred to core beliefs on environmental policy, namely, the value framework and sustainable development, and secondary beliefs, that is, beliefs on social consensus and ecotourism development. Our study used as a starting point respondent recruitment on the basis of a traditional product-centered approach. We investigated whether environmental policy beliefs can be used to effectively segregate stakeholders in well-defined segments, which override the product-oriented definition of stakeholders. Indeed, K-means clustering revealed an innovation-introduction and an implementation-charged sample segment. The instrument utilized in this research proved quite reliable and valid in measuring stakeholder environmental policy beliefs. Furthermore, the methodology implied that stakeholder groups differ in a significant number of belief-system elements. On the other hand, stakeholder groups were effectively distinguished on a small set of both core and secondary beliefs. Therefore, the instrument used can be an effective tool for determining and monitoring environmental policy beliefs of stakeholders in protected area management. This is of considerable importance in the Greek case, given the recent establishment of 27 administrative bodies of protected areas, all of which are required to incorporate public consultation into management practices.

Environmental Policy Beliefs of Stakeholders in Protected Area Management

NASA Astrophysics Data System (ADS)

Hovardas, Tasos; Poirazidis, Kostas

2007-04-01

Although the importance of understanding stakeholder beliefs regarding environmental policy has been noted by many authors, research focusing on the heterogeneity of stakeholder views is still very scarce and concentrated on a product-oriented definition of stakeholders. The aim of the present study is to address this gap by examining environmental policy beliefs of stakeholder groups engaged in protected area management. Questionnaires containing 73 five-point Likert scale items were administered to eight different stakeholder groups involved in the management of Greek protected areas. Items referred to core beliefs on environmental policy, namely, the value framework and sustainable development, and secondary beliefs, that is, beliefs on social consensus and ecotourism development. Our study used as a starting point respondent recruitment on the basis of a traditional product-centered approach. We investigated whether environmental policy beliefs can be used to effectively segregate stakeholders in well-defined segments, which override the product-oriented definition of stakeholders. Indeed, K-means clustering revealed an innovation-introduction and an implementation-charged sample segment. The instrument utilized in this research proved quite reliable and valid in measuring stakeholder environmental policy beliefs. Furthermore, the methodology implied that stakeholder groups differ in a significant number of belief-system elements. On the other hand, stakeholder groups were effectively distinguished on a small set of both core and secondary beliefs. Therefore, the instrument used can be an effective tool for determining and monitoring environmental policy beliefs of stakeholders in protected area management. This is of considerable importance in the Greek case, given the recent establishment of 27 administrative bodies of protected areas, all of which are required to incorporate public consultation into management practices.

Integrated decision-making about housing, energy and wellbeing: a qualitative system dynamics model.

PubMed

Macmillan, Alexandra; Davies, Michael; Shrubsole, Clive; Luxford, Naomi; May, Neil; Chiu, Lai Fong; Trutnevyte, Evelina; Bobrova, Yekatherina; Chalabi, Zaid

2016-03-08

The UK government has an ambitious goal to reduce carbon emissions from the housing stock through energy efficiency improvements. This single policy goal is a strong driver for change in the housing system, but comes with positive and negative "unintended consequences" across a broad range of outcomes for health, equity and environmental sustainability. The resulting policies are also already experiencing under-performance through a failure to consider housing as a complex system. This research aimed to move from considering disparate objectives of housing policies in isolation to mapping the links between environmental, economic, social and health outcomes as a complex system. We aimed to support a broad range of housing policy stakeholders to improve their understanding of housing as a complex system through a collaborative learning process. We used participatory system dynamics modelling to develop a qualitative causal theory linking housing, energy and wellbeing. Qualitative interviews were followed by two interactive workshops to develop the model, involving representatives from national and local government, housing industries, non-government organisations, communities and academia. More than 50 stakeholders from 37 organisations participated. The process resulted in a shared understanding of wellbeing as it relates to housing; an agreed set of criteria against which to assess to future policy options; and a comprehensive set of causal loop diagrams describing the housing, energy and wellbeing system. The causal loop diagrams cover seven interconnected themes: community connection and quality of neighbourhoods; energy efficiency and climate change; fuel poverty and indoor temperature; household crowding; housing affordability; land ownership, value and development patterns; and ventilation and indoor air pollution. The collaborative learning process and the model have been useful for shifting the thinking of a wide range of housing stakeholders towards a more integrated approach to housing. The qualitative model has begun to improve the assessment of future policy options across a broad range of outcomes. Future work is needed to validate the model and increase its utility through computer simulation incorporating best quality data and evidence. Combining system dynamics modelling with other methods for weighing up policy options, as well as methods to support shifts in the conceptual frameworks underpinning policy, will be necessary to achieve shared housing goals across physical, mental, environmental, economic and social wellbeing.

Preference weights for cost-outcome analyses of schizophrenia treatments: comparison of four stakeholder groups.

PubMed

Shumway, Martha

2003-01-01

This study quantified preferences for schizophrenia outcomes in four stakeholder groups, tested the hypotheses that outcomes differ in importance and stakeholder groups have different preferences, and produced preference weights for seven outcomes for cost-outcome analysis. Fifty patients with schizophrenia, 50 clinicians, 41 family members of patients, and 50 members of the general public rated 16 schizophrenia-related health states, yielding preference weights for seven outcomes: positive symptoms, negative symptoms, extrapyramidal symptoms, tardive dyskinesia, social function, independent living, and vocational function. Outcomes differed in importance (F = 23.4, p < 0.01). All stakeholders rated positive symptoms and social functioning as more important than negative and extrapyramidal symptoms. Stakeholder groups had different preferences (F = 1.9, p = 0.01). Patients rated extrapyramidal symptoms as more important than did other groups (p < 0.01); clinicians rated social functioning as more important than did patients or family members (p < 0.05); and clinicians and family members rated vocational functioning as more important than did patients and the general public (p < 0.05). Results show that schizophrenia outcomes are not equally important and that stakeholder groups value outcomes differently, demonstrating the importance of incorporating stakeholder preferences in cost-outcome analyses and other treatment comparisons.

Values and DSM-5: looking at the debate on attenuated psychosis syndrome.

PubMed

Gonçalves, Arthur Maciel Nunes; Dantas, Clarissa de Rosalmeida; Banzato, Claudio E M

2016-01-20

Although values have increasingly received attention in psychiatric literature over the last three decades, their role has been only partially acknowledged in psychiatric classification endeavors. The review process of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) received harsh criticism, and was even considered secretive by some authors. Also, it lacked an official discussion of values at play. In this perspective paper we briefly discuss the interplay of some values in the scientific and non-scientific debate around one of the most debated DSM-5 category proposals, the Attenuated Psychosis Syndrome (APS). Then, we point out some ethical consequences of a facts-plus-values perspective in psychiatric classification. Different stakeholders participated in the APS-debate and for analytical purposes we divided them into four groups: (i) researchers in the field of high-risk mental states; (ii) the DSM-5 Psychotic Disorders Work Group; (iii) patient, carers and advocacy groups; and (iv) external stakeholders, not related to the previous groups, but which also publicly expressed their opinions about APS inclusion in DSM-5. We found that each group differently stressed the role of values we examined in the APS-debate. These values were ethical, but also epistemic, political, economic and ontological. The prominence given to some values, and the lack of discussion about others, generated divergent positions among stakeholders in the debate. As exemplified by the APS discussion, although medicine is primarily an ethical endeavor, values of different kinds that take part in it also shape to a large extent the profession. Thus, it may be strategic to openly discuss values at play in the elaboration of diagnostic tools and classificatory systems. This task, more than scientifically or politically significant, is ethically important.

Governance Options to Enhance Ecosystem Services in Cocoa, Soy, Tropical Timber and Palm Oil Value Chains.

PubMed

Ingram, Verina; van den Berg, Jolanda; van Oorschot, Mark; Arets, Eric; Judge, Lucas

2018-02-06

Dutch policies have advocated sustainable commodity value chains, which have implications for the landscapes from which these commodities originate. This study examines governance and policy options for sustainability in terms of how ecosystem services are addressed in cocoa, soy, tropical timber and palm oil value chains with Dutch links. A range of policies addressing ecosystem services were identified, from market governance (certification, payments for ecosystem services) to multi-actor platforms (roundtables) and public governance (policies and regulations). An analysis of policy narratives and interviews identified if and how ecosystem services are addressed within value chains and policies; how the concept has been incorporated into value chain governance; and which governance options are available. The Dutch government was found to take a steering but indirect role in all the cases, primarily through supporting, financing, facilitating and partnering policies. Interventions mainly from end-of-chain stakeholders located in processing and consumption countries resulted in new market governance, notably voluntary sustainability standards. These have been successful in creating awareness of some ecosystem services and bringing stakeholders together. However, they have not fully addressed all ecosystem services or stakeholders, thus failing to increase the sustainability of value chains or of the landscapes of origin. We argue that chains sourced in tropical landscapes may be governed more effectively for sustainability if voluntary, market policy tools and governance arrangements have more integrated goals that take account of sourcing landscapes and impacts along the entire value chain. Given the international nature of these commodities. These findings have significance for debates on public-private approaches to value chain and landscape governance.

A qualitative study of health care providers' perceptions and experiences of working together to care for children with medical complexity (CMC).

PubMed

Altman, Lisa; Zurynski, Yvonne; Breen, Christie; Hoffmann, Tim; Woolfenden, Susan

2018-01-31

Children with medical complexity (CMC) have a wide range of long term health problems and disabilities that have an adverse impact on their quality of life. They have high levels of family identified health care needs and health care utilisation. There is no Australian literature on the experiences of health care providers working in the Australian tertiary, secondary and primary health care system, whilst managing CMC. This information is essential to inform the design of integrated health care systems for these children. We address this knowledge gap by exploring the perceptions and experiences of health care providers on the provision of health care for CMC aged 0 to 18 years. A qualitative research study was undertaken. Stakeholder forums, group and individual in depth interviews were undertaken using a semi-structured interview guide. The stakeholder forums were audio recorded and transcribed verbatim. Field notes of the stakeholder forums, group and individual interviews were taken. Inductive thematic analysis was undertaken to identify key themes. One hundred and three providers took part in the stakeholder forums and interviews across 3 local health districts, a tertiary paediatric hospital network, and primary health care organisations. Providers expressed concern regarding family capacity to negotiate the system, which was impacted by the medical complexity of the children and psychosocial complexity of their families. Lack of health care provider capacity in terms of their skills, time and availability to manage CMC was also a key problem. These issues occurred within a health system that had impaired capacity in terms of fragmentation of care and limited communication among health care providers. When designing integrated care models for CMC, it is essential to understand and address the challenges experienced by their health care providers. This requires adequate training of providers, additional resources and time for coordination of care, improved systems of communication among services, with timely access to key information for parents and providers.

A matter of trust? A study of coordination of Swedish stakeholders in return-to-work.

PubMed

Ståhl, Christian; Svensson, Tommy; Petersson, Gunilla; Ekberg, Kerstin

2010-09-01

Stakeholder cooperation in return-to-work has been increasingly emphasized over the last years. However, there is a lack of empirical studies on the subject. This study explores different public stakeholders' experiences of participating in Coordination Associations (CAs), a Swedish form of structured cooperation in return-to-work. The aim of the study is to determine the impact of stakeholder interests on the prerequisites for cooperation. Thirty-five representatives from two CAs in eastern Sweden were interviewed regarding the aim, structure and strategies for their common work. Stakeholders' actions are to a high degree determined by their institutional preferences and self-interest. In the CAs, the motives for cooperation differ, and although these differences supposedly could be overcome, they are in fact not. One of the stakeholders, the Public Employment Service, limit its interest to coordinating resources, while the other three wishes to engage in elaborated cooperative work forms, implying the crossing of organizational borders. This discrepancy can largely be attributed to the difficulties for representatives from state authorities in changing their priorities in order to make cooperation work. Stakeholders' interests have a high impact on the prerequisites for cooperation in return-to-work. By referring to organizational goals, stakeholders engage in non-cooperative behaviour, which threatens to spoil cooperative initiatives and to develop distrust in cooperative work forms. The results of this study expose the complexity of and threats to cooperation, and its conclusions may be used by return-to-work stakeholders in different jurisdictions to improve the possibilities for the development of cooperative structures.

Defining Scenarios: Linking Integrated Models, Regional Concerns, and Stakeholders

NASA Astrophysics Data System (ADS)

Hartmann, H. C.; Stewart, S.; Liu, Y.; Mahmoud, M.

2007-05-01

Scenarios are important tools for long-term planning, and there is great interest in using integrated models in scenario studies. However, scenario definition and assessment are creative, as well as scientific, efforts. Using facilitated creative processes, we have worked with stakeholders to define regionally significant scenarios that encompass a broad range of hydroclimatic, socioeconomic, and institutional dimensions. The regional scenarios subsequently inform the definition of local scenarios that work with context-specific integrated models that, individually, can address only a subset of overall regional complexity. Based on concerns of stakeholders in the semi-arid US Southwest, we prioritized three dimensions that are especially important, yet highly uncertain, for long-term planning: hydroclimatic conditions (increased variability, persistent drought), development patterns (urban consolidation, distributed rural development), and the nature of public institutions (stressed, proactive). Linking across real-world decision contexts and integrated modeling efforts poses challenges of creatively connecting the conceptual models held by both the research and stakeholder communities.

Competitive advantage in the ERP system's value-chain and its influence on future development

NASA Astrophysics Data System (ADS)

Johansson, Björn; Newman, Mike

2010-02-01

Using the resource-based view, we present a set of propositions related to enterprise resource planning (ERP) development, reflections on competitive advantage and the different roles that stakeholders play in the value-chain. This has the goal of building a foundation for future research on ERPs and how stakeholders' desire to achieve competitive advantage influence ERP development, especially when it comes to development of a more standardised or pre-customised ERP system. The propositions also act as a foundation for increasing our knowledge concerning the difficulty in developing improved ERP systems.

Differentiating innovation priorities among stakeholder in hospital care.

PubMed

Lambooij, Mattijs S; Hummel, Marjan J

2013-08-16

Decisions to adopt a particular innovation may vary between stakeholders because individual stakeholders may disagree on the costs and benefits involved. This may translate to disagreement between stakeholders on priorities in the implementation process, possibly explaining the slow diffusion of innovations in health care. In this study, we explore the differences in stakeholder preferences for innovations, and quantify the difference in stakeholder priorities regarding costs and benefits. The decision support technique called the analytic hierarchy process was used to quantify the preferences of stakeholders for nine information technology (IT) innovations in hospital care. The selection of the innovations was based on a literature review and expert judgments. Decision criteria related to the costs and benefits of the innovations were defined. These criteria were improvement in efficiency, health gains, satisfaction with care process, and investments required. Stakeholders judged the importance of the decision criteria and subsequently prioritized the selected IT innovations according to their expectations of how well the innovations would perform for these decision criteria. The stakeholder groups (patients, nurses, physicians, managers, health care insurers, and policy makers) had different preference structures for the innovations selected. For instance, self-tests were one of the innovations most preferred by health care insurers and managers, owing to their expected positive impacts on efficiency and health gains. However, physicians, nurses and patients strongly doubted the health gains of self-tests, and accordingly ranked self-tests as the least-preferred innovation. The various stakeholder groups had different expectations of the value of the nine IT innovations. The differences are likely due to perceived stakeholder benefits of each innovation, and less to the costs to individual stakeholder groups. This study provides a first exploratory quantitative insight into stakeholder positions concerning innovation in health care, and presents a novel way to study differences in stakeholder preferences. The results may be taken into account by decision makers involved in the implementation of innovations.

Differentiating innovation priorities among stakeholder in hospital care

PubMed Central

2013-01-01

Background Decisions to adopt a particular innovation may vary between stakeholders because individual stakeholders may disagree on the costs and benefits involved. This may translate to disagreement between stakeholders on priorities in the implementation process, possibly explaining the slow diffusion of innovations in health care. In this study, we explore the differences in stakeholder preferences for innovations, and quantify the difference in stakeholder priorities regarding costs and benefits. Methods The decision support technique called the analytic hierarchy process was used to quantify the preferences of stakeholders for nine information technology (IT) innovations in hospital care. The selection of the innovations was based on a literature review and expert judgments. Decision criteria related to the costs and benefits of the innovations were defined. These criteria were improvement in efficiency, health gains, satisfaction with care process, and investments required. Stakeholders judged the importance of the decision criteria and subsequently prioritized the selected IT innovations according to their expectations of how well the innovations would perform for these decision criteria. Results The stakeholder groups (patients, nurses, physicians, managers, health care insurers, and policy makers) had different preference structures for the innovations selected. For instance, self-tests were one of the innovations most preferred by health care insurers and managers, owing to their expected positive impacts on efficiency and health gains. However, physicians, nurses and patients strongly doubted the health gains of self-tests, and accordingly ranked self-tests as the least-preferred innovation. Conclusions The various stakeholder groups had different expectations of the value of the nine IT innovations. The differences are likely due to perceived stakeholder benefits of each innovation, and less to the costs to individual stakeholder groups. This study provides a first exploratory quantitative insight into stakeholder positions concerning innovation in health care, and presents a novel way to study differences in stakeholder preferences. The results may be taken into account by decision makers involved in the implementation of innovations. PMID:23947398

A Second Opinion: A Case Narrative on Clinical Ethics Mediation.

PubMed

Weinstein, Michael S

2015-01-01

Contrasting traditional and common forms if ethics consultation with bioethics mediation. I describe the case of a "second opinion" consultation in the care of a patient with advanced cancer for whom treatment was futile. While the initial ethics consultation, performed by a colleague, let to a recommendation that some may deem ethical, the process failed to involve key stakeholders and failed to explore the underlying values and reasons for the opinions voiced by various stakeholders. The process of mediation ultimately led to creative solutions in which all stakeholders could reach consensus on a plan of care.

Using workshops to develop theories of change in five low and middle income countries: lessons from the programme for improving mental health care (PRIME)

PubMed Central

2014-01-01

Background The Theory of Change (ToC) approach has been used to develop and evaluate complex health initiatives in a participatory way in high income countries. Little is known about its use to develop mental health care plans in low and middle income countries where mental health services remain inadequate. Aims ToC workshops were held as part of formative phase of the Programme for Improving Mental Health Care (PRIME) in order 1) to develop a structured logical and evidence-based ToC map as a basis for a mental health care plan in each district; (2) to contextualise the plans; and (3) to obtain stakeholder buy-in in Ethiopia, India, Nepal, South Africa and Uganda. This study describes the structure and facilitator’s experiences of ToC workshops. Methods The facilitators of the ToC workshops were interviewed and the interviews were recorded, transcribed and analysed together with process documentation from the workshops using a framework analysis approach. Results Thirteen workshops were held in the five PRIME countries at different levels of the health system. The ToC workshops achieved their stated goals with the contributions of different stakeholders. District health planners, mental health specialists, and researchers contributed the most to the development of the ToC while service providers provided detailed contextual information. Buy-in was achieved from all stakeholders but valued more from those in control of resources. Conclusions ToC workshops are a useful approach for developing ToCs as a basis for mental health care plans because they facilitate logical, evidence based and contextualised plans, while promoting stakeholder buy in. Because of the existing hierarchies within some health systems, strategies such as limiting the types of participants and stratifying the workshops can be used to ensure productive workshops. PMID:24808923

Building Adaptive Capacity with the Delphi Method and Mediated Modeling for Water Quality and Climate Change Adaptation in Lake Champlain Basin

NASA Astrophysics Data System (ADS)

Coleman, S.; Hurley, S.; Koliba, C.; Zia, A.; Exler, S.

2014-12-01

Eutrophication and nutrient pollution of surface waters occur within complex governance, social, hydrologic and biophysical basin contexts. The pervasive and perennial nutrient pollution in Lake Champlain Basin, despite decades of efforts, exemplifies problems found across the world's surface waters. Stakeholders with diverse values, interests, and forms of explicit and tacit knowledge determine water quality impacts through land use, agricultural and water resource decisions. Uncertainty, ambiguity and dynamic feedback further complicate the ability to promote the continual provision of water quality and ecosystem services. Adaptive management of water resources and land use requires mechanisms to allow for learning and integration of new information over time. The transdisciplinary Research on Adaptation to Climate Change (RACC) team is working to build regional adaptive capacity in Lake Champlain Basin while studying and integrating governance, land use, hydrological, and biophysical systems to evaluate implications for adaptive management. The RACC team has engaged stakeholders through mediated modeling workshops, online forums, surveys, focus groups and interviews. In March 2014, CSS2CC.org, an interactive online forum to source and identify adaptive interventions from a group of stakeholders across sectors was launched. The forum, based on the Delphi Method, brings forward the collective wisdom of stakeholders and experts to identify potential interventions and governance designs in response to scientific uncertainty and ambiguity surrounding the effectiveness of any strategy, climate change impacts, and the social and natural systems governing water quality and eutrophication. A Mediated Modeling Workshop followed the forum in May 2014, where participants refined and identified plausible interventions under different governance, policy and resource scenarios. Results from the online forum and workshop can identify emerging consensus across scales and sectors and be simulated in adaptation scenarios within integrated models. Comparing interventions and scenarios to existing and planned policy and governance systems in Lake Champlain Basin allows for new feedback to build adaptive capacity to identify key leverage points in the coupled natural and human system.

Transforming Conflict into Effective Action: A Case Study on the Effects of Anthropogenic Sound on Marine Mammals

NASA Astrophysics Data System (ADS)

Lewandowski, Jill K.

Like many wicked environmental problems of our time, marine sound and its potential effects on marine mammals is characterized by high levels of scientific uncertainty, diversified values across many stakeholder groups, political and regulatory complexities, and a continually evolving ecological and social environment. Further, the history of conflict and the relationships between major actors has rooted the issue firmly in identity conflict where prejudices lead to avoidance of working together. What results is continuing controversy, failed management decisions, litigation and an increasing frustration by all parties on why a better solution cannot be found. Ultimately, the intractability of the issue is not about the science, nor will the science ever tame the issue on its own. Rather, the issue is intractable because of the conflict between people about the most appropriate path forward. It is then imperative to understand, address, and transform this conflict in order to move off the decision carousel toward improved conservation outcomes and sustainable decisions for all. This research used an explanatory case study approach to quantitatively and qualitatively investigate the context and reasoning underlying conflict on this issue. Three methods were used in order to triangulate the data, and thus add rigor, including: (1) a document review of 230 publications: (2) exploratory interviews with 10 collaborative action experts and semi-structured interviews with 58 marine mammals and sound stakeholders; and (3) participant review of selected analyses. Data elucidate how different stakeholder groups define the problem and potential solutions, how they see their role and view the role of other stakeholders, specific experiences that increased or decrease conflict, and design preferences for a collaborative effort. These data are combined with conflict transformation principles to provide recommendations for a collaborative, transformative framework designed to help build capacity for groups to work together and ultimately tame this wicked issue.

Personality Testing and Workplace Training: Exploring Stakeholders, Products and Purpose in Western Europe

ERIC Educational Resources Information Center

Lundgren, Henriette; Kroon, Brigitte; Poell, Rob F.

2017-01-01

Purpose: The purpose of this paper is to explore how and why personality tests are used in workplace training. This research paper is guided by three research questions that inquire about the role of external and internal stakeholders, the value of psychometric and practical considerations in test selection, and the purpose of personality test use…

Valued and Performed or Not? Teachers' Ratings of Transition Activities for Young Children with Learning Disability

ERIC Educational Resources Information Center

Lillvist, Anne; Wilder, Jenny

2017-01-01

Stakeholder collaboration has been identified as a facilitator for positive transition outcomes for all children, and especially for children in need of special support. However, the type and extent of stakeholder collaboration have shown to be related to teachers' view of their transition practises. Thus, this study set out to examine the…

Eco-efficiency improvements in industrial water-service systems: assessing options with stakeholders.

PubMed

Levidow, Les; Lindgaard-Jørgensen, Palle; Nilsson, Asa; Skenhall, Sara Alongi; Assimacopoulos, Dionysis

2014-01-01

The well-known eco-efficiency concept helps to assess the economic value and resource burdens of potential improvements by comparison with the baseline situation. But eco-efficiency assessments have generally focused on a specific site, while neglecting wider effects, for example, through interactions between water users and wastewater treatment (WWT) providers. To address the methodological gap, the EcoWater project has developed a method and online tools for meso-level analysis of the entire water-service value chain. This study investigated improvement options in two large manufacturing companies which have significant potential for eco-efficiency gains. They have been considering investment in extra processes which can lower resource burdens from inputs and wastewater, as well as internalising WWT processes. In developing its methodology, the EcoWater project obtained the necessary information from many agents, involved them in the meso-level assessment and facilitated their discussion on alternative options. Prior discussions with stakeholders stimulated their attendance at a workshop to discuss a comparative eco-efficiency assessment for whole-system improvement. Stakeholders expressed interest in jointly extending the EcoWater method to more options and in discussing investment strategies. In such ways, optimal solutions will depend on stakeholders overcoming fragmentation by sharing responsibility and knowledge.

Reducing the Burden of Suicide in the U.S

PubMed Central

Claassen, Cynthia A.; Pearson, Jane L.; Khodyakov, Dmitry; Satow, Phillip M.; Gebbia, Robert; Berman, Alan L.; Reidenberg, Daniel J.; Feldman, Saul; Molock, Sherry; Carras, Michelle C.; Lento, René M.; Sherrill, Joel; Pringle, Beverly; Dalal, Siddhartha; Insel, Thomas R.

2017-01-01

Background The National Action Alliance for Suicide Prevention Research Prioritization Task Force (RPTF) has created a prioritized national research agenda with the potential to rapidly and substantially reduce the suicide burden in the U.S. if fully funded and implemented. Purpose Viable, sustainable scientific research agendas addressing challenging public health issues such as suicide often need to incorporate perspectives from multiple stakeholder groups (e.g., researchers, policymakers, and other end-users of new knowledge) during an agenda-setting process. The Stakeholder Survey was a web-based survey conducted and analyzed in 2011–2012 to inform the goal-setting step in the RPTF agenda development process. The survey process, and the final list of “aspirational” research goals it produced, are presented here. Methods Using a modified Delphi process, diverse constituent groups generated and evaluated candidate research goals addressing pressing suicide prevention research needs. Results A total of 716 respondents representing 49 U.S. states and 18 foreign countries provided input that ultimately produced 12 overarching, research-informed aspirational goals aimed at reducing the U.S. suicide burden. Highest-rated goals addressed prevention of subsequent suicidal behavior after an initial attempt, strategies to retain patients in care, improved healthcare provider training, and generating care models that would ensure accessible treatment. Conclusions The Stakeholder Survey yielded widely valued research targets. Findings were diverse in focus, type, and current phase of research development but tended to prioritize practical solutions over theoretical advancement. Other complex public health problems requiring input from a broad-based constituency might benefit from web-based tools that facilitate such community input. PMID:24750971

The perceived value of using BIM for energy simulation

NASA Astrophysics Data System (ADS)

Lewis, Anderson M.

Building Information Modeling (BIM) is becoming an increasingly important tool in the Architectural, Engineering & Construction (AEC) industries. Some of the benefits associated with BIM include but are not limited to cost and time savings through greater trade and design coordination, and more accurate estimating take-offs. BIM is a virtual 3D, parametric design software that allows users to store information of a model within and can be used as a communication platform between project stakeholders. Likewise, energy simulation is an integral tool for predicting and optimizing a building's performance during design. Creating energy models and running energy simulations can be a time consuming activity due to the large number of parameters and assumptions that must be addressed to achieve reasonably accurate results. However, leveraging information imbedded within Building Information Models (BIMs) has the potential to increase accuracy and reduce the amount of time required to run energy simulations and can facilitate continuous energy simulations throughout the design process, thus optimizing building performance. Although some literature exists on how design stakeholders perceive the benefits associated with leveraging BIM for energy simulation, little is known about how perceptions associated with leveraging BIM for energy simulation differ between various green design stakeholder user groups. Through an e-survey instrument, this study seeks to determine how perceptions of using BIMs to inform energy simulation differ among distinct design stakeholder groups, which include BIM-only users, energy simulation-only users and BIM and energy simulation users. Additionally, this study seeks to determine what design stakeholders perceive as the main barriers and benefits of implementing BIM-based energy simulation. Results from this study suggest that little to no correlation exists between green design stakeholders' perceptions of the value associated with using information from BIMs to inform energy simulation and their engagement level with BIM and/or energy simulation. However, green design stakeholder perceptions of the value associated with using information from BIMs to inform energy simulation and their engagement with BIM and/or energy simulation may differ between different user groups (i.e. BIM users only, energy simulation users only, and BIM and energy simulation users). For example, the BIM-only user groups appeared to have a strong positive correlation between the perceptions of the value associated with using information from BIMs to inform energy simulation and their engagement with BIM. Additionally, this study suggests that the top perceived benefits of using BIMs to inform energy simulations among green design stakeholders are: facilitation of communication, reducing of process related costs, and giving users the ability examine more design options. The main perceived barrier of using BIMs to inform energy simulations among green design stakeholders was a lack of BIM standards for model integration with multidisciplinary teams. Results from this study will help readers understand how to better implement BIM-based energy simulation while mitigating barriers and optimizing benefits. Additionally, examining discrepancies between user groups can lead the identification and improvement of shortfalls in current BIM-based energy simulation processes. Understanding how perceptions and engagement levels differ among different software user groups will help in developing a strategies for implementing BIM-based energy simulation that are tailored to each specific user group.

Documentation Driven Development for Complex Real-Time Systems

DTIC Science & Technology

2004-12-01

This paper presents a novel approach for development of complex real - time systems , called the documentation-driven development (DDD) approach. This... time systems . DDD will also support automated software generation based on a computational model and some relevant techniques. DDD includes two main...stakeholders to be easily involved in development processes and, therefore, significantly improve the agility of software development for complex real

Team Science, Justice, and the Co-Production of Knowledge.

PubMed

Tebes, Jacob Kraemer

2018-06-08

Science increasingly consists of interdisciplinary team-based research to address complex social, biomedical, public health, and global challenges through a practice known as team science. In this article, I discuss the added value of team science, including participatory team science, for generating scientific knowledge. Participatory team science involves the inclusion of public stakeholders on science teams as co-producers of knowledge. I also discuss how constructivism offers a common philosophical foundation for both community psychology and team science, and how this foundation aligns well with contemporary developments in science that emphasize the co-production of knowledge. I conclude with a discussion of how the co-production of knowledge in team science can promote justice. © Society for Community Research and Action 2018.

'What the patient wants': an investigation of the methods of ascertaining patient values in evidence-based medicine and values-based practice.

PubMed

Wieten, Sarah

2018-02-01

Evidence-Based Medicine (EBM), Values-Based Practice (VBP) and Person-Centered Healthcare (PCH) are all concerned with the values in play in the clinical encounter. However, these recent movements are not in agreement about how to discover these relevant values. In some parts of EBM textbooks, the prescribed method for discovering values is through social science research on the average values in a particular population. VBP by contrast always investigates the individually held values of the different stakeholders in the particular clinical encounter, although the account has some other difficulties. I argue that although average values for populations might be very useful in informing questions of resource distribution and policy making, their use cannot replace the individual solicitation of patient (and other stakeholder) values in the clinical encounter. Because of the inconsistency of the EBM stance on values, the incompatibility of some versions of the EBM treatment of values with PCH, and EBM's attempt to transplant research methods from science into the realm of values, I must recommend the use of the VBP account of values discovery. © 2015 John Wiley & Sons, Ltd.

Clarity versus complexity: land-use modeling as a practical tool for decision-makers

USGS Publications Warehouse

Sohl, Terry L.; Claggett, Peter

2013-01-01

The last decade has seen a remarkable increase in the number of modeling tools available to examine future land-use and land-cover (LULC) change. Integrated modeling frameworks, agent-based models, cellular automata approaches, and other modeling techniques have substantially improved the representation of complex LULC systems, with each method using a different strategy to address complexity. However, despite the development of new and better modeling tools, the use of these tools is limited for actual planning, decision-making, or policy-making purposes. LULC modelers have become very adept at creating tools for modeling LULC change, but complicated models and lack of transparency limit their utility for decision-makers. The complicated nature of many LULC models also makes it impractical or even impossible to perform a rigorous analysis of modeling uncertainty. This paper provides a review of land-cover modeling approaches and the issues causes by the complicated nature of models, and provides suggestions to facilitate the increased use of LULC models by decision-makers and other stakeholders. The utility of LULC models themselves can be improved by 1) providing model code and documentation, 2) through the use of scenario frameworks to frame overall uncertainties, 3) improving methods for generalizing key LULC processes most important to stakeholders, and 4) adopting more rigorous standards for validating models and quantifying uncertainty. Communication with decision-makers and other stakeholders can be improved by increasing stakeholder participation in all stages of the modeling process, increasing the transparency of model structure and uncertainties, and developing user-friendly decision-support systems to bridge the link between LULC science and policy. By considering these options, LULC science will be better positioned to support decision-makers and increase real-world application of LULC modeling results.

Contrasts and synergies in different biofuel reports.

PubMed

Michalopoulos, A; Landeweerd, L; Van der Werf-Kulichova, Z; Puylaert, P G B; Osseweijer, P

2011-04-06

The societal debate on biofuels is characterised by increased complexity. This can hinder the effective governance of the field. This paper attempts a quantitative bird's eye meta-analysis of this complexity by mapping different stakeholder perspectives and expected outcomes as seen in the secondary literature on biofuels, along the lines of the People-Planet-Profit framework. Our analysis illustrates the tension between stated and actual drivers of large scale biofuel development, especially for first generation biofuels. Although environmental (Planet) aspects have dominated the biofuel debate, their overall assessment is mostly negative with regard to first generation biofuels. By contrast, economic (Profit) aspects are the only ones that are assessed positively with regard to first generation biofuels. Furthermore, positive and negative assessments of biofuel development are strongly influenced by the differences in focus between different stakeholder clusters. Stakeholders who appear generally supportive to biofuel development (industry) focus relatively more on aspects that are generally assessed as positive (Profit). By contrast, non-supportive stakeholders (NGO's) tend to focus mainly on aspects that are generally assessed as negative (Planet). Moreover, our analysis of reference lists revealed few citations of primary scientific data, and also that intergovernmental organizations produce the most influential publications in the debate. The surprising lack of listed references to scientific (primary) data reveals a need to assess in which arena the transition of scientific data towards secondary publications takes place, and how one can measure its quality. This work should be understood as a first effort to take some control over a complex and contradictory number of publications, and to allow the effective governance of the field through the identification of areas of overlapping consensus and persisting controversy, without reverting to claims on technical detail.

An Overview of Value, Perspective, and Decision Context-A Health Economics Approach: An ISPOR Special Task Force Report [2].

PubMed

Garrison, Louis P; Pauly, Mark V; Willke, Richard J; Neumann, Peter J

2018-02-01

The second section of our Special Task Force builds on the discussion of value and perspective in the previous article of the report by 1) defining a health economics approach to the concept of value in health care systems; 2) discussing the relationship of value to perspective and decision context, that is, how recently proposed value frameworks vary by the types of decisions being made and by the stakeholders involved; 3) describing the patient perspective on value because the patient is a key stakeholder, but one also wearing the hat of a health insurance purchaser; and 4) discussing how value is relevant in the market-based US system of mixed private and public insurance, and differs from its use in single-payer systems. The five recent value frameworks that motivated this report vary in the types of decisions they intend to inform, ranging from coverage, access, and pricing decisions to those defining appropriate clinical pathways and to supporting provider-clinician shared decision making. Each of these value frameworks must be evaluated in its own decision context for its own objectives. Existing guidelines for cost-effectiveness analysis emphasize the importance of clearly specifying the perspective from which the analysis is undertaken. Relevant perspectives may include, among others, 1) the health plan enrollee, 2) the patient, 3) the health plan manager, 4) the provider, 5) the technology manufacturer, 6) the specialty society, 7) government regulators, or 8) society as a whole. A valid and informative cost-effectiveness analysis could be conducted from the perspective of any of these stakeholders, depending on the decision context. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Barriers and enablers that influence sustainable interprofessional education: a literature review.

PubMed

Lawlis, Tanya Rechael; Anson, Judith; Greenfield, David

2014-07-01

The effective incorporation of interprofessional education (IPE) within health professional curricula requires the synchronised and systematic collaboration between and within the various stakeholders. Higher education institutions, as primary health education providers, have the capacity to advocate and facilitate this collaboration. However, due to the diversity of stakeholders, facilitating the pedagogical change can be challenging and complex, and brings a degree of uncertainty and resistance. This review, through an analysis of the barriers and enablers investigates the involvement of stakeholders in higher education IPE through three primary stakeholder levels: Government and Professional, Institutional and Individual. A review of eight primary databases using 21 search terms resulted in 40 papers for review. While the barriers to IPE are widely reported within the higher education IPE literature, little is documented about the enablers of IPE. Similarly, the specific identification and importance of enablers for IPE sustainability and the dual nature of some barriers and enablers have not been previously reported. An analysis of the barriers and enablers of IPE across the different stakeholder levels reveals five key "fundamental elements" critical to achieving sustainable IPE in higher education curricula.

Rules of engagement: perspectives on stakeholder engagement for genomic biobanking research in South Africa.

PubMed

Staunton, Ciara; Tindana, Paulina; Hendricks, Melany; Moodley, Keymanthri

2018-02-27

Genomic biobanking research is undergoing exponential growth in Africa raising a host of legal, ethical and social issues. Given the scientific complexity associated with genomics, there is a growing recognition globally of the importance of science translation and community engagement (CE) for this type of research, as it creates the potential to build relationships, increase trust, improve consent processes and empower local communities. Despite this level of recognition, there is a lack of empirical evidence of the practise and processes for effective CE in genomic biobanking in Africa. To begin to address this vacuum, 17 in-depth face to face interviews were conducted with South African experts in genomic biobanking research and CE to provide insight into the process, benefits and challenges of CE in South Africa. Emerging themes were analysed using a contextualised thematic approach. Several themes emerged concerning the conduct of CE in genomic biobanking research in Africa. Although the literature tends to focus on the local community in CE, respondents in this study described three different layers of stakeholder engagement: community level, peer level and high level. Community level engagement includes potential participants, community advisory boards (CAB) and field workers; peer level engagement includes researchers, biobankers and scientists, while high level engagement includes government officials, funders and policy makers. Although education of each stakeholder layer is important, education of the community layer can be most challenging, due to the complexity of the research and educational levels of stakeholders in this layer. CE is time-consuming and often requires an interdisciplinary research team approach. However careful planning of the engagement strategy, including an understanding of the differing layers of stakeholder engagement, and the specific educational needs at each layer, can help in the development of a relationship based on trust between the research team and various stakeholder groups. Since the community layer often comprises vulnerable populations in low and middle income countries (LMICs), co-development of innovative educational tools on genomic biobanking is essential. CE is clearly a component of a broader process best described as stakeholder engagement.

Participatory Planning, Monitoring and Evaluation of Multi-Stakeholder Platforms in Integrated Landscape Initiatives.

PubMed

Kusters, Koen; Buck, Louise; de Graaf, Maartje; Minang, Peter; van Oosten, Cora; Zagt, Roderick

2018-07-01

Integrated landscape initiatives typically aim to strengthen landscape governance by developing and facilitating multi-stakeholder platforms. These are institutional coordination mechanisms that enable discussions, negotiations, and joint planning between stakeholders from various sectors in a given landscape. Multi-stakeholder platforms tend to involve complex processes with diverse actors, whose objectives and focus may be subjected to periodic re-evaluation, revision or reform. In this article we propose a participatory method to aid planning, monitoring, and evaluation of such platforms, and we report on experiences from piloting the method in Ghana and Indonesia. The method is comprised of three components. The first can be used to look ahead, identifying priorities for future multi-stakeholder collaboration in the landscape. It is based on the identification of four aspirations that are common across multi-stakeholder platforms in integrated landscape initiatives. The second can be used to look inward. It focuses on the processes within an existing multi-stakeholder platform in order to identify areas for possible improvement. The third can be used to look back, identifying the main outcomes of an existing platform and comparing them to the original objectives. The three components can be implemented together or separately. They can be used to inform planning and adaptive management of the platform, as well as to demonstrate performance and inform the design of new interventions.

Interactive and Participatory Decision Support: Linking Cyberinfrastructure, Multi-Touch Interfaces, and Substantive Dialogue for Geothermal Systems

NASA Astrophysics Data System (ADS)

Malin, R.; Pierce, S. A.; Bass, B. J.

2012-12-01

Socio-technical approaches to complex, ill-structured decision problems are needed to identify adaptive responses for earth resource management. This research presents a hybrid approach to create decision tools and engender dialogue among stakeholders for geothermal development in Idaho, United States and El Tatio, Chile. Based on the scarcity of data, limited information availability, and tensions across stakeholder interests we designed and constructed a decision support model that allows stakeholders to rapidly collect, input, and visualize geoscientific data to assess geothermal system impacts and possible development strategies. We have integrated this decision support model into multi-touch interfaces that can be easily used by scientists and stakeholders alike. This toolkit is part of a larger cyberinfrastructure project designed to collect and present geoscientific information to support decision making processes. Consultation with stakeholders at the El Tatio geothermal complex of northern Chile—indigenous communities, local and national government agencies, developers, and geoscientists - informed the implementation of a sustained dialogue process. The El Tatio field case juxtaposes basic parameters such as pH, spring temperature, geochemical content, and FLIR imagery with stakeholder perceptions of risks due to mineral extraction and energy exploration efforts. The results of interviews and a participatory workshop are driving the creation of three initiatives within an indigenous community group; 1) microentrepreneurial efforts for science-based tourism, 2) design of a citizen-led environmental monitoring network in the Altiplano, and 3) business planning for an indigenous renewable energy cooperative. This toolkit is also being applied in the Snake River Plain of Idaho has as part of the DOE sponsored National Student Geothermal Competition. The Idaho case extends results from the Chilean case to implement a more streamlined system to analyze geothermal resource potential as well as integrate the decision support system with multi-touch interfaces which allow multiple stakeholders to view and interact with data. Beyond visual and tactile appeal, these interfaces also allow participants to dynamically update decision variables and decision preferences to create multiple scenarios and evaluate potential outcomes. Through this interactive scenario building, potential development sites can be targeted and stakeholders can interact with data to engage in substantive dialogue for related long-term planning or crisis response.

Cultivating a disease management partnership: a value-chain model.

PubMed

Murray, Carolyn F; Monroe, Wendy; Stalder, Sharon A

2003-01-01

Disease management (DM) is one of the health care industry's more innovative value-chain models, whereby multiple relationships are created to bring complex and time-sensitive services to market. The very nature of comprehensive, seamless DM provided through an outsourced arrangement necessitates a level of cooperation, trust, and synergy that may be lacking from more traditional vendor-customer relationships. This discussion highlights the experience of one health plan and its vendor partner and their approach to the development and delivery of an outsourced heart failure (HF) DM program. The program design and rollout are discussed within principles adapted from the theoretical framework of a value-chain model. Within the value-chain model, added value is created by the convergence and synergistic integration of the partners' discrete strengths. Although each partner brings unique attributes to the relationship, those attributes are significantly enhanced by the value-chain model, thus allowing each party to bring the added value of the relationship to their respective customers. This partnership increases innovation, leverages critical capabilities, and improves market responsiveness. Implementing a comprehensive, outsourced DM program is no small task. DM programs incorporate a broad array of services affecting nearly every department in a health plan's organization. When true seamless integration between multiple organizations with multiple stakeholders is the objective, implementation and ongoing operations can become even more complex. To effectively address the complexities presented by an HF DM program, the parties in this case moved beyond a typical purchaser-vendor relationship to one that is more closely akin to a strategic partnership. This discussion highlights the development of this partnership from the perspective of both organizations, as revealed through contracting and implementation activities. It is intended to provide insight into the program development and rollout processes that one health plan and its partner have adopted to advance a DM model that integrates appropriately within the local environment. This discussion also highlights how an organizational culture can shift from an emphasis on cost, growth, and control to an emphasis on quality, innovation, and service within a value-chain model.

Learners with Profound and Complex Needs in Scotland's Colleges

ERIC Educational Resources Information Center

Her Majesty's Inspectorate of Education, 2009

2009-01-01

The Scottish Further and Higher Education Funding Council's (SFC) Corporate Plan (2009-12) makes clear its commitment to learners with profound and complex needs. Under "Outcome 2 Access, Inclusion and Progression" it states: "we will work with the Scottish Government, colleges and other stakeholders to ensure that appropriate…

Visualizing Teacher Education as a Complex System: A Nested Simplex System Approach

ERIC Educational Resources Information Center

Ludlow, Larry; Ell, Fiona; Cochran-Smith, Marilyn; Newton, Avery; Trefcer, Kaitlin; Klein, Kelsey; Grudnoff, Lexie; Haigh, Mavis; Hill, Mary F.

2017-01-01

Our purpose is to provide an exploratory statistical representation of initial teacher education as a complex system comprised of dynamic influential elements. More precisely, we reveal what the system looks like for differently-positioned teacher education stakeholders based on our framework for gathering, statistically analyzing, and graphically…

Researchers and stakeholders shape advances in management of tree and vine trunk-disease complexes

USDA-ARS?s Scientific Manuscript database

The grapevine trunk-disease complex limits grape production and vineyard longevity worldwide. Every vineyard in California eventually is infected by one or more trunk diseases. The causal fungi, which are taxonomically unrelated Ascomycetes, infect and then degrade the permanent woody structure of t...

Communities of Practice: A New Approach to Solving Complex Educational Problems

ERIC Educational Resources Information Center

Cashman, J.; Linehan, P.; Rosser, M.

2007-01-01

Communities of Practice offer state agency personnel a promising approach for engaging stakeholder groups in collaboratively solving complex and, often, persistent problems in special education. Communities of Practice can help state agency personnel drive strategy, solve problems, promote the spread of best practices, develop members'…

Performance Measures for Evaluating Public Participation Activities in the Office of Environmental Management (DOE)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Carnes, S.A.

2001-02-15

Public participation in Office of Environmental Management (EM) activities throughout the DOE complex is a critical component of the overall success of remediation and waste management efforts. The challenges facing EM and its stakeholders over the next decade or more are daunting (Nuclear Waste News 1996). Achieving a mission composed of such challenges will require innovation, dedication, and a significant degree of good will among all stakeholders. EM's efforts to date, including obtaining and using inputs offered by EM stakeholders, have been notable. Public participation specialists have accepted and met challenges and have consistently tried to improve their performance. Theymore » have reported their experiences both formally and informally (e.g., at professional conferences and EM Public Participation Network Workshops, other internal meetings of DOE and contractor public participation specialists, and one-on-one consultations) in order to advance the state of their practice. Our research, and our field research in particular (including our interactions with many representatives of numerous stakeholder groups at nine DOE sites with diverse EM problems), have shown that it, is possible to develop coherent results even in a problem domain as complex as that of EM. We conclude that performance-based evaluations of public participation appear possible, and we have recommended an approach, based on combined and integrated multi-stakeholder views on the attributes of successful public participation and associated performance indicators, that seems workable and should be acceptable to diverse stakeholders. Of course, as an untested recommendation, our approach needs the validation that can only be achieved by application (perhaps at a few DOE sites with ongoing EM activities). Such an application would serve to refine the proposed approach in terms of its clarity, its workability, and its potential for full-scale use by EM and, potentially, other government agencies and private sector concerns.« less

Integrating science into management of ecosystems in the Greater Blue Mountains.

PubMed

Chapple, Rosalie S; Ramp, Daniel; Bradstock, Ross A; Kingsford, Richard T; Merson, John A; Auld, Tony D; Fleming, Peter J S; Mulley, Robert C

2011-10-01

Effective management of large protected conservation areas is challenged by political, institutional and environmental complexity and inconsistency. Knowledge generation and its uptake into management are crucial to address these challenges. We reflect on practice at the interface between science and management of the Greater Blue Mountains World Heritage Area (GBMWHA), which covers approximately 1 million hectares west of Sydney, Australia. Multiple government agencies and other stakeholders are involved in its management, and decision-making is confounded by numerous plans of management and competing values and goals, reflecting the different objectives and responsibilities of stakeholders. To highlight the complexities of the decision-making process for this large area, we draw on the outcomes of a recent collaborative research project and focus on fire regimes and wild-dog control as examples of how existing knowledge is integrated into management. The collaborative research project achieved the objectives of collating and synthesizing biological data for the region; however, transfer of the project's outcomes to management has proved problematic. Reasons attributed to this include lack of clearly defined management objectives to guide research directions and uptake, and scientific information not being made more understandable and accessible. A key role of a local bridging organisation (e.g., the Blue Mountains World Heritage Institute) in linking science and management is ensuring that research results with management significance can be effectively transmitted to agencies and that outcomes are explained for nonspecialists as well as more widely distributed. We conclude that improved links between science, policy, and management within an adaptive learning-by-doing framework for the GBMWHA would assist the usefulness and uptake of future research.

Integrating Science into Management of Ecosystems in the Greater Blue Mountains

NASA Astrophysics Data System (ADS)

Chapple, Rosalie S.; Ramp, Daniel; Bradstock, Ross A.; Kingsford, Richard T.; Merson, John A.; Auld, Tony D.; Fleming, Peter J. S.; Mulley, Robert C.

2011-10-01

Effective management of large protected conservation areas is challenged by political, institutional and environmental complexity and inconsistency. Knowledge generation and its uptake into management are crucial to address these challenges. We reflect on practice at the interface between science and management of the Greater Blue Mountains World Heritage Area (GBMWHA), which covers approximately 1 million hectares west of Sydney, Australia. Multiple government agencies and other stakeholders are involved in its management, and decision-making is confounded by numerous plans of management and competing values and goals, reflecting the different objectives and responsibilities of stakeholders. To highlight the complexities of the decision-making process for this large area, we draw on the outcomes of a recent collaborative research project and focus on fire regimes and wild-dog control as examples of how existing knowledge is integrated into management. The collaborative research project achieved the objectives of collating and synthesizing biological data for the region; however, transfer of the project's outcomes to management has proved problematic. Reasons attributed to this include lack of clearly defined management objectives to guide research directions and uptake, and scientific information not being made more understandable and accessible. A key role of a local bridging organisation (e.g., the Blue Mountains World Heritage Institute) in linking science and management is ensuring that research results with management significance can be effectively transmitted to agencies and that outcomes are explained for nonspecialists as well as more widely distributed. We conclude that improved links between science, policy, and management within an adaptive learning-by-doing framework for the GBMWHA would assist the usefulness and uptake of future research.

Design of operating rules in complex water resources systems using historical records, expert criteria and fuzzy logic

NASA Astrophysics Data System (ADS)

Pulido-Velazquez, Manuel; Macian-Sorribes, Hector; María Benlliure-Moreno, Jose; Fullana-Montoro, Juan

2015-04-01

Water resources systems in areas with a strong tradition in water use are complex to manage by the high amount of constraints that overlap in time and space, creating a complicated framework in which past, present and future collide between them. In addition, it is usual to find "hidden constraints" in system operations, which condition operation decisions being unnoticed by anyone but the river managers and users. Being aware of those hidden constraints requires usually years of experience and a degree of involvement in that system's management operations normally beyond the possibilities of technicians. However, their impact in the management decisions is strongly imprinted in the historical data records available. The purpose of this contribution is to present a methodology capable of assessing operating rules in complex water resources systems combining historical records and expert criteria. Both sources are coupled using fuzzy logic. The procedure stages are: 1) organize expert-technicians preliminary meetings to let the first explain how they manage the system; 2) set up a fuzzy rule-based system (FRB) structure according to the way the system is managed; 3) use the historical records available to estimate the inputs' fuzzy numbers, to assign preliminary output values to the FRB rules and to train and validate these rules; 4) organize expert-technician meetings to discuss the rule structure and the input's quantification, returning if required to the second stage; 5) once the FRB structure is accepted, its output values must be refined and completed with the aid of the experts by using meetings, workshops or surveys; 6) combine the FRB with a Decision Support System (DSS) to simulate the effect of those management decisions; 7) compare its results with the ones offered by the historical records and/or simulation or optimization models; and 8) discuss with the stakeholders the model performance returning, if it's required, to the fifth or the second stage. The methodology proposed has been applied to the Jucar River Basin (Spain). This basin has 3 reservoirs, 4 headwaters, 11 demands and 5 environmental flows; which form together a complex constraint set. After the preliminary meetings, one 81-rule FRB was created, using as inputs the system state variables at the start of the hydrologic year, and as outputs the target reservoir release schedule. The inputs' fuzzy numbers were estimated jointly using surveys. Fifteen years of historical records were used to train the system's outputs. The obtained FRB was then refined during additional expert-technician meetings. After that, the resulting FRB was introduced into a DSS simulating the effect of those management rules for different hydrological conditions. Three additional FRB's were created using: 1) exclusively the historical records; 2) a stochastic optimization model; and 3) a deterministic optimization model. The results proved to be consistent with the expectations, with the stakeholder's FRB performance located between the data-driven simulation and the stochastic optimization FRB's; and reflect the stakeholders' major goals and concerns about the river management. ACKNOWLEDGEMENT: This study has been partially supported by the IMPADAPT project (CGL2013-48424-C2-1-R) with Spanish MINECO (Ministerio de Economía y Competitividad) funds.

Using decision pathway surveys to inform climate engineering policy choices

PubMed Central

Gregory, Robin; Satterfield, Terre; Hasell, Ariel

2016-01-01

Over the coming decades citizens living in North America and Europe will be asked about a variety of new technological and behavioral initiatives intended to mitigate the worst impacts of climate change. A common approach to public input has been surveys whereby respondents’ attitudes about climate change are explained by individuals’ demographic background, values, and beliefs. In parallel, recent deliberative research seeks to more fully address the complex value tradeoffs linked to novel technologies and difficult ethical questions that characterize leading climate mitigation alternatives. New methods such as decision pathway surveys may offer important insights for policy makers by capturing much of the depth and reasoning of small-group deliberations while meeting standard survey goals including large-sample stakeholder engagement. Pathway surveys also can help participants to deepen their factual knowledge base and arrive at a more complete understanding of their own values as they apply to proposed policy alternatives. The pathway results indicate more fully the conditional and context-specific nature of support for several “upstream” climate interventions, including solar radiation management techniques and carbon dioxide removal technologies. PMID:26729883

Using decision pathway surveys to inform climate engineering policy choices.

PubMed

Gregory, Robin; Satterfield, Terre; Hasell, Ariel

2016-01-19

Over the coming decades citizens living in North America and Europe will be asked about a variety of new technological and behavioral initiatives intended to mitigate the worst impacts of climate change. A common approach to public input has been surveys whereby respondents' attitudes about climate change are explained by individuals' demographic background, values, and beliefs. In parallel, recent deliberative research seeks to more fully address the complex value tradeoffs linked to novel technologies and difficult ethical questions that characterize leading climate mitigation alternatives. New methods such as decision pathway surveys may offer important insights for policy makers by capturing much of the depth and reasoning of small-group deliberations while meeting standard survey goals including large-sample stakeholder engagement. Pathway surveys also can help participants to deepen their factual knowledge base and arrive at a more complete understanding of their own values as they apply to proposed policy alternatives. The pathway results indicate more fully the conditional and context-specific nature of support for several "upstream" climate interventions, including solar radiation management techniques and carbon dioxide removal technologies.

What vaccine product attributes do immunization program stakeholders value? Results from interviews in six low- and middle-income countries.

PubMed

Kristensen, Debra D; Bartholomew, Kate; Villadiego, Shirley; Lorenson, Kristina

2016-12-07

This study attempts to capture the opinions of stakeholders working in immunization programs in low- and middle-income countries to understand how vaccine products could be improved to better meet their needs and to obtain feedback on specific vaccine product attributes including the number of doses per container and ease of preparing a dose for administration. We also reviewed how procurement decisions are made within immunization programs. Semi-structured interviews were undertaken with 158 immunization stakeholders in Brazil, China, India, Peru, the Philippines, and Tanzania. Interviewees included national decision-makers and advisors involved in vaccine-purchasing decisions (n=30), national Expanded Programme on Immunization managers (n=6), and health and logistics personnel at national, subnational, and health-facility levels (n=122). Immunization stakeholders at all levels of the supply chain valued vaccine product attributes that prevent heat damage, decrease vaccine wastage, and simplify delivery. Minimizing the time required to prepare a dose is especially valued by those closest to the work of actually administering vaccines. Respondents appreciated the benefits of lower-multidose presentations on reducing wastage but seemed to prefer single-dose vials even more. They also expressed concern about the need for training and the potential for confusion and vial contamination if opened vials of liquid preservative-free vaccines are not handled properly. Procurement decision-making processes varied widely between countries, though most relied heavily on international agencies and vaccine manufacturers for information. Copyright © 2016. Published by Elsevier Ltd.

Wrestling with the complexity of evaluation for organizations at the boundary of science, policy and practice.

PubMed

Pitt, Ruth; Wyborn, Carina; Page, Glenn; Hutton, Jonathon; Virah Sawmy, Malika; Ryan, Melanie; Gallagher, Louise

2018-04-16

Boundary organizations have been promoted as a measure to improve the effectiveness of conservation efforts by building stronger relationships between scientists, policy makers, industry and practitioners (Cook et al. 2013). While their promise has been discussed in theory, the work of and expectations for boundary organizations are less defined in practice. Biodiversity conservation is characterized by complexity, uncertainty, dissent and tight budgets, so boundary organizations face the challenging task of demonstrating their value to diverse stakeholders. This paper examines the challenges that boundary organizations face when seeking to evaluate their work. While no 'off-the-shelf' solution is available for a given boundary organization, many lessons can be learned from the evaluation literature. This paper synthesizes key areas of decision making to underpin the choice of evaluation approaches, with the aim of encouraging more productive conversations about evaluation of boundary organizations and the projects they deliver. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

African stakeholders' views of research options to improve nutritional status in sub-Saharan Africa.

PubMed

Holdsworth, Michelle; Kruger, Annamarie; Nago, Eunice; Lachat, Carl; Mamiro, Peter; Smit, Karlien; Garimoi-Orach, Chris; Kameli, Yves; Roberfroid, Dominique; Kolsteren, Patrick

2015-09-01

Setting research priorities for improving nutrition in Africa is currently ad hoc and there is a need to shift the status quo in the light of slow progress in reducing malnutrition. This study explored African stakeholders' views on research priorities in the context of environmental and socio-demographic changes that will impact on nutritional status in Africa in the coming years. Using Multi-Criteria Mapping, quantitative and qualitative data were gathered from 91 stakeholders representing 6 stakeholder groups (health professionals, food Industry, government, civil society, academics and research funders) in Benin, Mozambique, South Africa, Tanzania, Togo and Uganda. Stakeholders appraised six research options (ecological nutrition, nutritional epidemiology, community nutrition interventions, behavioural nutrition, clinical nutrition and molecular nutrition) for how well they could address malnutrition in Africa. Impact (28.3%), research efficacy (23.6%) and social acceptability (22.4%) were the criteria chosen the most to evaluate the performance of research options. Research on the effectiveness of community interventions was seen as a priority by stakeholders because they were perceived as likely to have an impact relatively quickly, were inexpensive and cost-effective, involved communities and provided direct evidence of what works. Behavioural nutrition research was also highly appraised. Many stakeholders, particularly academics and government were optimistic about the value of ecological nutrition research (the impact of environmental change on nutritional status). Research funders did not share this enthusiasm. Molecular nutrition was least preferred, considered expensive, slow to have an impact and requiring infrastructure. South Africa ranked clinical and molecular nutrition the highest of all countries. Research funders should redirect research funds in Africa towards the priorities identified by giving precedence to develop the evidence for effective community nutrition interventions. Expanding research funding in behavioural and ecological nutrition was also valued and require multi-disciplinary collaborations between nutritionists, social scientists, agricultural and climate change scientists. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre.

PubMed

Stergiopoulos, Vicky; Saab, Dima; Francombe Pridham, Kate; Aery, Anjana; Nakhost, Arash

2018-01-24

Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto's local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation. We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis. Findings revealed wide-ranging endorsement for the two team-based models' success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions. Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.

Social Networks and Community-Based Natural Resource Management

NASA Astrophysics Data System (ADS)

Lauber, T. Bruce; Decker, Daniel J.; Knuth, Barbara A.

2008-10-01

We conducted case studies of three successful examples of collaborative, community-based natural resource conservation and development. Our purpose was to: (1) identify the functions served by interactions within the social networks of involved stakeholders; (2) describe key structural properties of these social networks; and (3) determine how these structural properties varied when the networks were serving different functions. The case studies relied on semi-structured, in-depth interviews of 8 to 11 key stakeholders at each site who had played a significant role in the collaborative projects. Interview questions focused on the roles played by key stakeholders and the functions of interactions between them. Interactions allowed the exchange of ideas, provided access to funding, and enabled some stakeholders to influence others. The exchange of ideas involved the largest number of stakeholders, the highest percentage of local stakeholders, and the highest density of interactions. Our findings demonstrated the value of tailoring strategies for involving stakeholders to meet different needs during a collaborative, community-based natural resource management project. Widespread involvement of local stakeholders may be most appropriate when ideas for a project are being developed. During efforts to exert influence to secure project approvals or funding, however, involving specific individuals with political connections or influence on possible sources of funds may be critical. Our findings are consistent with past work that has postulated that social networks may require specific characteristics to meet different needs in community-based environmental management.

Promoting the Appropriate Use of Advanced Radiation Technologies in Oncology: Summary of a National Cancer Policy Forum Workshop.

PubMed

Smith, Grace L; Ganz, Patricia A; Bekelman, Justin E; Chmura, Steven J; Dignam, James J; Efstathiou, Jason A; Jagsi, Reshma; Johnstone, Peter A; Steinberg, Michael L; Williams, Stephen B; Yu, James B; Zietman, Anthony L; Weichselbaum, Ralph R; Tina Shih, Ya-Chen

2017-03-01

Leaders in the oncology community are sounding a clarion call to promote "value" in cancer care decisions. Value in cancer care considers the clinical effectiveness, along with the costs, when selecting a treatment. To discuss possible solutions to the current obstacles to achieving value in the use of advanced technologies in oncology, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a workshop, "Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology" in July 2015. The present report summarizes the discussions related to radiation oncology. The workshop convened stakeholders, including oncologists, researchers, payers, policymakers, and patients. Speakers presented on key themes, including the rationale for a value discussion on advanced technology use in radiation oncology, the generation of scientific evidence for value of advanced radiation technologies, the effect of both scientific evidence and "marketplace" (or economic) factors on the adoption of technologies, and newer approaches to improving value in the practice of radiation oncology. The presentations were followed by a panel discussion with dialogue among the stakeholders. Challenges to generating evidence for the value of advanced technologies include obtaining contemporary, prospective, randomized, and representative comparative effectiveness data. Proposed solutions include the use of prospective registry data; integrating radiation oncology treatment, outcomes, and quality benchmark data; and encouraging insurance coverage with evidence development. Challenges to improving value in practice include the slow adoption of higher value and the de-adoption of lower value treatments. The proposed solutions focused on engaging stakeholders in iterative, collaborative, and evidence-based efforts to define value and promote change in radiation oncology practice. Recent examples of ongoing or successful responses to the discussed challenges were provided. Discussions of "value" have increased as a priority in the radiation oncology community. Practitioners in the radiation oncology community can play a critical role in promoting a value-oriented framework to approach radiation oncology treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Key stakeholders' perceptions of the acceptability and usefulness of a tablet-based tool to improve communication and shared decision making in ICUs.

PubMed

Ernecoff, Natalie C; Witteman, Holly O; Chon, Kristen; Chen, Yanquan Iris; Buddadhumaruk, Praewpannarai; Chiarchiaro, Jared; Shotsberger, Kaitlin J; Shields, Anne-Marie; Myers, Brad A; Hough, Catherine L; Carson, Shannon S; Lo, Bernard; Matthay, Michael A; Anderson, Wendy G; Peterson, Michael W; Steingrub, Jay S; Arnold, Robert M; White, Douglas B

2016-06-01

Although barriers to shared decision making in intensive care units are well documented, there are currently no easily scaled interventions to overcome these problems. We sought to assess stakeholders' perceptions of the acceptability, usefulness, and design suggestions for a tablet-based tool to support communication and shared decision making in ICUs. We conducted in-depth semi-structured interviews with 58 key stakeholders (30 surrogates and 28 ICU care providers). Interviews explored stakeholders' perceptions about the acceptability of a tablet-based tool to support communication and shared decision making, including the usefulness of modules focused on orienting families to the ICU, educating them about the surrogate's role, completing a question prompt list, eliciting patient values, educating about treatment options, eliciting perceptions about prognosis, and providing psychosocial support resources. The interviewer also elicited stakeholders' design suggestions for such a tool. We used constant comparative methods to identify key themes that arose during the interviews. Overall, 95% (55/58) of participants perceived the proposed tool to be acceptable, with 98% (57/58) of interviewees finding six or more of the seven content domains acceptable. Stakeholders identified several potential benefits of the tool including that it would help families prepare for the surrogate role and for family meetings as well as give surrogates time and a framework to think about the patient's values and treatment options. Key design suggestions included: conceptualize the tool as a supplement to rather than a substitute for surrogate-clinician communication; make the tool flexible with respect to how, where, and when surrogates can access the tool; incorporate interactive exercises; use video and narration to minimize the cognitive load of the intervention; and build an extremely simple user interface to maximize usefulness for individuals with low computer literacy. There is broad support among stakeholders for the use of a tablet-based tool to improve communication and shared decision making in ICUs. Eliciting the perspectives of key stakeholders early in the design process yielded important insights to create a tool tailored to the needs of surrogates and care providers in ICUs. Copyright © 2016 Elsevier Inc. All rights reserved.

Principles for consistent value assessment and sustainable funding of orphan drugs in Europe.

PubMed

Gutierrez, Laura; Patris, Julien; Hutchings, Adam; Cowell, Warren

2015-05-03

The European Orphan Medicinal Products (OMP) Regulation has successfully encouraged research to develop treatments for rare diseases resulting in the authorisation of new OMPs in Europe. While decisions on OMP designation and marketing authorisation are made at the European Union level, reimbursement decisions are made at the national level. OMP value and affordability are high priority issues for policymakers and decisions regarding their pricing and funding are highly complex. There is currently no European consensus on how OMP value should be assessed and inequalities of access to OMPs have previously been observed. Against this background, policy makers in many countries are considering reforms to improve access to OMPs. This paper proposes ten principles to be considered when undertaking such reforms, from the perspective of an OMP manufacturer. We recommend the continued prioritisation of rare diseases by policymakers, an increased alignment between payer and regulatory frameworks, pricing centred on OMP value, and mechanisms to ensure long-term financial sustainability allowing a continuous and virtuous development of OMPs. Our recommendations support the development of more consistent frameworks and encourage collaboration between all stakeholders, including research-based industry, payers, clinicians, and patients.

OysterFutures: Integrating Stakeholder Objectives with Natural System Models to Promote Sustainable Natural Resource Policy

NASA Astrophysics Data System (ADS)

North, E. W.; Blair, J.; Cornwell, J. C.; Freitag, A. E.; Gawde, R. K.; Hartley, T. W.; Hood, R. R.; Jones, R. M.; Miller, T. J.; Thomas, J. E.; Wainger, L. A.; Wilberg, M. J.

2016-02-01

Achieving effective natural resource management is challenged by multiple and often competing objectives, a restricted set of policy options, and uncertainty in the performance of those options. Yet, managers need policies that allow continued use of natural resources while ensuring access for future generations and maintenance of ecosystem services. Formal approaches are needed that will assist managers and stakeholders in choosing policy options that have a high likelihood of achieving social, ecological, and economic goals. The goal of this project, OysterFutures, is to address this need by improving the use of predictive models to support sustainable natural resource policy and management. A stakeholder-centered process will be used to build an integrated model that combines estuarine physics, oyster life history, and the ecosystem services that oysters provide (e.g., harvest, water quality) to forecast outcomes under alternative management strategies. Through a series of facilitated meetings, stakeholders will participate in a science-based collaborative process which will allow them to project how well policies are expected to meet their objectives using the integrated model. This iterative process will ensure that the model will incorporate the complex human uses of the ecosystem as well as focus on the outcomes most important to the stakeholders. In addition, a study of the socioeconomic drivers of stakeholder involvement, information flow, use and influence, and policy formation will be undertaken to improve the process, enhance implementation success of recommended policies, and provide new ideas for integrating natural and social sciences, and scientists, in sustainable resource management. In this presentation, the strategy for integrating natural system models, stakeholder views, and sociological studies as well as methods for selecting stakeholders and facilitating stakeholder meetings will be described and discussed.

Forms of benefit sharing in global health research undertaken in resource poor settings: a qualitative study of stakeholders' views in Kenya.

PubMed

Lairumbi, Geoffrey M; Parker, Michael; Fitzpatrick, Raymond; English, Michael C

2012-01-17

Increase in global health research undertaken in resource poor settings in the last decade though a positive development has raised ethical concerns relating to potential for exploitation. Some of the suggested strategies to address these concerns include calls for providing universal standards of care, reasonable availability of proven interventions and more recently, promoting the overall social value of research especially in clinical research. Promoting the social value of research has been closely associated with providing fair benefits to various stakeholders involved in research. The debate over what constitutes fair benefits; whether those that addresses micro level issues of justice or those focusing on the key determinants of health at the macro level has continued. This debate has however not benefited from empirical work on what stakeholders consider fair benefits. This study explores practical experiences of stakeholders involved in global health research in Kenya, over what benefits are fair within a developing world context. We conducted in-depth interviews with key informants drawn from within the broader health research system in Kenya including researchers from the mainstream health research institutions, networks and universities, teaching hospitals, policy makers, institutional review boards, civil society organisations and community representative groups.The range of benefits articulated by stakeholders addresses both micro and macro level concerns for justice by for instance, seeking to engage with interests of those facilitating research, and the broader systemic issues that make resource poor settings vulnerable to exploitation. We interpret these views to suggest a need for global health research to engage with current crises that face people in these settings as well as the broader systemic issues that produce them. Global health research should provide benefits that address both the micro and macro level issues of justice in order to forestall exploitation. Embracing the two is however challenging in terms of how the various competing interests/needs should be balanced ethically, especially in the absence of structures to guide the process. This challenge should point to the need for greater dialogue to facilitate value clarification among stakeholders.

VASSAR: Value assessment of system architectures using rules

NASA Astrophysics Data System (ADS)

Selva, D.; Crawley, E. F.

A key step of the mission development process is the selection of a system architecture, i.e., the layout of the major high-level system design decisions. This step typically involves the identification of a set of candidate architectures and a cost-benefit analysis to compare them. Computational tools have been used in the past to bring rigor and consistency into this process. These tools can automatically generate architectures by enumerating different combinations of decisions and options. They can also evaluate these architectures by applying cost models and simplified performance models. Current performance models are purely quantitative tools that are best fit for the evaluation of the technical performance of mission design. However, assessing the relative merit of a system architecture is a much more holistic task than evaluating performance of a mission design. Indeed, the merit of a system architecture comes from satisfying a variety of stakeholder needs, some of which are easy to quantify, and some of which are harder to quantify (e.g., elegance, scientific value, political robustness, flexibility). Moreover, assessing the merit of a system architecture at these very early stages of design often requires dealing with a mix of: a) quantitative and semi-qualitative data; objective and subjective information. Current computational tools are poorly suited for these purposes. In this paper, we propose a general methodology that can used to assess the relative merit of several candidate system architectures under the presence of objective, subjective, quantitative, and qualitative stakeholder needs. The methodology called VASSAR (Value ASsessment for System Architectures using Rules). The major underlying assumption of the VASSAR methodology is that the merit of a system architecture can assessed by comparing the capabilities of the architecture with the stakeholder requirements. Hence for example, a candidate architecture that fully satisfies all critical sta- eholder requirements is a good architecture. The assessment process is thus fundamentally seen as a pattern matching process where capabilities match requirements, which motivates the use of rule-based expert systems (RBES). This paper describes the VASSAR methodology and shows how it can be applied to a large complex space system, namely an Earth observation satellite system. Companion papers show its applicability to the NASA space communications and navigation program and the joint NOAA-DoD NPOESS program.

Recruitment of multiple stakeholders to health services research: lessons from the front lines.

PubMed

Kho, Michelle E; Rawski, Ellen; Makarski, Julie; Brouwers, Melissa C

2010-05-13

Self-administered surveys are an essential methodological tool for health services and knowledge translation research, and engaging end-users of the research is critical. However, few documented accounts of the efforts invested in recruitment of multiple different stakeholders to one health services research study exist. Here, we highlight the challenges of recruiting key stakeholders (policy-makers, clinicians, guideline developers) to a Canadian Institutes of Health Research (CIHR) funded health services research (HSR) study aimed to develop an updated and refined version of a guideline appraisal tool, the AGREE. Using evidence-based methods of recruitment, our goal was to recruit 192 individuals: 80 international guideline developers, 80 Canadian clinicians and 32 Canadian policy/decision-makers. We calculated the participation rate and the recruitment efficiency. We mailed 873 invitation letters. Of 838 approached, our participation rate was 29%(240) and recruitment efficiency, 19%(156). One policy-maker manager did not allow policy staff to participate in the study. Based on the results from this study, we suggest that future studies aiming to engage similar stakeholders in HSR over sample by at least 5 times to achieve their target sample size and allow for participant withdrawals. We need continued efforts to communicate the value of research between researchers and end-users of research (policy-makers, clinicians, and other researchers), integration of participatory research strategies, and promotion of the value of end-user involvement in research. Future research to understand methods of improving recruitment efficiency and engaging key stakeholders in HSR is warranted.

Researchers', Regulators', and Sponsors' Views on Pediatric Clinical Trials: A Multinational Study.

PubMed

Joseph, Pathma D; Craig, Jonathan C; Tong, Allison; Caldwell, Patrina H Y

2016-10-01

The last decade has seen dramatic changes in the regulatory landscape to support more trials involving children, but child-specific challenges and inequitable conduct across income regions persist. The goal of this study was to describe the attitudes and opinions of stakeholders toward trials in children, to inform additional strategies to promote more high-quality, relevant pediatric trials across the globe. Key informant semi-structured interviews were conducted with stakeholders (researchers, regulators, and sponsors) who were purposively sampled from low- to middle-income countries and high-income countries. The transcripts were thematically analyzed. Thirty-five stakeholders from 10 countries were interviewed. Five major themes were identified: addressing pervasive inequities (paucity of safety and efficacy data, knowledge disparities, volatile environment, double standards, contextual relevance, market-driven forces, industry sponsorship bias and prohibitive costs); contending with infrastructural barriers (resource constraints, dearth of pediatric trial expertise, and logistical complexities); navigating complex ethical and regulatory frameworks ("draconian" oversight, ambiguous requirements, exploitation, excessive paternalism and precariousness of coercion versus volunteerism); respecting uniqueness of children (pediatric research paradigms, child-appropriate approaches, and family-centered empowerment); and driving evidence-based child health (advocacy, opportunities, treatment access, best practices, and research prioritization). Stakeholders acknowledge that changes in the regulatory environment have encouraged more trials in children, but they contend that inequities and political, regulatory, and resource barriers continue to exist. Embedding trials as part of routine clinical care, addressing the unique needs of children, and streamlining regulatory approvals were suggested. Stakeholders recommended increasing international collaboration, establishing centralized trials infrastructure, and aligning research to child health priorities to encourage trials that address global child health care needs. Copyright © 2016 by the American Academy of Pediatrics.

Arsenic mitigation in Bangladesh: an analysis of institutional stakeholders' opinions.

PubMed

Khan, Nasreen Islam; Yang, Hong

2014-08-01

While Bangladesh made significant achievements in safe water coverage via installation of shallow tubewells (STWs) nationwide, this success was shattered by the discovery of arsenic (As) in the STWs. The extent and severity of As groundwater contamination throughout Bangladesh and its detrimental effects on human health are well known and demand long-term sustainable mitigation. It is an immensely complex and expensive task to bring tens of millions of arsenic exposed people under safe water coverage. While various mitigation measures have been undertaken by various organizations, most have not achieved their expected outcomes due to technical, spatial and socio-economic challenges. Better understanding of these challenges by institutional stakeholders is crucial for sustainable arsenic mitigation in Bangladesh. In this study, institutional stakeholders' opinions on various aspects of As mitigation were elicited to identify their preferences for and reservations of specific mitigation measures. The current status of As mitigation activities and the factors influencing the success of As mitigation were also explored. Institutional weakness, lack of accountability and a latency period were the major factors hindering sustainable As mitigation. The results also suggested that the stakeholders' understanding of the As problem and their preferences for the different mitigation measures have a significant impact on the effectiveness of As mitigation. Mitigation of As contamination is a complex issue that requires a coordinated effort from various levels of stakeholders. The concept of "paying for water", which is currently potentially unknown in the rural areas of Bangladesh, also needs to be developed as this will create a stronger sense of user ownership of As safe water and thus better water management. Copyright © 2013 Elsevier B.V. All rights reserved.

The impact of stakeholder values and power relations on community-based health insurance coverage: qualitative evidence from three Senegalese case studies.

PubMed

Mladovsky, Philipa; Ndiaye, Pascal; Ndiaye, Alfred; Criel, Bart

2015-07-01

Continued low rates of enrolment in community-based health insurance (CBHI) suggest that strategies proposed for scaling up are unsuccessfully implemented or inadequately address underlying limitations of CBHI. One reason may be a lack of incorporation of social and political context into CBHI policy. In this study, the hypothesis is proposed that values and power relations inherent in social networks of CBHI stakeholders can explain levels of CBHI coverage. To test this, three case studies constituting Senegalese CBHI schemes were studied. Transcripts of interviews with 64 CBHI stakeholders were analysed using inductive coding. The five most important themes pertaining to social values and power relations were: voluntarism, trust, solidarity, political engagement and social movements. Analysis of these themes raises a number of policy and implementation challenges for expanding CBHI coverage. First is the need to subsidize salaries for CBHI scheme staff. Second is the need to develop more sustainable internal and external governance structures through CBHI federations. Third is ensuring that CBHI resonates with local values concerning four dimensions of solidarity (health risk, vertical equity, scale and source). Government subsidies is one of the several potential strategies to achieve this. Fourth is the need for increased transparency in national policy. Fifth is the need for CBHI scheme leaders to increase their negotiating power vis-à-vis health service providers who control the resources needed for expanding CBHI coverage, through federations and a social movement dynamic. Systematically addressing all these challenges would represent a fundamental reform of the current CBHI model promoted in Senegal and in Africa more widely; this raises issues of feasibility in practice. From a theoretical perspective, the results suggest that studying values and power relations among stakeholders in multiple case studies is a useful complement to traditional health systems analysis. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Managing sustainable development conflicts: the impact of stakeholders in small-scale hydropower schemes.

PubMed

Watkin, Laura Jane; Kemp, Paul S; Williams, Ian D; Harwood, Ian A

2012-06-01

The growing importance of the environment and its management has simultaneously emphasized the benefits of hydroelectric power and its environmental costs. In a changing policy climate, giving importance to renewable energy development and environmental protection, conflict potential between stakeholders is considerable. Navigation of conflict determines the scheme constructed, making sustainable hydropower a function of human choice. To meet the needs of practitioners, greater understanding of stakeholder conflict is needed. This paper presents an approach to illustrate the challenges that face small-scale hydropower development as perceived by the stakeholders involved, and how they influence decision-making. Using Gordleton Mill, Hampshire (UK), as an illustrative case, soft systems methodology, a systems modeling approach, was adopted. Through individual interviews, a range of problems were identified and conceptually modeled. Stakeholder bias towards favoring economic appraisal over intangible social and environmental aspects was identified; costs appeared more influential than profit. Conceptual evaluation of the requirements to meet a stakeholder-approved solution suggested a complex linear systems approach, considerably different from the real-life situation. The stakeholders introduced bias to problem definition by transferring self-perceived issues onto the project owner. Application of soft systems methodology caused a shift in project goals away from further investigation towards consideration of project suitability. The challenge of sustainable hydropower is global, with a need to balance environmental, economic, and social concerns. It is clear that in this type of conflict, an individual can significantly influence outcomes; highlighting the need for more structured approaches to deal with stakeholder conflicts in sustainable hydropower development.

Community stakeholders' perceptions of barriers to childhood obesity prevention in low-income families, Massachusetts 2012-2013.

PubMed

Ganter, Claudia; Chuang, Emmeline; Aftosmes-Tobio, Alyssa; Blaine, Rachel E; Giannetti, Mary; Land, Thomas; Davison, Kirsten K

2015-03-26

The etiology of childhood obesity is multidimensional and includes individual, familial, organizational, and societal factors. Policymakers and researchers are promoting social-ecological approaches to obesity prevention that encompass multiple community sectors. Programs that successfully engage low-income families in making healthy choices are greatly needed, yet little is known about the extent to which stakeholders understand the complexity of barriers encountered by families. The objective of this study was to contextually frame barriers faced by low-income families reported by community stakeholders by using the Family Ecological Model (FEM). From 2012 through 2013, we conducted semistructured interviews with 39 stakeholders from 2 communities in Massachusetts that were participating in a multisector intervention for childhood obesity prevention. Stakeholders represented schools; afterschool programs; health care; the Special Supplemental Nutrition Program for Women, Infants, and Children; and early care and education. Interviews were audio-recorded, transcribed, coded, and summarized. Stakeholder reports of the barriers experienced by low-income families had a strong degree of overlap with FEM and reflected awareness of the broader contextual factors (eg, availability of community resources, family culture, education) and social and emotional dynamics within families (eg, parent knowledge, social norms, distrust of health care providers, chronic life stressors) that could affect family adoption of healthy lifestyle behaviors. Furthermore, results illustrated a level of consistency in stakeholder awareness across multiple community sectors. The congruity of stakeholder perspectives with those of low-income parents as summarized in FEM and across community sectors illustrates potential for synergizing the efforts necessary for multisector, multilevel community interventions for the prevention of childhood obesity.

Managing Sustainable Development Conflicts: The Impact of Stakeholders in Small-Scale Hydropower Schemes

NASA Astrophysics Data System (ADS)

Watkin, Laura Jane; Kemp, Paul S.; Williams, Ian D.; Harwood, Ian A.

2012-06-01

The growing importance of the environment and its management has simultaneously emphasized the benefits of hydroelectric power and its environmental costs. In a changing policy climate, giving importance to renewable energy development and environmental protection, conflict potential between stakeholders is considerable. Navigation of conflict determines the scheme constructed, making sustainable hydropower a function of human choice. To meet the needs of practitioners, greater understanding of stakeholder conflict is needed. This paper presents an approach to illustrate the challenges that face small-scale hydropower development as perceived by the stakeholders involved, and how they influence decision-making. Using Gordleton Mill, Hampshire (UK), as an illustrative case, soft systems methodology, a systems modeling approach, was adopted. Through individual interviews, a range of problems were identified and conceptually modeled. Stakeholder bias towards favoring economic appraisal over intangible social and environmental aspects was identified; costs appeared more influential than profit. Conceptual evaluation of the requirements to meet a stakeholder-approved solution suggested a complex linear systems approach, considerably different from the real-life situation. The stakeholders introduced bias to problem definition by transferring self-perceived issues onto the project owner. Application of soft systems methodology caused a shift in project goals away from further investigation towards consideration of project suitability. The challenge of sustainable hydropower is global, with a need to balance environmental, economic, and social concerns. It is clear that in this type of conflict, an individual can significantly influence outcomes; highlighting the need for more structured approaches to deal with stakeholder conflicts in sustainable hydropower development.

A Second Opinion: A Case Narrative on Clinical Ethics Mediation.

PubMed

Weinstein, Michael S

2015-01-01

Contrasting traditional and common forms of ethics consultation with bioethics mediation, I describe the case of a "second opinion" consultation in the care of a patient with advanced cancer for whom treatment was futile. While the initial ethics consultation, performed by a colleague, led to a recommendation that some may deem ethical, the process failed to involve key stakeholders and failed to explore the underlying values and reasons for the opinions voiced by various stakeholders. The process of mediation ultimately led to creative solutions in which all stakeholders could reach consensus on a plan of care. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

SU-B-BRA-07: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Halvorsen, P.

2016-06-15

In the current rapidly changing Healthcare environment, many groups are competing for limited resources. How can medical physicists position themselves to be a relevant stakeholder in the discussion of how those resources are allocated Our value goes beyond what can be shown in a business plan and is heavily involved with safety and quality. Three areas will be explored: What is our value? Who needs to receive that message? How do we communicate that message? To help frame the discussion in terms of how other stakeholders may view the value of medical physicists, a physician and an administrator will presentmore » their perspective. Lastly, a multidisciplinary panel will present real life examples of strategies that can be utilized today to establish the value of medical physicists. The presentation of these examples will lead into an interactive question and answer time. V. Willcut, I work for Elekta. There was no research associated with this talk.« less

SU-B-BRA-09: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Willcut, V.

2016-06-15

In the current rapidly changing Healthcare environment, many groups are competing for limited resources. How can medical physicists position themselves to be a relevant stakeholder in the discussion of how those resources are allocated Our value goes beyond what can be shown in a business plan and is heavily involved with safety and quality. Three areas will be explored: What is our value? Who needs to receive that message? How do we communicate that message? To help frame the discussion in terms of how other stakeholders may view the value of medical physicists, a physician and an administrator will presentmore » their perspective. Lastly, a multidisciplinary panel will present real life examples of strategies that can be utilized today to establish the value of medical physicists. The presentation of these examples will lead into an interactive question and answer time. V. Willcut, I work for Elekta. There was no research associated with this talk.« less

SU-B-BRA-08: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hazle, J.

2016-06-15

In the current rapidly changing Healthcare environment, many groups are competing for limited resources. How can medical physicists position themselves to be a relevant stakeholder in the discussion of how those resources are allocated Our value goes beyond what can be shown in a business plan and is heavily involved with safety and quality. Three areas will be explored: What is our value? Who needs to receive that message? How do we communicate that message? To help frame the discussion in terms of how other stakeholders may view the value of medical physicists, a physician and an administrator will presentmore » their perspective. Lastly, a multidisciplinary panel will present real life examples of strategies that can be utilized today to establish the value of medical physicists. The presentation of these examples will lead into an interactive question and answer time. V. Willcut, I work for Elekta. There was no research associated with this talk.« less

SU-B-BRA-05: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pavord, D.

2016-06-15

In the current rapidly changing Healthcare environment, many groups are competing for limited resources. How can medical physicists position themselves to be a relevant stakeholder in the discussion of how those resources are allocated Our value goes beyond what can be shown in a business plan and is heavily involved with safety and quality. Three areas will be explored: What is our value? Who needs to receive that message? How do we communicate that message? To help frame the discussion in terms of how other stakeholders may view the value of medical physicists, a physician and an administrator will presentmore » their perspective. Lastly, a multidisciplinary panel will present real life examples of strategies that can be utilized today to establish the value of medical physicists. The presentation of these examples will lead into an interactive question and answer time. V. Willcut, I work for Elekta. There was no research associated with this talk.« less

SU-B-BRA-06: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clements, J.

2016-06-15

In the current rapidly changing Healthcare environment, many groups are competing for limited resources. How can medical physicists position themselves to be a relevant stakeholder in the discussion of how those resources are allocated Our value goes beyond what can be shown in a business plan and is heavily involved with safety and quality. Three areas will be explored: What is our value? Who needs to receive that message? How do we communicate that message? To help frame the discussion in terms of how other stakeholders may view the value of medical physicists, a physician and an administrator will presentmore » their perspective. Lastly, a multidisciplinary panel will present real life examples of strategies that can be utilized today to establish the value of medical physicists. The presentation of these examples will lead into an interactive question and answer time. V. Willcut, I work for Elekta. There was no research associated with this talk.« less

DEVELOPMENTS IN VALUE FRAMEWORKS TO INFORM THE ALLOCATION OF HEALTHCARE RESOURCES.

PubMed

Oortwijn, Wija; Sampietro-Colom, Laura; Habens, Fay

2017-01-01

In recent years, there has been a surge in the development of frameworks to assess the value of different types of health technologies to inform healthcare resource allocation. The reasons for, and the potential of, these value frameworks were discussed during the 2017 Health Technology Assessment International (HTAi) Policy Forum Meeting. This study reflects the discussion, drawing on presentations from invited experts and Policy Forum members, as well as a background paper. The reasons given for a proliferation of value frameworks included: rising healthcare costs; more complex health technology; perceived disconnect between price and value in some cases; changes in societal values; the need for inclusion of additional considerations, such as ethical issues; and greater empowerment of clinicians and patients in defining and using value frameworks. Many Policy Forum participants recommended learning from existing frameworks. Furthermore, there was a desire to agree on the core components of value frameworks, defining the additional value elements as necessary and considering how they might be measured and used in practice. Furthermore, adherence to the principles of transparency, predictability, broad stakeholder involvement, and accountability were widely supported, along with being forward looking, explicit, and consistent across decisions. Value frameworks continue to evolve with significant implications for global incentives for innovation and access to health technologies. There is a role for the HTA community to address some of the key areas discussed during the meeting, such as defining the core components for assessing the value of a health technology.

Community Engagement in a complex intervention to improve access to primary mental health care for hard-to-reach groups.

PubMed

Lamb, Jonathan; Dowrick, Christopher; Burroughs, Heather; Beatty, Susan; Edwards, Suzanne; Bristow, Kate; Clarke, Pam; Hammond, Jonathan; Waheed, Waquas; Gabbay, Mark; Gask, Linda

2015-12-01

Despite the availability of effective evidence-based treatments for depression and anxiety, many 'harder-to-reach' social and patient groups experience difficulties accessing treatment. We developed a complex intervention, the AMP (Improving Access to Mental Health in Primary Care) programme, which combined community engagement (CE), tailored (individual and group) psychosocial interventions and primary care involvement. To develop and evaluate a model for community engagement component of the complex intervention. This paper focuses on the development of relationships between stakeholders, their engagement with the issue of access to mental health and with the programme through the CE model. Our evaluation draws on process data, qualitative interviews and focus groups, brought together through framework analysis to evaluate the issues and challenges encountered. A case study of the South Asian community project carried out in Longsight in Greater Manchester, United Kingdom. Complex problems require multiple local stakeholders to work in concert. Assets based approaches implicitly make demands on scarce time and resources. Community development approaches have many benefits, but perceptions of open-ended investment are a barrier. The time-limited nature of a CE intervention provides an impetus to 'do it now', allowing stakeholders to negotiate their investment over time and accommodating their wider commitments. Both tangible outcomes and recognition of process benefits were vital in maintaining involvement. CE interventions can play a key role in improving accessibility and acceptability by engaging patients, the public and practitioners in research and in the local service ecology. © 2014 John Wiley & Sons Ltd.

Navigating the Complexities at an LGTTQQI-Identified Charter School: An Ethnography of C/Overt Narratives

ERIC Educational Resources Information Center

Goodrich, Kristopher M.; Luke, Melissa

2016-01-01

The authors describe ethnographic research exploring the experiences of school stakeholders at a lesbian, gay, bisexual, transgender, queer, questioning, and intersex (LGBTQQI)-identified charter school. Participants evidenced use of an overt and covert narrative that appeared to reflect how they navigated the complexities at the…

Understanding Wicked Problems: A Key to Advancing Environmental Health Promotion

ERIC Educational Resources Information Center

Kreuter, Marshall W.; De Rosa, Christopher; Howze, Elizabeth H.; Baldwin, Grant T.

2004-01-01

Complex environmental health problems--like air and water pollution, hazardous waste sites, and lead poisoning--are in reality a constellation of linked problems embedded in the fabric of the communities in which they occur. These kinds of complex problems have been characterized by some as "wicked problems" wherein stakeholders may have…

Bilevel formulation of a policy design problem considering multiple objectives and incomplete preferences

NASA Astrophysics Data System (ADS)

Hawthorne, Bryant; Panchal, Jitesh H.

2014-07-01

A bilevel optimization formulation of policy design problems considering multiple objectives and incomplete preferences of the stakeholders is presented. The formulation is presented for Feed-in-Tariff (FIT) policy design for decentralized energy infrastructure. The upper-level problem is the policy designer's problem and the lower-level problem is a Nash equilibrium problem resulting from market interactions. The policy designer has two objectives: maximizing the quantity of energy generated and minimizing policy cost. The stakeholders decide on quantities while maximizing net present value and minimizing capital investment. The Nash equilibrium problem in the presence of incomplete preferences is formulated as a stochastic linear complementarity problem and solved using expected value formulation, expected residual minimization formulation, and the Monte Carlo technique. The primary contributions in this article are the mathematical formulation of the FIT policy, the extension of computational policy design problems to multiple objectives, and the consideration of incomplete preferences of stakeholders for policy design problems.

Assumption-aware tools and agency; an interrogation of the primary artifacts of the program evaluation and design profession in working with complex evaluands and complex contexts.

PubMed

Morrow, Nathan; Nkwake, Apollo M

2016-12-01

Like artisans in a professional guild, we evaluators create tools to suit our ever evolving practice. The tools we use as evaluators are the primary artifacts of our profession, reflect our practice and embody an amalgamation of paradigms and assumptions. With the increasing shifts in evaluation purposes from judging program worth to understanding how programs work, the evaluator's role is changing to that of facilitating stakeholders in a learning process. This involves clarifying purposes and choices, as well as unearthing critical assumptions. In such a role, evaluators become major tool-users and begin to innovate with small refinements or produce completely new tools to fit a specific challenge or context. We interrogate the form and function of 12 tools used by evaluators when working with complex evaluands and complex contexts. The form is described in terms of traditional qualitative techniques and particular characteristics of the elements, use and presentation of each tool. Then the function of each tool is analyzed with respect to articulating assumptions and affecting the agency of evaluators and stakeholders in complex contexts. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluating the Role of Intermediaries in the Electronic Value Chain.

ERIC Educational Resources Information Center

Janssen, Marijn; Sol, Henk G.

2000-01-01

Presents a business engineering methodology that supports the identification of electronic intermediary roles in the electronic value chain. The goal of this methodology is to give stakeholders insight into their current, and possible alternative, situations by means of visualization, to evaluate the added value of business models using…

PACE Continuous Innovation Indicators-a novel tool to measure progress in cancer treatments.

PubMed

Paddock, Silvia; Brum, Lauren; Sorrow, Kathleen; Thomas, Samuel; Spence, Susan; Maulbecker-Armstrong, Catharina; Goodman, Clifford; Peake, Michael; McVie, Gordon; Geipel, Gary; Li, Rose

2015-01-01

Concerns about rising health care costs and the often incremental nature of improvements in health outcomes continue to fuel intense debates about 'progress' and 'value' in cancer research. In times of tightening fiscal constraints, it is increasingly important for patients and their representatives to define what constitutes 'value' to them. It is clear that diverse stakeholders have different priorities. Harmonisation of values may be neither possible nor desirable. Stakeholders lack tools to visualise or otherwise express these differences and to track progress in cancer treatments based on variable sets of values. The Patient Access to Cancer care Excellence (PACE) Continuous Innovation Indicators are novel, scientifically rigorous progress trackers that employ a three-step process to quantify progress in cancer treatments: 1) mine the literature to determine the strength of the evidence supporting each treatment; 2) allow users to weight the analysis according to their priorities and values; and 3) calculate Evidence Scores (E-Scores), a novel measure to track progress, based on the strength of the evidence weighted by the assigned value. We herein introduce a novel, flexible value model, show how the values from the model can be used to weight the evidence from the scientific literature to obtain E-Scores, and illustrate how assigning different values to new treatments influences the E-Scores. The Indicators allow users to learn how differing values lead to differing assessments of progress in cancer research and to check whether current incentives for innovation are aligned with their value model. By comparing E-Scores generated by this tool, users are able to visualise the relative pace of innovation across areas of cancer research and how stepwise innovation can contribute to substantial progress against cancer over time. Learning from experience and mapping current unmet needs will help to support a broad audience of stakeholders in their efforts to accelerate and maximise progress against cancer.

Perspectives of key stakeholders and smokers on a very low nicotine content cigarette-only policy: qualitative study.

PubMed

Fraser, Trish; Kira, Anette

2017-06-02

To investigate views of New Zealand key stakeholders (stakeholders) and smokers on very low nicotine content (VLNC) cigarettes, and a policy mandating that only VLNC cigarettes are available for sale. Using a semi-structured interview schedule, we interviewed 17 stakeholders and held focus groups with 21 smokers. Questions were asked about VLNC cigarettes and a VLNC cigarette-only policy. Smokers were given approximately 15 VLNC cigarettes to take home and smoke. One week after the focus groups, 17 smokers were interviewed. Data were analysed using a general inductive approach. Stakeholders and smokers were largely unconvinced of the value of a mandated reduction in nicotine in cigarettes. After smoking VLNC cigarettes, smokers had less interest in them but would support them being sold alongside high nicotine content (HNC) cigarettes at a much cheaper price. The government is not likely to mandate nicotine reduction in cigarettes if there is a perceived lack of support from stakeholders or smokers. However, they could make VLNC cigarettes available as an option for smokers utilising a differential tax favouring VLNC cigarettes. If this were combined with better access to nicotine containing e-cigarettes, smokers may shift away from HNC cigarettes.

A practical approach to communicating benefit-risk decisions of medicines to stakeholders.

PubMed

Leong, James; Walker, Stuart; Salek, Sam

2015-01-01

The importance of a framework for a systematic structured assessment of the benefits and risks has been established, but in addition, it is necessary that the benefit-risk decisions and the processes to derive those decisions are documented and communicated to various stakeholders for accountability. Hence there is now a need to find appropriate tools to enhance communication between regulators and other stakeholders, in a manner that would uphold transparency, consistency and standards. A retrospective, non-comparative study was conducted to determine the applicability and practicality of a summary template in documenting benefit-risk assessment and communicating benefit-risk balance and conclusions for reviewers to other stakeholders. The benefit-risk (BR) Summary Template and its User Manual was evaluated by 12 reviewers within a regulatory agency in Singapore, the Health Sciences Authority (HSA). The BR Summary Template was found to be adequate in documenting benefits, risks, relevant summaries and conclusions, while the User Manual was useful in guiding the reviewer in completing the template. The BR Summary Template was also considered a useful tool for communicating benefit-risk decisions to a variety of stakeholders. The use of a template may be of value for the communicating benefit-risk assessment of medicines to stakeholders.

A Framework for Multi-Stakeholder Decision-Making and ...

EPA Pesticide Factsheets

This contribution describes the implementation of the conditional-value-at-risk (CVaR) metric to create a general multi-stakeholder decision-making framework. It is observed that stakeholder dissatisfactions (distance to their individual ideal solutions) can be interpreted as random variables. We thus shape the dissatisfaction distribution and find an optimal compromise solution by solving a CVaR minimization problem parameterized in the probability level. This enables us to generalize multi-stakeholder settings previously proposed in the literature that minimizes average and worst-case dissatisfactions. We use the concept of the CVaR norm to give a geometric interpretation to this problem and use the properties of this norm to prove that the CVaR minimization problem yields Pareto optimal solutions for any choice of the probability level. We discuss a broad range of potential applications of the framework. We demonstrate the framework in a bio-waste processing facility location case study, where we seek compromise solutions (facility locations) that balance stakeholder priorities on transportation, safety, water quality, and capital costs. This conference presentation abstract explains a new decision-making framework that computes compromise solution alternatives (reach consensus) by mitigating dissatisfactions among stakeholders as needed for SHC Decision Science and Support Tools project.

Knowledge, data and interests: Challenges in participation of diverse stakeholders in HIA

DOE Office of Scientific and Technical Information (OSTI.GOV)

Negev, Maya, E-mail: negevm@bgu.ac.il

2012-02-15

Stakeholder participation is considered an integral part of HIA. However, the challenges that participation implies in a multi-disciplinary and multi-ethnic society are less studied. This paper presents the manifestations of the multiplicity of sectors and population groups in HIA and discusses the challenges that such diversity imposes. Specifically, there is no common ground between participants, as their positions entail contradictory knowledge regarding the current situation, reliance on distinct data and conflicting interests. This entails usage of multiple professional and ethnic languages, disagreements regarding the definition of health and prioritizing health issues in HIA, and divergent perceptions of risk. These differencesmore » between participants are embedded culturally, socially, individually and, maybe most importantly, professionally. This complex picture of diverse stakeholder attributes is grounded in a case study of stakeholder participation in HIA, regarding zoning of a hazardous industry site in Israel. The implication is that participatory HIAs should address the multiplicity of stakeholders and types of knowledge, data and interests in a more comprehensive way. - Highlights: Black-Right-Pointing-Pointer This paper analyses challenges in participation of diverse stakeholders in HIA. Black-Right-Pointing-Pointer The multiplicity of disciplines and population groups raises fundamental challenges. Black-Right-Pointing-Pointer Stakeholders possess distinct and often contradictory knowledge, data and interests. Black-Right-Pointing-Pointer They speak different languages, and differ on approaches to health and risk perceptions. Black-Right-Pointing-Pointer Substantial amendments to diverse participation are needed, in HIA and generally.« less

Scenario-based stakeholder engagement: incorporating stakeholders preferences into coastal planning for climate change.

PubMed

Tompkins, Emma L; Few, Roger; Brown, Katrina

2008-09-01

Climate change poses many challenges for ecosystem and resource management. In particular, coastal planners are struggling to find ways to prepare for the potential impacts of future climate change while dealing with immediate pressures. Decisions on how to respond to future risks are complicated by the long time horizons and the uncertainty associated with the distribution of impacts. Existing coastal zone management approaches in the UK either do not adequately incorporate changing stakeholder preferences, or effectively ensure that stakeholders are aware of the trade-offs inherent in any coastal management decision. Using a novel method, scenario-based stakeholder engagement, which brings together stakeholder analysis, climate change management scenarios and deliberative techniques, the necessary trade-offs associated with long term coastal planning are explored. The method is applied to two case studies of coastal planning in Christchurch Bay on the south coast of England and the Orkney Islands off the north coast of Scotland. A range of conflicting preferences exist on the ideal governance structure to manage the coast under different climate change scenarios. In addition, the results show that public understanding of the trade-offs that have to be made is critical in gaining some degree of public support for long term coastal decision-making. We conclude that scenario-based stakeholder engagement is a useful tool to facilitate coastal management planning that takes into account the complexities and challenges of climate change, and could be used in conjunction with existing approaches such as the Shoreline Management Planning process.

Similarities and Differences of Preferred Traits in Character Education Programs by Ethnicity and Class According to Parents, Faculty/Staff, and Students at Two Middle Schools in California

ERIC Educational Resources Information Center

Boen, Jennifer

2010-01-01

This study provides two perspectives on the various character traits provided by character education programs by comparing the voices of minority and lower-lower middle class stakeholders with those of upper middle class stakeholders. The literature on the values and virtues based approaches to moral development and character education were…

Unravelling networks in local public health policymaking in three European countries - a systems analysis.

PubMed

Spitters, Hilde P E M; Lau, Cathrine J; Sandu, Petru; Quanjel, Marcel; Dulf, Diana; Glümer, Charlotte; van Oers, Hans A M; van de Goor, Ien A M

2017-02-03

Facilitating and enhancing interaction between stakeholders involved in the policymaking process to stimulate collaboration and use of evidence, is important to foster the development of effective Health Enhancing Physical Activity (HEPA) policies. Performing an analysis of real-world policymaking processes will help reveal the complexity of a network of stakeholders. Therefore, the main objectives were to unravel the stakeholder network in the policy process by conducting three systems analyses, and to increase insight into the similarities and differences in the policy processes of these European country cases. A systems analysis of the local HEPA policymaking process was performed in three European countries involved in the 'REsearch into POlicy to enhance Physical Activity' (REPOPA) project, resulting in three schematic models showing the main stakeholders and their relationships. The models were used to compare the systems, focusing on implications with respect to collaboration and use of evidence in local HEPA policymaking. Policy documents and relevant webpages were examined and main stakeholders were interviewed. The systems analysis in each country identified the main stakeholders involved and their position and relations in the policymaking process. The Netherlands and Denmark were the most similar and both differed most from Romania, especially at the level of accountability of the local public authorities for local HEPA policymaking. The categories of driving forces underlying the relations between stakeholders were formal relations, informal interaction and knowledge exchange. A systems analysis providing detailed descriptions of positions and relations in the stakeholder network in local level HEPA policymaking is rather unique in this area. The analyses are useful when a need arises for increased interaction, collaboration and use of knowledge between stakeholders in the local HEPA network, as they provide an overview of the stakeholders involved and their mutual relations. This information can be an important starting point to enhance the uptake of evidence and build more effective public health policies.

SU-B-BRA-03: A Physician Perspective on the Value of Medical Physics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burri, S.

In the current rapidly changing Healthcare environment, many groups are competing for limited resources. How can medical physicists position themselves to be a relevant stakeholder in the discussion of how those resources are allocated Our value goes beyond what can be shown in a business plan and is heavily involved with safety and quality. Three areas will be explored: What is our value? Who needs to receive that message? How do we communicate that message? To help frame the discussion in terms of how other stakeholders may view the value of medical physicists, a physician and an administrator will presentmore » their perspective. Lastly, a multidisciplinary panel will present real life examples of strategies that can be utilized today to establish the value of medical physicists. The presentation of these examples will lead into an interactive question and answer time. V. Willcut, I work for Elekta. There was no research associated with this talk.« less

SU-B-BRA-04: An Administrators Perspective on the Value of Medical Physics

DOE Office of Scientific and Technical Information (OSTI.GOV)

McNary, D.

In the current rapidly changing Healthcare environment, many groups are competing for limited resources. How can medical physicists position themselves to be a relevant stakeholder in the discussion of how those resources are allocated Our value goes beyond what can be shown in a business plan and is heavily involved with safety and quality. Three areas will be explored: What is our value? Who needs to receive that message? How do we communicate that message? To help frame the discussion in terms of how other stakeholders may view the value of medical physicists, a physician and an administrator will presentmore » their perspective. Lastly, a multidisciplinary panel will present real life examples of strategies that can be utilized today to establish the value of medical physicists. The presentation of these examples will lead into an interactive question and answer time. V. Willcut, I work for Elekta. There was no research associated with this talk.« less

SU-B-BRA-00: The Medical Physicist Value Proposition for Tomorrow and Today

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sherouse, G.

In the current rapidly changing Healthcare environment, many groups are competing for limited resources. How can medical physicists position themselves to be a relevant stakeholder in the discussion of how those resources are allocated Our value goes beyond what can be shown in a business plan and is heavily involved with safety and quality. Three areas will be explored: What is our value? Who needs to receive that message? How do we communicate that message? To help frame the discussion in terms of how other stakeholders may view the value of medical physicists, a physician and an administrator will presentmore » their perspective. Lastly, a multidisciplinary panel will present real life examples of strategies that can be utilized today to establish the value of medical physicists. The presentation of these examples will lead into an interactive question and answer time. V. Willcut, I work for Elekta. There was no research associated with this talk.« less

SU-B-BRA-02: The Medical Physics Value Proposition for Tomorrow and Today

DOE Office of Scientific and Technical Information (OSTI.GOV)

White, G.

In the current rapidly changing Healthcare environment, many groups are competing for limited resources. How can medical physicists position themselves to be a relevant stakeholder in the discussion of how those resources are allocated Our value goes beyond what can be shown in a business plan and is heavily involved with safety and quality. Three areas will be explored: What is our value? Who needs to receive that message? How do we communicate that message? To help frame the discussion in terms of how other stakeholders may view the value of medical physicists, a physician and an administrator will presentmore » their perspective. Lastly, a multidisciplinary panel will present real life examples of strategies that can be utilized today to establish the value of medical physicists. The presentation of these examples will lead into an interactive question and answer time. V. Willcut, I work for Elekta. There was no research associated with this talk.« less

The Possibilities of Reducing Food Choice to Improve the Performance of College Foodservices.

PubMed

Mirosa, Miranda; Loh, Joanne; Spence, Heather

2016-07-01

College administrative and management leaders, foodservice personnel, and student residents value social, nutritional, financial, and environmental sustainability in their dining expectations. Menu choice reduction looks promising as a strategy to achieve these goals. However, foodservice research about dominant attitudes across these stakeholders is limited. To identify qualitative views from all stakeholders about choice reduction to ensure that any changes to the meal service are not to the detriment of consumer satisfaction. A comprehensive list of 74 statements representing the spectrum of attitudes surrounding choice was generated by searching a variety of resources, including academic literature and Internet sites, and by conducting semistructured interviews with stakeholders. A final set of 42 statements resulted from researcher scrutiny for optimum balance, clarity, appropriateness, simplicity, and applicability. A new sample of participants was then asked to sort these 42 statements into a normal distribution grid from "strongly disagree" to "strongly agree." A purposive convenience sample of stakeholders (staff n=5 and residents n=4) was used to identify statements about choice reduction. A second sample of stakeholders (staff n=6 and residents n=29) were recruited to sort the final 42 statements. Q methodology analysis techniques were used. This involved conducting a by-person factor analysis, using the centroid factor extraction method because of the permissiveness it allows for data exploration. A varimax factor rotation to enhance interpretability of the results identified shared viewpoints. Three dominant viewpoints toward the possibility of choice reduction in the meal service were identified. Factor 1 was "health driven" (in which healthiness was paramount). Factor 2 was "variety seekers" (in which choice had instrumental value). Factor 3 was "choice lovers" (in which choice had intrinsic value). Although participants could see a number of benefits of choice reduction, strong attitudinal barriers existed toward adopting choice reduction initiatives. These barriers need to be overcome to avoid dissatisfaction with the foodservice should choice reduction measures be implemented. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

EPODE approach for childhood obesity prevention: methods, progress and international development

PubMed Central

Borys, J-M; Le Bodo, Y; Jebb, S A; Seidell, J C; Summerbell, C; Richard, D; De Henauw, S; Moreno, L A; Romon, M; Visscher, T L S; Raffin, S; Swinburn, B

2012-01-01

Summary Childhood obesity is a complex issue and needs multistakeholder involvement at all levels to foster healthier lifestyles in a sustainable way. ‘Ensemble Prévenons l'ObésitéDes Enfants’ (EPODE, Together Let's Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to prevent childhood obesity. This paper describes EPODE methodology and its objective of preventing childhood obesity. At a central level, a coordination team, using social marketing and organizational techniques, trains and coaches a local project manager nominated in each EPODE community by the local authorities. The local project manager is also provided with tools to mobilize local stakeholders through a local steering committee and local networks. The added value of the methodology is to mobilize stakeholders at all levels across the public and the private sectors. Its critical components include political commitment, sustainable resources, support services and a strong scientific input – drawing on the evidence-base – together with evaluation of the programme. Since 2004, EPODE methodology has been implemented in more than 500 communities in six countries. Community-based interventions are integral to childhood obesity prevention. EPODE provides a valuable model to address this challenge. PMID:22106871

Energy Efficiency Collaboratives

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Michael; Bryson, Joe

2015-09-01

Collaboratives for energy efficiency have a long and successful history and are currently used, in some form, in more than half of the states. Historically, many state utility commissions have used some form of collaborative group process to resolve complex issues that emerge during a rate proceeding. Rather than debate the issues through the formality of a commission proceeding, disagreeing parties are sent to discuss issues in a less-formal setting and bring back resolutions to the commission. Energy efficiency collaboratives take this concept and apply it specifically to energy efficiency programs—often in anticipation of future issues as opposed to reactingmore » to a present disagreement. Energy efficiency collaboratives can operate long term and can address the full suite of issues associated with designing, implementing, and improving energy efficiency programs. Collaboratives can be useful to gather stakeholder input on changing program budgets and program changes in response to performance or market shifts, as well as to provide continuity while regulators come and go, identify additional energy efficiency opportunities and innovations, assess the role of energy efficiency in new regulatory contexts, and draw on lessons learned and best practices from a diverse group. Details about specific collaboratives in the United States are in the appendix to this guide. Collectively, they demonstrate the value of collaborative stakeholder processes in producing successful energy efficiency programs.« less

Integrated planning and spatial evaluation of megasite remediation and reuse options

NASA Astrophysics Data System (ADS)

Schädler, Sebastian; Morio, Maximilian; Bartke, Stephan; Finkel, Michael

2012-01-01

Redevelopment of large contaminated brownfields (megasites) is often hampered by a lack of communication and harmonization among diverse stakeholders with potentially conflicting interests. Decision support is required to provide integrative yet transparent evaluation of often complex spatial information to stakeholders with different areas of expertise. It is considered crucial for successful redevelopment to identify a shared vision of how the respective contaminated site could be remediated and redeveloped. We describe a framework of assessment methods and models that analyzes and visualizes site- and land use-specific spatial information at the screening level, with the aim to support the derivation of recommendable land use layouts and to initiate further and more detailed planning. The framework integrates a GIS-based identification of areas to be remediated, an estimation of associated clean-up costs, a spatially explicit market value appraisal, and an assessment of the planned future land use's contribution to sustainable urban and regional development. Case study results show that derived options are potentially favorable in both a sustainability and an economic sense and that iterative re-planning is facilitated by the evaluation and visualization of economic, ecological and socio-economic aspects. The framework supports an efficient early judgment about whether and how abandoned land may be assigned a sustainable and marketable land use.

An assessment of innovative pricing schemes for the communication of value: is price discrimination and two-part pricing a way forward?

PubMed

Hertzman, Peter; Miller, Paul; Tolley, Keith

2018-02-01

With the introduction of new expensive medicines, traditional pricing schemes based on constructs such as price per pill/vial have been challenged. Potential innovative schemes could be either financial-based or performance-based. Within financial-based schemes the use of price discrimination is an emerging option, which we explore in this assessment. Areas covered: In the short term the price per indication approach is likely to become more prevalent for high cost, high benefit new pharmaceuticals, such as those emerging in oncology (e.g. new combination immunotherapies). 'Two-Part Pricing' (2PP) is a frequently used payment method in other industries, which consists of an Entry Fee, giving the buyer the right to use the product, and a Usage Price charged every time the product is purchased. Introducing 2PP into biopharma could have cross-stakeholder benefits including broader patient access, and improvement in budget/revenue predictability. A concern however is the potential complexity of the negotiation between manufacturer and payer. Expert commentary: We believe 'price discrimination' and 2PP in particular can be relevant for some new, expensive specialist medicines. A recommended first step would be to initiate pilots to test to what degree the 2PP approach meets stakeholder objectives and is practical to implement within specialty care.

Multi-Attribute Tradespace Exploration in Space System Design

NASA Astrophysics Data System (ADS)

Ross, A. M.; Hastings, D. E.

2002-01-01

The complexity inherent in space systems necessarily requires intense expenditures of resources both human and monetary. The high level of ambiguity present in the early design phases of these systems causes long, highly iterative, and costly design cycles. This paper looks at incorporating decision theory methods into the early design processes to streamline communication of wants and needs among stakeholders and between levels of design. Communication channeled through formal utility interviews and analysis enables engineers to better understand the key drivers for the system and allows a more thorough exploration of the design tradespace. Multi-Attribute Tradespace Exploration (MATE), an evolving process incorporating decision theory into model and simulation- based design, has been applied to several space system case studies at MIT. Preliminary results indicate that this process can improve the quality of communication to more quickly resolve project ambiguity, and enable the engineer to discover better value designs for multiple stakeholders. MATE is also being integrated into a concurrent design environment to facilitate the transfer knowledge of important drivers into higher fidelity design phases. Formal utility theory provides a mechanism to bridge the language barrier between experts of different backgrounds and differing needs (e.g. scientists, engineers, managers, etc). MATE with concurrent design couples decision makers more closely to the design, and most importantly, maintains their presence between formal reviews.

Participatory Systems Modeling to Explore Sustainable ...

EPA Pesticide Factsheets

Decision makers often need assistance in understanding dynamic interactions and linkages among economic, environmental and social systems in coastal watersheds. They also need scientific input to better evaluate potential costs and benefits of alternative policy interventions. The US EPA is applying sustainability science to address these needs. Triple Value (3V) Scoping and Modeling projects bring a systems approach to understand complex environmental problems, incorporate local knowledge, and allow decision-makers to explore policy scenarios. This leads to better understanding of feedbacks and outcomes to both human and environmental systems. The Suffolk County, NY (eastern Long Island) 3V Case uses SES interconnections to explore possible policy options and scenarios for intervention to mitigate the effects of excess nitrogen (N) loading to ground, surface, and estuarine waters. Many of the environmental impacts of N pollution negatively affect social and economic well-being and productivity. Key are loss of enjoyment and recreational use of local beach environments and loss of income and revenues from tourism and local fisheries. Stakeholders generated this Problem Statement: Suffolk County is experiencing widespread degradation to groundwater and the coastal marine environment caused by excess nitrogen. How can local stakeholders and decision makers in Suffolk County arrest and reverse this degradation, restore conditions to support a healthy thriving ecos

Redispensing of medicines unused by patients: a qualitative study among stakeholders.

PubMed

Bekker, Charlotte L; Gardarsdottir, Helga; Egberts, Toine C G; Bouvy, Marcel L; van den Bemt, Bart J F

2017-02-01

Background Medication waste has undesirable economic and environmental consequences. This waste is partly unavoidable, but might be reduced by redispensing medicines unused by patients. However, there is little knowledge of stakeholders' views on the redispensing. Objective To identify the stakeholders' views on the redispensing of medicines unused by patients. Setting Dutch healthcare system. Method Semi-structured interviews were conducted with 19 Dutch stakeholders from September 2014 until April 2015. The interview guide included two themes: medication waste and redispensing of unused medicines. The latter included qualitative-, legal- and financial aspects and stakeholder involvement, with specific attention to the patient. Interview transcripts were subjected to thematic content analysis. Main outcome measure Requirements related to the redispensing of unused medicines. Results All stakeholders considered the redispensing of medicines desirable if the implementation is feasible and the requirements for the safe redispensing are met. All of them pointed out that the product quality of redispensed medicines should be guaranteed and that it should be clear who is responsible for the quality of redispensed medicines. The stakeholders stated that transparent communication to patients is essential to guarantee trust in the redispensing system and that patients should be willing to use redispensed medicines. Moreover, the redispensing system's benefits should outweigh the costs and a minimal economic value of medicines suitable for redispensing should be determined. Conclusion Redispensing unused medicines could decrease medication waste if several requirements are met. For successful implementation of a redispensing system, all relevant stakeholders should be involved and cooperate as a joint-force.

Applications of monsoon research: Opportunities to inform decisionmaking and reduce regional vulnerability

NASA Astrophysics Data System (ADS)

Ray, A. J.; Garfin, G. M.; Wilder, M.; Lenart, M.; Vásquez-León, M.; Comrie, A. C.

2007-05-01

This presentation will describe ongoing efforts to understand interactions between the North American Monsoon and society, in order to develop applications for monsoon research in a highly complex, multicultural and binational region. The North American Monsoon is an annual precipitation regime that begins in early June in Mexico and progresses northward to the southwestern United States. The region includes stakeholders in large urban complexes, productive agricultural areas, and sparsely populated arid and semi-arid ecosystems. The political, cultural, and socioeconomic divisions between the U.S. and Mexico create a broad range of sensitivities to climate variability as well as capacities to use forecasts and other information to cope with climate. We will highlight methodologies to link climate science with society and analyze opportunities for monsoon science to benefit society in four sectors: natural hazards management, agriculture, public health, and water management. We present a synthesized list of stakeholder needs and a calendar of decisions to help scientists link user needs to potential forecasts and products. To ensure usability of forecasts and other research products, we recommend iterative scientist-stakeholder interactions, through integrated assessments. These knowledge- exchange interactions can improve the capacity for stakeholders to use forecasts thoughtfully and inform the development of research, and for the research community to obtain feedback on climate-related products and receive insights to guide research direction. We expect that integrated assessments can capitalize on the opportunities for monsoon science to inform decisionmaking, in the best instances, reduce regional climate vulnerabilities and enhance regional sustainability

Fostering Ecological Literacy: A Case Study of the Saint John Harbour in Two High School English Language Arts Classrooms

NASA Astrophysics Data System (ADS)

Douglas, Velta

Integrating environmental education into curriculum in a way that tackles the holistic and complicated nature of multi-dimensional issues continues to be a challenge for educators and administrators. There is potential in using ecological literacy to introduce local environmental case studies into English Language Arts high school classrooms. This research examines the experiences of two ELA classrooms in one Saint John, NB, high school with a two-week unit based on stakeholder relationships within the Saint John Harbour. Through presentations by guest speakers and research sourced from local community groups, students learned about the highly complex environmental issues that inform management decisions for the Harbour. Using these materials as background, students participated in a mock stakeholders meeting. Case study methodology was used to explore student learning in both a higher-level and a lower-level grade 10 ELA class. Data for the analysis included: cognitive mapping exercises; oral and written classroom assignments and activities; a videotape of the mock stakeholder meetings; a focus group interview with selected students; and researcher field notes. Data demonstrated significant student learning about environmental issues including increased sophistication in describing links between and among environmental issues affecting the harbour, and much more complex understandings of the positions and roles of the various stakeholder groups. Some important areas of resistance to new learning were also evident. Implications for practice and policy and recommendations for future research are discussed.

Standardised outcomes in nephrology - Haemodialysis (SONG-HD): study protocol for establishing a core outcome set in haemodialysis.

PubMed

Tong, Allison; Manns, Braden; Hemmelgarn, Brenda; Wheeler, David C; Tugwell, Peter; Winkelmayer, Wolfgang C; van Biesen, Wim; Crowe, Sally; Kerr, Peter G; Polkinghorne, Kevan R; Howard, Kirsten; Pollock, Carol; Hawley, Carmel M; Johnson, David W; McDonald, Stephen P; Gallagher, Martin P; Urquhart-Secord, Rachel; Craig, Jonathan C

2015-08-19

Chronic kidney disease is a significant contributor to mortality and morbidity worldwide, and the number of people who require dialysis or transplantation continues to increase. People on dialysis are 15 times more likely to die than the general population. Dialysis is also costly, intrusive, and time-consuming and imposes an enormous burden on patients and their families. This escalating problem has spurred a proliferation of trials in dialysis, yet health and quality of life remain poor. The reasons for this are complex and varied but are attributable in part to problems in the design and reporting of studies, particularly outcome selection. Problems related to outcomes include use of unvalidated surrogates, outcomes of little or no relevance to patients, highly variable outcome selection limiting comparability across studies, and bias in reporting outcomes. The aim of the Standardised Outcomes in Nephrology-Haemodialysis (SONG-HD) study is to establish a core outcome set for haemodialysis trials, to improve the quality of reporting, and the relevance of trials conducted in people on haemodialysis. SONG-HD is a five-phase project that includes the following: a systematic review to identify outcomes that have been reported in haemodialysis systematic reviews and trials; nominal group technique with patients and caregivers to identify, rank, and describe reasons for their choices; qualitative stakeholder interviews with patients, caregivers, clinicians, researchers, and policy makers to elicit individual values and perspectives on outcomes for haemodialysis trials; a three-round Delphi survey with stakeholder groups to distil and generate a prioritised list of core outcomes; and a consensus workshop to establish a core outcome set for haemodialysis trials. Establishing a core outcome set to be consistently measured and reported in haemodialysis trials will improve the integrity, transparency, usability, and contribution of research relevant to patients requiring haemodialysis; ensure that outcomes of relevance to all stakeholders are consistently reported across trials; and mitigate against outcome reporting bias. Ultimately, patients will be more protected from potential harm, patients and clinicians will be better able to make informed decisions about treatment, and researchers and policy makers will be more able to maximise the value of research to the public.

Current trends in pharmacy benefit designs: a threat to disease management in chronic complex diseases.

PubMed

Owens, Gary; Emons, Matthew F; Christian-Herman, Jennifer; Lawless, Grant

2007-04-01

With a focus on those patients who are candidates for treatment with biologic agents, we review the impact that current pharmacy benefit trends have on patients with chronic complex diseases and how they affect opportunities for disease management in this unique patient population. Dramatic increases in health care costs have led to a variety of strategies to manage cost. Many of these strategies either limit access to care or increase the patient's responsibility for choosing and paying for care, especially for medications. These strategies have a disproportionate impact on patients with chronic complex diseases, particularly those who require the use of biologic medications. A fundamental prerequisite of disease management has been coverage of disease-modifying therapies. If current pharmacy benefit trends continue, unintended consequences will likely occur including lost opportunities for disease management. Current pharmacy benefit trends could adversely impact disease management, particularly for patients requiring the use of biologic agents. Health plans should consider innovative benefit designs that reflect an appropriate level of cost sharing across all key stake-holders, ensuring appropriate access to needed therapies. Additional research is needed to clarify the value of newer approaches to therapies or benefit design changes.

Dictating participation? Rethinking the adaptive co-management of socio-ecological systems in West Africa

NASA Astrophysics Data System (ADS)

El Vilaly, Audra; Abd salam El Vilaly, Mohamed

2015-04-01

In the face of environmental change, enhancing adaptive capacity relies on stakeholder engagement. But the participatory process, while critical to the translation, transfer, and application of scientific knowledge to society, is not without its own contradictions. These include the asymmetrical relations of power that prevail between environmental scientists, managers, and local users; discrepant understandings of knowledge and its appropriate uses; and conflicting social, economic, and ecological values, to name only a few. Our research examines five major transboundary river basin organizations in West Africa and their efforts to improve adaptive basin management via stakeholder collaboration. In particular, we evaluate the participatory strategies of these organizations to measure non-linear, multi-directional feedbacks between the social and biophysical factors of land use/land cover change, as well as the impacts of this change on basins and their dependent populations. Our research suggests that oftentimes, these methods paradoxically produce a hierarchical and marginalizing effect on local stakeholders in relation to the scientists that study them. In seeking to address these limitations, we assess the potential costs and benefits of integrating select components of a Participatory Action Research (PAR) framework (see, for example, Reason & Bradbury-Huang, 2007) into studies of complex socio-ecological problems. This approach, used widely in the social sciences, promotes critical reflection on and minimization of the power inequities inherent in science-society collaborations. It instead favors more horizontal forms of knowledge co-production that support and foster the expansion of local, existing movements for social and environmental justice. A PAR framework may therefore improve the efficiency, sustainability, and equitability of land-based adaptation to environmental change; further research is thus recommended to test this hypothesis. References: Reason, P. & Bradbury-Huang, H. (2007). Handbook of Action Research: Participative Inquiry and Practice, London, Sage.

Stakeholders' participatory diagnosis of climate change impacts on subsistence agriculture in Sikkim, India, for identifying adaptation strategies

NASA Astrophysics Data System (ADS)

Azhoni, A.; Goyal, M. K.

2017-12-01

Narrowing the gap between research, policy making and implementing adaptation remains a challenge in many parts of the world where climate change is likely to severely impact subsistence agriculture. This research aims to narrow this gap by matching the adaptation strategies being framed by policy makers and perspectives of consultants and researchers which are expected to be implemented by development agencies farmers in the state of Sikkim in India. Our case study examined the framing and implementation of State Action Plan on Climate Change through semi-structured interviews carried out with decision makers in the State Government, Scientific Organisations, consultants, local academia, implementing and development agencies, and farmers for whom the adaptation strategies are targeted. Using Social Network and Stakeholder Analysis approach, this research unravels the complexities of perceiving climate change impacts, identifying adaptation strategies, and implementing climate change adaptation strategies. While farmers are less aware about the global phenomenon of climate change impacts for their subsistence livelihood, their knowledge of the local conditions and their close interaction with the State Government Agriculture Department provides them an access to new and high value crops. Although important steps are initiated through the Sikkim State Action Plan on Climate Change it is yet to deliver effective means of adaptation implementation and identifying the networks of close coordination between the various implementing agencies will likely to pay rich dividends. While Sikkim being a small and hilly state with specific contextual challenges of climate change impacts, the results from this study highlights how the internal and external networks between various types of stakeholders informs decision makers in identifying local impacts of climate change and plan adaptation strategies.

The organising vision for telehealth and telecare: discourse analysis.

PubMed

Greenhalgh, Trisha; Procter, Rob; Wherton, Joe; Sugarhood, Paul; Shaw, Sara

2012-01-01

To (1) map how different stakeholders understand telehealth and telecare technologies and (2) explore the implications for development and implementation of telehealth and telecare services. Discourse analysis. 68 publications representing diverse perspectives (academic, policy, service, commercial and lay) on telehealth and telecare plus field notes from 10 knowledge-sharing events. Following a familiarisation phase (browsing and informal interviews), we studied a systematic sample of texts in detail. Through repeated close reading, we identified assumptions, metaphors, storylines, scenarios, practices and rhetorical positions. We added successive findings to an emerging picture of the whole. Telehealth and telecare technologies featured prominently in texts on chronic illness and ageing. There was no coherent organising vision. Rather, four conflicting discourses were evident and engaged only minimally with one another's arguments. Modernist discourse presented a futuristic utopian vision in which assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe 'smart' home environment where help was always at hand, while generating efficiency savings. Humanist discourse emphasised the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems. Political economy discourse envisaged a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business. Change management discourse recognised the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes. Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions, values and world views, 'talk past' each other and compete for recognition and resources. If investments in these technologies are to bear fruit, more effective inter-stakeholder dialogue must occur to establish an organising vision that better accommodates competing discourses.

A framework for complexity in palliative care: A qualitative study with patients, family carers and professionals.

PubMed

Pask, Sophie; Pinto, Cathryn; Bristowe, Katherine; van Vliet, Liesbeth; Nicholson, Caroline; Evans, Catherine J; George, Rob; Bailey, Katharine; Davies, Joanna M; Guo, Ping; Daveson, Barbara A; Higginson, Irene J; Murtagh, Fliss Em

2018-06-01

Palliative care patients are often described as complex but evidence on complexity is limited. We need to understand complexity, including at individual patient-level, to define specialist palliative care, characterise palliative care populations and meaningfully compare interventions/outcomes. To explore palliative care stakeholders' views on what makes a patient more or less complex and insights on capturing complexity at patient-level. In-depth qualitative interviews, analysed using Framework analysis. Semi-structured interviews across six UK centres with patients, family, professionals, managers and senior leads, purposively sampled by experience, background, location and setting (hospital, hospice and community). 65 participants provided an understanding of complexity, which extended far beyond the commonly used physical, psychological, social and spiritual domains. Complexity included how patients interact with family/professionals, how services' respond to needs and societal perspectives on care. 'Pre-existing', 'cumulative' and 'invisible' complexity are further important dimensions to delivering effective palliative and end-of-life care. The dynamic nature of illness and needs over time was also profoundly influential. Adapting Bronfenbrenner's Ecological Systems Theory, we categorised findings into the microsystem (person, needs and characteristics), chronosystem (dynamic influences of time), mesosystem (interactions with family/health professionals), exosystem (palliative care services/systems) and macrosystem (societal influences). Stakeholders found it acceptable to capture complexity at the patient-level, with perceived benefits for improving palliative care resource allocation. Our conceptual framework encompasses additional elements beyond physical, psychological, social and spiritual domains and advances systematic understanding of complexity within the context of palliative care. This framework helps capture patient-level complexity and target resource provision in specialist palliative care.

Stakeholder assessment of comparative effectiveness research needs for Medicaid populations.

PubMed

Fischer, Michael A; Allen-Coleman, Cora; Farrell, Stephen F; Schneeweiss, Sebastian

2015-09-01

Patients, providers and policy-makers rely heavily on comparative effectiveness research (CER) when making complex, real-world medical decisions. In particular, Medicaid providers and policy-makers face unique challenges in decision-making because their program cares for traditionally underserved populations, especially children, pregnant women and people with mental illness. Because these patient populations have generally been underrepresented in research discussions, CER questions for these groups may be understudied. To address this problem, the Agency for Healthcare Research and Quality commissioned our team to work with Medicaid Medical Directors and other stakeholders to identify relevant CER questions. Through an iterative process of topic identification and refinement, we developed relevant, feasible and actionable questions based on issues affecting Medicaid programs nationwide. We describe challenges and limitations and provide recommendations for future stakeholder engagement.

Web-Based Self-Service Systems for Managed IT Support: Service Provider Perspectives of Stakeholder-Based Issues

NASA Astrophysics Data System (ADS)

Cooper, Vanessa A.; Lichtenstein, Sharman; Smith, Ross

This chapter explores the provision of after-sales information technology (IT) support services using Web-based self-service systems (WSSs) in a business-to-business (B2B) context. A recent study conducted at six large multi-national IT support organisations revealed a number of critical success factors (CSFs) and stakeholder-based issues. To better identify and understand these important enablers and barriers, we explain how WSSs should be considered within a complex network of service providers, business partners and customer firms. The CSFs and stakeholder-based issues are discussed. The chapter highlights that for more successful service provision using WSSs, IT service providers should collaborate more effectively with enterprise customers and business partners and should better integrate their WSSs.

Stakeholder assessment of comparative effectiveness research needs for Medicaid populations

PubMed Central

Fischer, Michael A; Allen-Coleman, Cora; Farrell, Stephen F; Schneeweiss, Sebastian

2015-01-01

Patients, providers and policy-makers rely heavily on comparative effectiveness research (CER) when making complex, real-world medical decisions. In particular, Medicaid providers and policy-makers face unique challenges in decision-making because their program cares for traditionally underserved populations, especially children, pregnant women and people with mental illness. Because these patient populations have generally been underrepresented in research discussions, CER questions for these groups may be understudied. To address this problem, the Agency for Healthcare Research and Quality commissioned our team to work with Medicaid Medical Directors and other stakeholders to identify relevant CER questions. Through an iterative process of topic identification and refinement, we developed relevant, feasible and actionable questions based on issues affecting Medicaid programs nationwide. We describe challenges and limitations and provide recommendations for future stakeholder engagement. PMID:26388438

WATERSHED-ESTUARY SUSTAINABILITY: WHAT STAKEHOLDERS VALUE

EPA Science Inventory

Sustainable development is defined as "development that meets the needs of the present without compromising the ability of future generations to meet their own needs"1. To evaluate the present attributes valued versus the potential effects of development and other land use chang...

Advancing the Guánica Bay (Puerto Rico) Watershed Management Plan

EPA Science Inventory

Consideration of stakeholder values in watershed planning and management is a necessity, but sufficiently eliciting, understanding, and organizing those values can be daunting. Many studies have demonstrated the usefulness of formal decision analysis to integrate expert knowledge...

Transit value capture coordination : case studies, best practices, and recommendations.

DOT National Transportation Integrated Search

2015-02-17

This study is based on the hypothesis that coordination between transit capital planners, municipal taxation authorities, and private developers and stakeholders can be a benefit to transit capital projects that choose to use value capture as a fundi...

Preparing the Dutch delta for future droughts: model based support in the national Delta Programme

NASA Astrophysics Data System (ADS)

ter Maat, Judith; Haasnoot, Marjolijn; van der Vat, Marnix; Hunink, Joachim; Prinsen, Geert; Visser, Martijn

2014-05-01

Keywords: uncertainty, policymaking, adaptive policies, fresh water management, droughts, Netherlands, Dutch Deltaprogramme, physically-based complex model, theory-motivated meta-model To prepare the Dutch Delta for future droughts and water scarcity, a nation-wide 4-year project, called Delta Programme, is established to assess impacts of climate scenarios and socio-economic developments and to explore policy options. The results should contribute to a national adaptive plan that is able to adapt to future uncertain conditions, if necessary. For this purpose, we followed a model-based step-wise approach, wherein both physically-based complex models and theory-motivated meta-models were used. First step (2010-2011) was to make a quantitative problem description. This involved a sensitivity analysis of the water system for drought situations under current and future conditions. The comprehensive Dutch national hydrological instrument was used for this purpose and further developed. Secondly (2011-2012) our main focus was on making an inventory of potential actions together with stakeholders. We assessed efficacy, sell-by date of actions, and reassessed vulnerabilities and opportunities for the future water supply system if actions were (not) taken. A rapid assessment meta-model was made based on the complex model. The effects of all potential measures were included in the tool. Thirdly (2012-2013), with support of the rapid assessment model, we assessed the efficacy of policy actions over time for an ensemble of possible futures including sea level rise and climate and land use change. Last step (2013-2014) involves the selection of preferred actions from a set of promising actions that meet the defined objectives. These actions are all modeled and evaluated using the complex model. The outcome of the process will be an adaptive management plan. The adaptive plan describes a set of preferred policy pathways - sequences of policy actions - to achieve targets under changing conditions. The plan commits to short term actions, and identifies signpost indicators and trigger values to assess if next actions of the identified policy pathways need to be implemented or if reassessment of the plan is needed. For example, river discharges could be measured to monitor changes in low discharges as a result of climate change, and assess whether policy options such as diverting more water the main fresh water lake (IJsselmeer) need to be implemented sooner or later or not at all. The adaptive plan of the Delta Programme will be presented in 2014. First lessons of this part of the Delta Programme can already be drawn: Both the complex and meta-model had its own purpose in each phase. The meta-model was particularly useful for identifying promising policy options and for consultation of stakeholders due to the instant response. The complex model had much more opportunities to assess impacts of regional policy actions, and was supported by regional stakeholders that recognized their areas better in this model. Different sector impact assessment modules are also included in the workflow of the complex model. However, the complex model has a long runtime (i.e. three days for 1 year simulation or more than 100 days for 35 year time series simulation), which makes it less suitable to support the dynamic policy process on instant demand and interactively.

Canadian 24-Hour Movement Guidelines for Children and Youth: Exploring the perceptions of stakeholders regarding their acceptability, barriers to uptake, and dissemination.

PubMed

Faulkner, Guy; White, Lauren; Riazi, Negin; Latimer-Cheung, Amy E; Tremblay, Mark S

2016-06-01

Engaging stakeholders in the development of guidelines and plans for implementation is vital. The purpose of this study was to examine stakeholders' (parents, teachers, exercise professionals, paediatricians, and youth) perceptions of the Canadian 24-Hour Movement Behaviour Guidelines for Children and Youth ("Movement Guidelines"). Stakeholders (n = 104) engaged in semi-structured focus groups or interviews to discuss the perceived acceptability of the guidelines, potential barriers to implementation, and preferred methods and messengers of dissemination. A thematic analysis was conducted. Overall, there was consistent support across all stakeholder groups, with the exception of youth participants, for the Movement Guidelines. Stakeholders identified a range of barriers to the uptake of the guidelines including concerns with accurately defining key terms such as "recreational" screen time; everyday challenges such as financial and time constraints; and the possibility of the Movement Guidelines becoming just another source of stress and guilt for already busy and overwhelmed parents. Participants identified a range of recommended methods and messengers for future dissemination. School and medical settings were the most commonly recommended settings through which dissemination efforts should be delivered. Overall, participants representing a range of stakeholder groups were receptive to the new Movement Guidelines and endorsed their value. In complementing the Movement Guidelines, messaging and resources will need to be developed that address common concerns participants had regarding their dissemination and implementation.

Stakeholders identify similar barriers but different strategies to facilitate return-to-work: A vignette of a worker with an upper extremity condition.

PubMed

Peters, Susan E; Truong, Anthony P; Johnston, Venerina

2018-01-01

Stakeholders involved in the return-to-work (RTW) process have different roles and qualificationsOBJECTIVE:To explore the perspectives of Australian stakeholders of the RTW barriers and strategies for a worker with an upper extremity condition and a complex workers' compensation case. Using a case vignette, stakeholders were asked to identify barriers and recommend strategies to facilitate RTW. Content analysis was performed on the open-ended responses. The responses were categorised into RTW barriers and strategies using the biopsychosocial model. Pearson's Chi Square and ANOVA were performed to establish group differences. 621 participants (488 healthcare providers (HCPs), 62 employers, 55 insurers and 16 lawyers) identified 36 barriers (31 modifiable): 4 demographic; 8 biological; 15 psychological and 9 social barriers. 484 participants reported 16 RTW strategies: 4 biological; 6 psychological and 6 social strategies. 'Work relationship stressors' (83.4%) and 'Personal relationship stressors' (64.7%) were the most frequently nominated barriers. HCPs most frequently nominated 'Pain management' (49.6%), while employers, insurers and lawyers nominated 'RTW planning/Suitable duties programs' (40.5%; 42.9%; 80%). Stakeholders perceived similar barriers for RTW but recommended different strategies. Stakeholders appeared to be more proficient in identifying barriers than recommending strategies. Future research should focus on tools to both identify RTW barriers and direct intervention.

Systems Thinking as a Competency for Community College Leaders in an Era of Increasing Complexity

ERIC Educational Resources Information Center

Davis, Anne Powel

2013-01-01

The pluralistic and often competing goals of myriad constituents, the changing demographics of students, the uncertainty of funding, and the growing demands for accountability from stakeholders have increased the complexity of systems which community college leaders must manage. Emerging from the recent literature on community colleges is a call…

Identifying Values: The Front-End of Systemic School Restructuring.

ERIC Educational Resources Information Center

Lee, In-Sook

The comprehensive categories of values, and the values in each category, to be articulated and consented to by stakeholders in school restructuring are explored through a qualitative case-study approach. A public elementary school that had approximately 530 students and that was undergoing restructuring was selected. Site visits, document reviews,…

Understandings of Environmental Quality: Ambiguities and Values Held by Environmental Professionals

Treesearch

R. Bruce Hull; David Richert; Erin Seekamp; David Robertson; Gregory J. Buhyoff

2003-01-01

The terms used to describe and negotiate environmental quality are both ambiguous and value-laden. Stakeholders intimately and actively involved in the management of forested lands were interviewed and found to use ambiguous, tautological, and value-laden definitions of terms such as health, biodiversity, sustainability, and naturalness. This confusing language...

Role of Health Services Research in Producing High-Value Rehabilitation Care.

PubMed

Rundell, Sean D; Goode, Adam P; Friedly, Janna L; Jarvik, Jeffrey G; Sullivan, Sean D; Bresnahan, Brian W

2015-12-01

The concept of value is receiving greater attention in rehabilitation and the broader health care environment. The overall purpose of this article is to present a framework to help clinicians, researchers, educators, and policy makers better understand the role of health services research in developing and evaluating evidence on value in rehabilitation. Value in health care is a multidimensional concept and may be defined differently by various stakeholders, but assessing value typically involves considering a combination of several health and economic outcomes. However, health care stakeholders often lack sufficient information on these outcomes to make well-informed decisions. Health services approaches such as comparative effectiveness research, patient-centered outcomes research, and health economics assessments are some ways to evaluate value. The evidence generated from such studies directly informs decision making and health policy. Rehabilitation professionals have a great opportunity to increase their engagement in describing, evaluating, delivering, and disseminating high-value care, but there are several barriers they need to consider to be most successful. Embracing health services research best practices is essential for advancing appropriate rehabilitation practice, research, and policy and for addressing challenges to implementing high-value care. © 2015 American Physical Therapy Association.

Role of Health Services Research in Producing High-Value Rehabilitation Care

PubMed Central

Goode, Adam P.; Friedly, Janna L.; Jarvik, Jeffrey G.; Sullivan, Sean D.; Bresnahan, Brian W.

2015-01-01

The concept of value is receiving greater attention in rehabilitation and the broader health care environment. The overall purpose of this article is to present a framework to help clinicians, researchers, educators, and policy makers better understand the role of health services research in developing and evaluating evidence on value in rehabilitation. Value in health care is a multidimensional concept and may be defined differently by various stakeholders, but assessing value typically involves considering a combination of several health and economic outcomes. However, health care stakeholders often lack sufficient information on these outcomes to make well-informed decisions. Health services approaches such as comparative effectiveness research, patient-centered outcomes research, and health economics assessments are some ways to evaluate value. The evidence generated from such studies directly informs decision making and health policy. Rehabilitation professionals have a great opportunity to increase their engagement in describing, evaluating, delivering, and disseminating high-value care, but there are several barriers they need to consider to be most successful. Embracing health services research best practices is essential for advancing appropriate rehabilitation practice, research, and policy and for addressing challenges to implementing high-value care. PMID:26316531

Integrated Reporting as a Tool for Communicating with Stakeholders - Advantages and Disadvantages

NASA Astrophysics Data System (ADS)

Matuszyk, Iwona; Rymkiewicz, Bartosz

2018-03-01

Financial and non-financial reporting from the beginning of its existence is the primary source of communication between the company and a wide range of stakeholders. Over the decades it has adapted to the needs of rapidly changing business and social environment. Currently, the final link in the evolution of organizational reporting, such as integrated reporting, assumes integration and mutual connectivity to both financial and non-financial data. The main interest in the concept of integrated reporting comes from the value it contributes to the organization. Undoubtedly, the concept of integrated reporting is a milestone in the evolution of organizational reporting. It is however important to consider whether it adequately addresses the information needs of a wide range of stakeholders, and whether it is a universal tool for communication between the company and its stakeholders. The aim of the paper is to discuss the advantages and disadvantages of the concept of integrated reporting as a tool for communication with stakeholders and to further directions of its development. The article uses the research methods such as literature analysis, the content analysis of the corporate publications and comparative analysis.

Two dimensions of nitrate pollution management in an agricultural catchment

NASA Astrophysics Data System (ADS)

Wachniew, Przemysław; Martinez, Grit; Bar-Michalczyk, Dominika; Kania, Jarosław; Malina, Grzegorz; Michalczyk, Tomasz; Różański, Kazimierz; Witczak, Stanisław; Zięba, Damian; Żurek, Anna J.; Berrini, Anne

2017-04-01

The Kocinka River catchment underlain by the karstic-fissured upper Jurrasic Częstochowa aquifer in Southern Poland is the site of an interdisciplinary research aimed at finding solutions to pollution of water resources with nutrients. These efforts are conducted in the framework of the BONUS Soils2Sea project that deals with the development of differentiated environmental management measures based on utilization of the natural ability of soils, groundwater and surface water to remove surplus nutrients. Implementation of these or any other measures for the improvement of water quality depends primarily on the perceptions and attitudes of the major actors, which in turn are a product of the socio-economic, cultural-historical and political development spanning many generations. The problem of the deteriorating water quality is therefore twofold. Understanding the complex natural system consisting of the coupled groundwater and surface water component with a wide spectrum of time lags of pollution transport is only the beginning of the solution. The mitigation policies and measures based on this scientific knowledge have to recognize the equally complex nature of social factors and interactions. Implementation of the European and national policies and legislations has to take into account the regional perspective. Identification of the key stakeholders is in this regard a first step followed by an inquiry into their values, perceptions and motivations through interviews, workshops, etc. Understanding of the socio-cultural, historical, economic and political factors that shape stakeholder actions is a prerequisite for the development of the successful management and mitigation schemes. The process of gaining insights into the environmental and social aspects of nutrient pollution in the Kocinka catchment is partly presented by the documentary film "Soils2Sea: Reducing nutrient loadings into the Baltic Sea" (https://www.youtube.com/watch?v=LUouES4SeJk).

Modeling and management of water in the Klamath River Basin: overcoming politics and conflicts

USGS Publications Warehouse

Flug, Marshall; Scott, John F.; Abt, Steven R.; Young-Pezeshk, Jayne; Watson, Chester C.

1998-01-01

The network flow model MODSIM, which was designed as a water quantity mass balance model for evaluating and selecting water management alternatives, has been applied to the Klamath River basin. A background of conflicting issues in the basin is presented. The complexity of water quantity model development, while satisfying the many stakeholders and involved special interest groups is discussed, as well as the efforts taken to have the technical model accepted and used, and overcome stakeholder criticism, skepticism, and mistrust of the government.

Developing principles of sustainability and stakeholder engagement for "gentle" remediation approaches: the European context.

PubMed

Cundy, A B; Bardos, R P; Church, A; Puschenreiter, M; Friesl-Hanl, W; Müller, I; Neu, S; Mench, M; Witters, N; Vangronsveld, J

2013-11-15

Gentle Remediation Options (GRO) are risk management strategies or techniques for contaminated sites that result in no gross reduction in soil functionality (or a net gain) as well as risk management. Intelligently applied GROs can provide: (a) rapid risk management via pathway control, through containment and stabilisation, coupled with a longer term removal or immobilisation/isolation of the contaminant source term; and (b) a range of additional economic (e.g. biomass generation), social (e.g. leisure and recreation) and environmental (e.g. CO2 sequestration) benefits. In order for these benefits to be optimised or indeed realised, effective stakeholder engagement is required. This paper reviews current sector practice in stakeholder engagement and its importance when implementing GRO and other remediation options. From this, knowledge gaps are identified, and strategies to promote more effective stakeholder engagement during GRO application are outlined. Further work is required on integrating stakeholder engagement strategies into decision support systems and tools for GRO (to raise the profile of the benefits of effective stakeholder engagement and participation, particularly with sector professionals), and developing criteria for the identification of different stakeholder profiles/categories. Demonstrator sites can make a significant contribution to stakeholder engagement via providing evidence on the effectiveness of GRO under varying site contexts and conditions. Effective and sustained engagement strategies however will be required to ensure that site risk is effectively managed over the longer-term, and that full potential benefits of GRO (e.g. CO2 sequestration, economic returns from biomass generation and "leverage" of marginal land, amenity and educational value, ecosystem services) are realised and communicated to stakeholders. Copyright © 2013 Elsevier Ltd. All rights reserved.

PACE Continuous Innovation Indicators—a novel tool to measure progress in cancer treatments

PubMed Central

Paddock, Silvia; Brum, Lauren; Sorrow, Kathleen; Thomas, Samuel; Spence, Susan; Maulbecker-Armstrong, Catharina; Goodman, Clifford; Peake, Michael; McVie, Gordon; Geipel, Gary; Li, Rose

2015-01-01

Concerns about rising health care costs and the often incremental nature of improvements in health outcomes continue to fuel intense debates about ‘progress’ and ‘value’ in cancer research. In times of tightening fiscal constraints, it is increasingly important for patients and their representatives to define what constitutes ’value’ to them. It is clear that diverse stakeholders have different priorities. Harmonisation of values may be neither possible nor desirable. Stakeholders lack tools to visualise or otherwise express these differences and to track progress in cancer treatments based on variable sets of values. The Patient Access to Cancer care Excellence (PACE) Continuous Innovation Indicators are novel, scientifically rigorous progress trackers that employ a three-step process to quantify progress in cancer treatments: 1) mine the literature to determine the strength of the evidence supporting each treatment; 2) allow users to weight the analysis according to their priorities and values; and 3) calculate Evidence Scores (E-Scores), a novel measure to track progress, based on the strength of the evidence weighted by the assigned value. We herein introduce a novel, flexible value model, show how the values from the model can be used to weight the evidence from the scientific literature to obtain E-Scores, and illustrate how assigning different values to new treatments influences the E-Scores. The Indicators allow users to learn how differing values lead to differing assessments of progress in cancer research and to check whether current incentives for innovation are aligned with their value model. By comparing E-Scores generated by this tool, users are able to visualise the relative pace of innovation across areas of cancer research and how stepwise innovation can contribute to substantial progress against cancer over time. Learning from experience and mapping current unmet needs will help to support a broad audience of stakeholders in their efforts to accelerate and maximise progress against cancer. PMID:25624879

Confronting Oahu's Water Woes: Identifying Scenarios for a Robust Evaluation of Policy Alternatives

NASA Astrophysics Data System (ADS)

van Rees, C. B.; Garcia, M. E.; Alarcon, T.; Sixt, G.

2013-12-01

The Pearl Harbor aquifer is the most important freshwater resource on Oahu (Hawaii, U.S.A), providing water to nearly half a million people. Recent studies show that current water use is reaching or exceeding sustainable yield. Climate change and increasing resident and tourist populations are predicted to further stress the aquifer. The island has lost huge tracts of freshwater and estuarine wetlands since human settlement; the dependence of many endemic, endangered species on these wetlands, as well as ecosystem benefits from wetlands, link humans and wildlife through water management. After the collapse of the sugar industry on Oahu (mid-1990s), the Waiahole ditch--a massive stream diversion bringing water from the island's windward to the leeward side--became a hotly disputed resource. Commercial interests and traditional farmers have clashed over the water, which could also serve to support the Pearl Harbor aquifer. Considering competing interests, impending scarcity, and uncertain future conditions, how can groundwater be managed most effectively? Complex water networks like this are characterized by conflicts between stakeholders, coupled human-natural systems, and future uncertainty. The Water Diplomacy Framework offers a model for analyzing such complex issues by integrating multiple disciplinary perspectives, identifying intervention points, and proposing sustainable solutions. The Water Diplomacy Framework is a theory and practice of implementing adaptive water management for complex problems by shifting the discussion from 'allocation of water' to 'benefit from water resources'. This is accomplished through an interactive process that includes stakeholder input, joint fact finding, collaborative scenario development, and a negotiated approach to value creation. Presented here are the results of the initial steps in a long term project to resolve water limitations on Oahu. We developed a conceptual model of the Pearl Harbor Aquifer system and identified three primary drivers of sustainability of the water supply: demand, recharge, and sea level rise. We then determined the secondary drivers shaping the primary drivers and separated them into two groups: policy-relevant drivers and external drivers. We developed a simple water balance model to calculate maximum sustainable yield based on soil properties, land cover, daily precipitation and temperature. To identify critical scenarios, the model was run over the full forecasted ranges of external drivers, such as temperature, precipitation, sea level, and population. Only the status quo of the policy drivers such as land use, water use per capita, and habitat protection has been modeled to date. However, our next steps include working with stakeholders to elicit policy strategies such as conservation regulations or zoning plans, and testing the robustness of proposed strategies with the model developed.

Financial Analysis for R&D Decisions.

ERIC Educational Resources Information Center

Carter, Robert

1997-01-01

Using personal computer spreadsheet software, standard corporate financial analysis can help university research administrators communicate the value of research and development to sponsors and other stakeholders; balance projects, technologies, or categories of research; and continually assess the value of investing in ongoing projects. It also…

Developing a framework to guide the de-adoption of low-value clinical practices in acute care medicine: a study protocol.

PubMed

Parsons Leigh, Jeanna; Niven, Daniel J; Boyd, Jamie M; Stelfox, Henry T

2017-01-19

Healthcare systems have difficulty incorporating scientific evidence into clinical practice, especially when science suggests that existing clinical practices are of low-value (e.g. ineffective or harmful to patients). While a number of lists outlining low-value practices in acute care medicine currently exist, less is known about how best to initiate and sustain the removal of low-value clinical practices (i.e. de-adoption). This study will develop a comprehensive list of barriers and facilitators to the de-adoption of low-value clinical practices in acute care facilities to inform the development of a framework to guide the de-adoption process. The proposed project is a multi-stage mixed methods study to develop a framework to guide the de-adoption of low-value clinical practices in acute care medicine that will be tested in a representative sample of acute care settings in Alberta, Canada. Specifically, we will: 1) conduct a systematic review of the de-adoption literature to identify published barriers and facilitators to the de-adoption of low-value clinical practices in acute care medicine and any associated interventions proposed (Phase one); 2) conduct focus groups with acute care stakeholders to identify important themes not published in the literature and obtain a comprehensive appreciation of stakeholder perspectives (Phase two); 3) extend the generalizability of focus group findings by conducting individual stakeholder surveys with a representative sample of acute care providers throughout the province to determine which barriers and facilitators identified in Phases one and two are most relevant in their clinical setting (Phase three). Identified barriers and facilitators will be catalogued and integrated with targeted interventions in a framework to guide the process of de-adoption in each of four targeted areas of acute care medicine (Emergency Medicine, Cardiovascular Health and Stroke, Surgery and Critical Care Medicine). Analyses will be descriptive using a combination of qualitative and quantitative analyses. There is a growing body of literature suggesting that the de-adoption of ineffective or harmful practices from patient care is integral to the delivery of high quality care and healthcare sustainability. The framework developed in this study will map barriers and facilitators to de-adoption to the most appropriate interventions, allowing stakeholders to effectively initiate, execute and sustain this process in an evidence-based manner.

How to and how not to develop a theory of change to evaluate a complex intervention: reflections on an experience in the Democratic Republic of Congo.

PubMed

Maini, Rishma; Mounier-Jack, Sandra; Borghi, Josephine

2018-01-01

Theories of change (ToCs) describe how interventions can bring about long-term outcomes through a logical sequence of intermediate outcomes and have been used to design and measure the impact of public health programmes in several countries. In recognition of their capacity to provide a framework for monitoring and evaluation, they are being increasingly employed in the development sector. The construction of a ToC typically occurs through a consultative process, requiring stakeholders to reflect on how their programmes can bring about change. ToCs help make explicit any underlying assumptions, acknowledge the role of context and provide evidence to justify the chain of causal pathways. However, while much literature exists on how to develop a ToC with respect to interventions in theory, there is comparatively little reflection on applying it in practice to complex interventions in the health sector. This paper describes the initial process of developing a ToC to inform the design of an evaluation of a complex intervention aiming to improve government payments to health workers in the Democratic Republic of Congo. Lessons learnt include: the need for the ToC to understand how the intervention produces effects on the wider system and having broad stakeholder engagement at the outset to maximise chances of the intervention's success and ensure ownership. Power relationships between stakeholders may also affect the ToC discourse but can be minimised by having an independent facilitator. We hope these insights are of use to other global public health practitioners using this approach to evaluate complex interventions.

Stakeholder analysis for the development of a community pharmacy service aimed at preventing cardiovascular disease.

PubMed

Franco-Trigo, L; Hossain, L N; Durks, D; Fam, D; Inglis, S C; Benrimoj, S I; Sabater-Hernández, D

Participatory approaches involving stakeholders across the health care system can help enhance the development, implementation and evaluation of health services. These approaches may be particularly useful in planning community pharmacy services and so overcome challenges in their implementation into practice. Conducting a stakeholder analysis is a key first step since it allows relevant stakeholders to be identified, as well as providing planners a better understanding of the complexity of the health care system. The main aim of this study was to conduct a stakeholder analysis to identify those individuals and organizations that could be part of a leading planning group for the development of a community pharmacy service (CPS) to prevent cardiovascular disease (CVD) in Australia. An experienced facilitator conducted a workshop with 8 key informants of the Australian health care system. Two structured activities were undertaken. The first explored current needs and gaps in cardiovascular care and the role of community pharmacists. The second was a stakeholder analysis, using both ex-ante and ad-hoc approaches. Identified stakeholders were then classified into three groups according to their relative influence on the development of the pharmacy service. The information gathered was analyzed using qualitative content analysis. The key informants identified 46 stakeholders, including (1) patient/consumers and their representative organizations, (2) health care providers and their professional organizations and (3) institutions and organizations that do not directly interact with patients but organize and manage the health care system, develop and implement health policies, pay for health care, influence funding for health service research or promote new health initiatives. From the 46 stakeholders, a core group of 12 stakeholders was defined. These were considered crucial to the service's development because they held positions that could drive or inhibit progress. Secondary results of the workshop included: a list of needs and gaps in cardiovascular care (n = 6), a list of roles for community pharmacists in cardiovascular prevention (n = 12) and a list of potential factors (n = 7) that can hinder the integration of community pharmacy services into practice. This stakeholder analysis provided a detailed picture of the wide range of stakeholders across the entire health care system that have a stake in the development of a community pharmacy service aimed at preventing CVD. Of these, a core group of key stakeholders, with complementary roles, can then be approached for further planning of the service. The results of this analysis highlight the relevance of establishing multilevel stakeholder groups for CPS planning. Copyright © 2016 Elsevier Inc. All rights reserved.

Using Multicriteria Approaches to Assess the Value of Health Care.

PubMed

Phelps, Charles E; Madhavan, Guruprasad

2017-02-01

Practitioners of cost-utility analysis know that their models omit several important factors that often affect real-world decisions about health care options. Furthermore, cost-utility analyses typically reflect only single perspectives (e.g., individual, business, and societal), further limiting the value for those with different perspectives (patients, providers, payers, producers, and planners-the 5Ps). We discuss how models based on multicriteria analyses, which look at problems from many perspectives, can fill this void. Each of the 5Ps can use multicriteria analyses in different ways to aid their decisions. Each perspective may lead to different value measures and outcomes, whereas no single-metric approach (such as cost-utility analysis) can satisfy all these stakeholders. All stakeholders have unique ways to measure value, even if assessing the same health intervention. We illustrate the benefits of this approach by comparing the value of five different hypothetical treatment choices for five hypothetical patients with cancer, each with different preference structures. Nine attributes describe each treatment option. We add a brief discussion regarding the use of these approaches in group-based decisions. We urge that methods to value health interventions embrace the multicriteria approaches that we discuss, because these approaches 1) increase transparency about the decision process, 2) allow flight simulator-type evaluation of alternative interventions before actual investment or deployment, 3) help focus efforts to improve data in an efficient manner, 4) at least in some cases help facilitate decision convergence among stakeholders with differing perspectives, and 5) help avoid potential cognitive errors known to impair intuitive judgments. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

One Health stakeholder and institutional analysis in Kenya

PubMed Central

Kimani, Tabitha; Ngigi, Margaret; Schelling, Esther; Randolph, Tom

2016-01-01

Introduction One Health (OH) can be considered a complex emerging policy to resolve health issues at the animal–human and environmental interface. It is expected to drive system changes in terms of new formal and informal institutional and organisational arrangements. This study, using Rift Valley fever (RVF) as a zoonotic problem requiring an OH approach, sought to understand the institutionalisation process at national and subnational levels in an early adopting country, Kenya. Materials and methods Social network analysis methodologies were used. Stakeholder roles and relational data were collected at national and subnational levels in 2012. Key informants from stakeholder organisations were interviewed, guided by a checklist. Public sector animal and public health organisations were interviewed first to identify other stakeholders with whom they had financial, information sharing and joint cooperation relationships. Visualisation of the OH social network and relationships were shown in sociograms and mathematical (degree and centrality) characteristics of the network summarised. Results and discussion Thirty-two and 20 stakeholders relevant to OH were identified at national and subnational levels, respectively. Their roles spanned wildlife, livestock, and public health sectors as well as weather prediction. About 50% of national-level stakeholders had made significant progress on OH institutionalisation to an extent that formal coordination structures (zoonoses disease unit and a technical working group) had been created. However, the process had not trickled down to subnational levels although cross-sectoral and sectoral collaborations were identified. The overall binary social network density for the stakeholders showed that 35 and 21% of the possible ties between the RVF and OH stakeholders existed at national and subnational levels, respectively, while public health actors’ collaborations were identified at community/grassroots level. We recommend extending the OH network to include the other 50% stakeholders and fostering of the process at subnational-level building on available cross-sectoral platforms. PMID:27330042

Evidence-Based and Value-Based Decision Making About Healthcare Design: An Economic Evaluation of the Safety and Quality Outcomes.

PubMed

Zadeh, Rana; Sadatsafavi, Hessam; Xue, Ryan

2015-01-01

This study describes a vision and framework that can facilitate the implementation of evidence-based design (EBD), scientific knowledge base into the process of the design, construction, and operation of healthcare facilities and clarify the related safety and quality outcomes for the stakeholders. The proposed framework pairs EBD with value-driven decision making and aims to improve communication among stakeholders by providing a common analytical language. Recent EBD research indicates that the design and operation of healthcare facilities contribute to an organization's operational success by improving safety, quality, and efficiency. However, because little information is available about the financial returns of evidence-based investments, such investments are readily eliminated during the capital-investment decision-making process. To model the proposed framework, we used engineering economy tools to evaluate the return on investments in six successful cases, identified by a literature review, in which facility design and operation interventions resulted in reductions in hospital-acquired infections, patient falls, staff injuries, and patient anxiety. In the evidence-based cases, calculated net present values, internal rates of return, and payback periods indicated that the long-term benefits of interventions substantially outweighed the intervention costs. This article explained a framework to develop a research-based and value-based communication language on specific interventions along the planning, design and construction, operation, and evaluation stages. Evidence-based and value-based design frameworks can be applied to communicate the life-cycle costs and savings of EBD interventions to stakeholders, thereby contributing to more informed decision makings and the optimization of healthcare infrastructures. © The Author(s) 2015.

Value of Adaptive Drought Forecasting and Management for the ACF River Basin in the Southeast U.S.

NASA Astrophysics Data System (ADS)

Georgakakos, A. P.; Kistenmacher, M.

2016-12-01

In recent times, severe droughts in the southeast U.S. occur every 6 to 10 years and last for up to 4 years. During such drought episodes, the ACF River Basin supplies decline by up to 50 % of their normal levels, and water stresses increase rather markedly, exacerbating stakeholder anxiety and conflicts. As part of the ACF Stakeholder planning process, GWRI has developed new tools and carried out comprehensive assessments to provide quantitative answers to several important questions related to drought prediction and management: (i) Can dry and wet climatic periods be reliably anticipated with sufficiently long lead times? What drought indices can support reliable, skillful, and long-lead forecasts? (ii) What management objectives can seasonal climate forecasts benefit? How should benefits/impacts be shared? (iii) What operational adjustments are likely to mitigate stakeholder impacts or increase benefits consistent with stakeholder expectations? Regarding drought prediction, a large number of indices were defined and tested at different basin locations and lag times. These included local/cumulative unimpaired flows (UIFs) at 10 river nodes; Mean Areal Precipitation (MAP); Standard Precipitation Index (SPI); Palmer Drought Severity Index; Palmer Modified Drought Index; Palmer Z-Index; Palmer Hydrologic Drought Severity Index; and Soil Moisture—GWRI watershed model. Our findings show that all ACF sub-basins exhibit good forecast skill throughout the year and with sufficient lead time. Index variables with high explanatory value include: previous UIFs, soil moisture states (generated by the GWRI watershed model), and PDSI. Regarding drought management, assessments with coupled forecast-management schemes demonstrate that the use of adaptive forecast-management procedures improves reservoir operations and meets basin demands more reliably. Such improvements can support better management of lake levels, higher environmental and navigation flows, higher dependable power generation hours, and better management of consumptive uses without adverse impacts on other stakeholder interests. However, realizing these improvements requires (1) usage of adaptive reservoir management procedures (incorporating forecasts), and (2) stakeholder agreement on equitable benefit sharing.

Stakeholder Alignment for Requirements in GEOValue

NASA Astrophysics Data System (ADS)

Cutcher-Gershenfeld, J.; King, J. L.

2016-12-01

Observation systems that collect information on environmental parameters relevant to biological and physical earth resources provide value. This has been demonstrated so many times in so many ways that it is not worth deliberating. Earlier projects for research (whether it is possible to do this or that), or for "dual use," typically involving defense, have been successful. Wealthy parties have built their own systems. Less wealthy parties seek to sustain the systems they have built. The history of systems suggests that "requirements" will be the next step. The objective is to maximize the "return" on the substantial investment required for construction, deployment, maintenance and renewal of observation systems. Stakeholders and their interests are assessed to construct the requirements from which specifications are built. Specifications drive procurement, and procurement produces built systems. Complicated (e.g. space-based) systems have long times between requirements analysis and deployment. It all depends on getting the requirements right, which depends on understanding stakeholders and requirements. And this is where things get complicated. Stakeholders and interests change, sometimes rapidly, as what is possible is altered. It becomes increasingly difficult to achieve stakeholder alignment required for effective management of constituent politics at the heart of any expensive endeavor. This paper presents results from a major study of stakeholder alignment in the Earth Sciences, focused especially on EarthCube.

Exploring bi-directional and SMS messaging for communications between Public Health Agencies and their stakeholders: a qualitative study.

PubMed

Revere, Debra; Calhoun, Rebecca; Baseman, Janet; Oberle, Mark

2015-07-08

Communication technologies that enable bi-directional/two-way communications and cell phone texting (SMS) between public health agencies and their stakeholders may improve public health surveillance, ensure targeted distribution of alerts to hard-to-reach populations, reduce mortality and morbidity in an emergency, and enable a crucial feedback loop between public health agencies and the communities they serve. Building on prior work regarding health care provider preferences for receiving one-way public health communications by email, fax or SMS, we conducted a formative, exploratory study to understand how a bi-directional system and the incorporation of SMS in that system might be used as a strategy to send and receive messages between public health agencies and community-based organizations which serve vulnerable populations, health care providers, and public health workers. Our research question: Under what conditions and/or situations might public health agencies utilize bi-directional and/or SMS messaging for disseminating time-sensitive public health information (alerts, advisories, updates, etc.) to their stakeholders? A mixed methods (qualitative and quantitative) study was conducted between April and July 2014. Data collection included a survey distributed to health care providers and semi-structured interviews with providers, community- and government-based organization leaders and directors, and public health agency internal workforce staff. Survey respondents and interviewees were asked about their exposure to public health messages, how these messages are received and how the information in these messages are handled, and in what situations (for example, a local vs. a national event, a pandemic or emergency vs. a health update) a bi-directional and/or SMS messaging system might improve communications between public health agencies and their stakeholder group. Interview and survey data were qualitatively analyzed. Thematic codes were quantitized into dichotomous variables of 0 or 1 on a per respondent basis to enumerate the presence or absence of each thematic code, enable quantitative analysis, and inform interpretation of findings. Five major themes emerged from synthesizing survey and interview results: 1) Regardless of situational context (emergency vs. non-urgent) and message recipient (stakeholder group), e-mail is a favored modality for receiving public health messages; 2) The decision to use bi-directional, SMS or multiple communication strategies is complex and public health agencies' need to manage messaging concerns/barriers and benefits for all parties; 3) Both public health agencies and their stakeholders share similar values/uses and concerns regarding two-way public health messaging and SMS; 4) Public health is highly trusted, thus thoughtful, effective messaging will ensure continuation of this goodwill; and 5) Information reciprocity between public health agencies and stakeholders who share their information is essential. Multiple communication strategies might be utilized but the choice of a specific strategy needs to balance message content (emergency vs. routine communications), delivery (one- vs. two-way), channel (SMS, email, etc.), and public health agency burden with stakeholder preferences and technical capabilities, all while mitigating the risk of message overload and disregard of important communications by recipients.

Identifying the causes, prevention and management of crises in dementia. An online survey of stakeholders.

PubMed

Ledgerd, Ritchard; Hoe, Juanita; Hoare, Zoë; Devine, Mike; Toot, Sandeep; Challis, David; Orrell, Martin

2016-06-01

Crisis situations in dementia can lead to hospital admission or institutionalisation. Offering immediate interventions may help avoid admission, whilst stabilising measures can help prevent future crises. Our objective was to identify the main causes of crisis and interventions to treat or prevent crisis in persons with dementia based on different stakeholder perspectives. An online questionnaire was developed to identify the causes of crisis and appropriate interventions in a crisis. Participants included people with dementia, family carers and staff working in health and social care, including emergency and voluntary sectors, and academia. The results ranked the main causes of crisis, interventions that can prevent a crisis and interventions that can be useful in a crisis. Wandering, falls and infection were highly rated as risk factors for crises across all stakeholder groups. Consumers rated aggression as less important but severity of memory impairment as much more important than the other groups did. Education and support for family carers and home care staff were highly valued for preventing crises. Well-trained home care staff, communication equipment, emergency contacts and access to respite were highly valued for managing crises. We identified triggers and interventions that different stakeholders see as important for crisis in dementia. Recognition of these may be critical to planning effective and accepted support and care for people with dementia. Copyright © 2015 John Wiley & Sons, Ltd.

Priority setting: what constitutes success? A conceptual framework for successful priority setting.

PubMed

Sibbald, Shannon L; Singer, Peter A; Upshur, Ross; Martin, Douglas K

2009-03-05

The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries). This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts.

Strategic Partnerships in Higher Education

ERIC Educational Resources Information Center

Ortega, Janet L.

2013-01-01

The purpose of this study was to investigate the impacts of strategic partnerships between community colleges and key stakeholders; to specifically examine strategic partnerships; leadership decision-making; criteria to evaluate strategic partnerships that added value to the institution, value to the students, faculty, staff, and the local…

Defining and Delivering Measurable Value: A Mega Thinking and Planning Primer

ERIC Educational Resources Information Center

Kaufman, Roger

2005-01-01

Mega planning has a primary focus on adding value for all stakeholders. It is realistic, practical, and ethical. Denning and then achieving sustained organizational success is possible. It relies on three basic elements: (1) "A societal value-added "frame of mind" or paradigm": your perspective about your organization, people, and our world. It…

Risk perceptions of public health and food safety hazards in poultry husbandry by citizens, poultry farmers and poultry veterinarians.

PubMed

van Asselt, M; Poortvliet, P M; Ekkel, E D; Kemp, B; Stassen, E N

2018-02-01

Differences in risk perceptions of public health and food safety hazards in various poultry husbandry systems by various stakeholder groups, may affect the acceptability of those husbandry systems. Therefore, the objective was to gain insight into risk perceptions of citizens, poultry farmers, and poultry veterinarians regarding food safety and public health hazards in poultry husbandry systems, and into factors explaining these risk perceptions. We surveyed risk perceptions of Campylobacter contamination of broiler meat, avian influenza introduction in laying hens, and altered dioxin levels in eggs for the most commonly used broiler and laying hen husbandry systems in Dutch citizens (n = 2,259), poultry farmers (n = 100), and poultry veterinarians (n = 41). Citizens perceived the risks of the three hazards in the indoor systems higher and in the outdoor systems lower than did the professionals. Citizens reported higher concerns regarding aspects reflecting underlying psychological factors of risk perception compared to professionals. Professionals indicated a relatively low level of personal control, which might imply risk denial. Of the socio-demographic characteristics, gender and childhood residence were associated with risk perceptions. The influence of other factors of risks perception are discussed. It is suggested that risk perceptions of all stakeholder groups are influenced by affect, stigma, and underlying values. To adapt current or new husbandry systems that can count on societal support, views of key stakeholders and multiple aspects such as animal welfare, public health, food safety, and underlying values should be considered integrally. When trade-offs, such as between animal welfare and public health have to be made, insight into underlying values might help to find consensus among stakeholders. © The Author 2017. Published by Oxford University Press on behalf of Poultry Science Association.

Risk perceptions of public health and food safety hazards in poultry husbandry by citizens, poultry farmers and poultry veterinarians

PubMed Central

Poortvliet, P M; Ekkel, E D; Kemp, B; Stassen, E N

2018-01-01

Abstract Differences in risk perceptions of public health and food safety hazards in various poultry husbandry systems by various stakeholder groups, may affect the acceptability of those husbandry systems. Therefore, the objective was to gain insight into risk perceptions of citizens, poultry farmers, and poultry veterinarians regarding food safety and public health hazards in poultry husbandry systems, and into factors explaining these risk perceptions. We surveyed risk perceptions of Campylobacter contamination of broiler meat, avian influenza introduction in laying hens, and altered dioxin levels in eggs for the most commonly used broiler and laying hen husbandry systems in Dutch citizens (n = 2,259), poultry farmers (n = 100), and poultry veterinarians (n = 41). Citizens perceived the risks of the three hazards in the indoor systems higher and in the outdoor systems lower than did the professionals. Citizens reported higher concerns regarding aspects reflecting underlying psychological factors of risk perception compared to professionals. Professionals indicated a relatively low level of personal control, which might imply risk denial. Of the socio-demographic characteristics, gender and childhood residence were associated with risk perceptions. The influence of other factors of risks perception are discussed. It is suggested that risk perceptions of all stakeholder groups are influenced by affect, stigma, and underlying values. To adapt current or new husbandry systems that can count on societal support, views of key stakeholders and multiple aspects such as animal welfare, public health, food safety, and underlying values should be considered integrally. When trade-offs, such as between animal welfare and public health have to be made, insight into underlying values might help to find consensus among stakeholders. PMID:29161444

Climate Adaptation is About More Than Climate: Value-Driven Science Delivery

NASA Astrophysics Data System (ADS)

Swanston, C.

2015-12-01

Efforts to deliver relevant scientific information and tools to diverse stakeholders have dramatically increased in recent years with the intention of promoting climate change adaptation. Much work has been done to understand the barriers to action, but these largely overlook the need to frame the discussion in terms of stakeholder values and co-create innovative solutions that meet their individual needs. A partnership-based effort in the upper Midwest and Northeast called the Climate Change Response Framework (CCRF; www.forestadaptation.org) ensures relevance, breadth, and credibility of its products through stakeholder inclusion at all levels. The fundamental role of the CCRF is to help people meet their land stewardship goals while minimizing climate risk. This represents a subtle but important shift in focus to people and their values, as opposed to climate change and its effects. The CCRF uses a climate planning tool, the Adaptation Workbook (www.adaptationworkbook.org), along with ecosystem vulnerability assessments and a diverse "menu" of adaptation approaches to generate site-specific adaptation actions that meet explicit conservation objectives. These tools are integrated into an Adaptation Planning and Practices workshop that leads organizations through this structured process of designing adaptation tactics for their projects and plans. All of these tools were developed with stakeholders, or in response to their direct and continuing feedback. The CCRF has involved thousands of people and over 100 organizations, published six ecoregional vulnerability assessments with more than 130 authors, and generated more than 125 intentional adaptation demonstrations in real-world land management projects on federal, state, tribal, county, conservancy, and private lands. The CCRF contributes strongly to the USDA Regional Climate Hubs, working on the applied end of the continuum of climate services occupied by providers such as the CSCs, LCCs, RISAs, and RCCs.

Development as a Complex Process of Change: Conception and Analysis of Projects, Programs and Policies

ERIC Educational Resources Information Center

Nordtveit, Bjorn Harald

2010-01-01

Development is often understood as a linear process of change towards Western modernity, a vision that is challenged by this paper, arguing that development efforts should rather be connected to the local stakeholders' sense of their own development. Further, the paper contends that Complexity Theory is more effective than a linear theory of…

Defining Success in Adult Basic Education Settings: Multiple Stakeholders, Multiple Perspectives

PubMed Central

Tighe, Elizabeth L.; Barnes, Adrienne E.; Connor, Carol M.; Steadman, Sharilyn C.

2015-01-01

This study employed quantitative and qualitative research approaches to investigate what constitutes “success” in Adult Basic Education (ABE) programs from the perspectives of multiple educational stakeholders: the state funding agency, the teachers, and the students. Success was defined in multiple ways. In the quantitative section of the study, we computed classroom value-added scores (used as a metric of the state’s definition of success) to identify more and less effective ABE classrooms in two Florida counties. In the qualitative section of the study, we observed and conducted interviews with teachers and students in the selected classrooms to investigate how these stakeholders defined success in ABE. Iterative consideration of the qualitative data revealed three principal markers of success: (a) instructional strategies and teacher-student interactions; (b) views on standardized testing; and (c) student motivational factors. In general, classrooms with higher value-added scores were characterized by multiple instructional approaches, positive and collaborative teacher-student interactions, and students engaging in goal setting and citing motivational factors such as family and personal fulfillment. The implications for ABE programs are discussed. PMID:26279590

Computational Medical Apportionment Determination for Impairment Ratings

NASA Astrophysics Data System (ADS)

Artz, Jerry; Thompson, Marten; Alchemy, Md, John; Penn, Md, Daniel

2017-01-01

Unique computational techniques are used to calculate apportionment percentages for Whole Person Impairment (WPI) Ratings for workers with job-related injuries/illnesses. This interdisciplinary project includes collaboration among physicists, engineers, and concerned medical professionals. Medical providers are often asked to medically determine multiple contributing factors to disease states (e.g. diabetes, obesity, arthritis, and prior injury) in the context of personal injury as it pertains to permanent impairment. The process of making this determination is referred to as ``apportionment''. The economic value of apportionment is far reaching and represents a significant impact to all stakeholders in the injury resolution and settlement arena. The process of apportionment is necessary to assign monetary value for the stakeholders when an injury occurs. The ultimate trier-of-fact is the judicial system. The medical provider's role in this capacity is to apply known medical scientific knowledge and present it in a format that is objective and reproducible for the stakeholders. In this presentation the traditional challenges of apportionment will be outlined, and a novel approach creating mathematical bounding and modeling of pathology-weighted data sets will be presented.

Lessons learned using a values-engaged approach to attend to culture, diversity, and equity in a STEM program evaluation.

PubMed

Boyce, Ayesha S

2017-10-01

Evaluation must attend meaningfully and respectfully to issues of culture, race, diversity, power, and equity. This attention is especially critical within the evaluation of science, technology, engineering, and mathematics (STEM) educational programming, which has an explicit agenda of broadening participation. The purpose of this article is to report lessons learned from the implementation of a values-engaged, educative (Greene et al., 2006) evaluation within a multi-year STEM education program setting. This meta-evaluation employed a case study design using data from evaluator weekly systematic reflections, review of evaluation and program artifacts, stakeholder interviews, and peer review and assessment. The main findings from this study are (a) explicit attention to culture, diversity, and equity was initially challenged by organizational culture and under-developed evaluator-stakeholder professional relationship and (b) evidence of successful engagement of culture, diversity, and equity emerged in formal evaluation criteria and documents, and informal dialogue and discussion with stakeholders. The paper concludes with lessons learned and implications for practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

Reallocation of water in the state of New Mexico based on cooperative game theory

NASA Astrophysics Data System (ADS)

Rouhi Rad, M.

2011-12-01

Water allocation models often aim to maximize net benefits in the river basin based on the water rights, thus there is no motivation to use water efficiently by the users with lower marginal value for water. Water markets not only could help increase the net benefits over the basin but also will encourage the stakeholders to save the water and use it in transfer markets and increase their income. This issue can be viewed as a game in which stakeholders can play non-cooperatively and try to increase their own benefits using the amount of water assigned to them or they could cooperate and make coalitions in order to increase the total benefits in the coalition and the whole basin. The aim of this study is to reallocate the water based on cooperation among different stakeholders, namely agricultural, municipal and industrial and environmental, in the Upper Rio Grande river basin in the state of New Mexico in order to increase efficiency, sustainability and equity of water distribution in the basin using different game theory schemes such as Nucleolus and the Shapley Value.

Scotland's Water Map: Understanding water sector links to support decision making for the Hydro Nation Agenda

NASA Astrophysics Data System (ADS)

Falconer, Ruth E.; Gilmour, Daniel; Duffy, Alison; Isaacs, John; Stojanovic, Vladeta; O'Keeffe, Juliette; Blackwood, David

2015-04-01

The value of Scotland's water and sewerage market is projected to grow to £1.24bn by 2016/17. Developing future opportunities must take place alongside maintaining current service provision; however the demand on water and waste water services is constantly evolving. An integrated approach to water management requires an understanding of complex interactions that exist between key actors in the sector to allow water management strategies to exploit inter-sectorial links. Successful integrated analysis of the water sector in Scotland will support management activities key to responding to the Hydro Nation themes of 1) Governance and international development 2) Environmental protection 3) Economic opportunities 4) Research development. In order to deliver on these objectives an approach is required to capture and communicate the scope and scale of the water sector and its interconnectedness. The methodology required to determine scope, scale and interconnectedness of water sector involved the identification and application of an appropriate range of techniques from the Information and Knowledge Management disciplines combined with the Information Visualisation field. Scope and scale of the water sector was identified by a desk based study and this data was visualized using a geographic map. Sector interconnectedness was determined by interviewing key actors. The interviews identified the stakeholders associated with information flows, and the purpose of the information transfer through Reporting/Managing (R/M), Influence and Information sharing (I) or Control (C) activities. Primary information flows were also scored with respect to importance against the 4 key Hydro Nation agenda themes. Many organisations were identified who interact within Scotland's water sector including the Scottish Government and Ministers, the Regulators (WICS, DWQR, SEPA), Scottish Water (core and non-core functions), plus many other stakeholders ranging from research institutions to private sector businesses. This data was used in a water wheel visualisation where connections between stakeholders are shown as links and the width of the link represents the importance of the information exchage. Both maps will be used by the Scottish Government and its stakeholders to support decision making and illustrate the management and control aspects of the water sector.

A Bottom-up Vulnerability Analysis of Water Systems with Decentralized Decision Making and Demographic Shifts- the Case of Jordan.

NASA Astrophysics Data System (ADS)

Lachaut, T.; Yoon, J.; Klassert, C. J. A.; Talozi, S.; Mustafa, D.; Knox, S.; Selby, P. D.; Haddad, Y.; Gorelick, S.; Tilmant, A.

2016-12-01

Probabilistic approaches to uncertainty in water systems management can face challenges of several types: non stationary climate, sudden shocks such as conflict-driven migrations, or the internal complexity and dynamics of large systems. There has been a rising trend in the development of bottom-up methods that place focus on the decision side instead of probability distributions and climate scenarios. These approaches are based on defining acceptability thresholds for the decision makers and considering the entire range of possibilities over which such thresholds are crossed. We aim at improving the knowledge on the applicability and relevance of this approach by enlarging its scope beyond climate uncertainty and single decision makers; thus including demographic shifts, internal system dynamics, and multiple stakeholders at different scales. This vulnerability analysis is part of the Jordan Water Project and makes use of an ambitious multi-agent model developed by its teams with the extensive cooperation of the Ministry of Water and Irrigation of Jordan. The case of Jordan is a relevant example for migration spikes, rapid social changes, resource depletion and climate change impacts. The multi-agent modeling framework used provides a consistent structure to assess the vulnerability of complex water resources systems with distributed acceptability thresholds and stakeholder interaction. A proof of concept and preliminary results are presented for a non-probabilistic vulnerability analysis that involves different types of stakeholders, uncertainties other than climatic and the integration of threshold-based indicators. For each stakeholder (agent) a vulnerability matrix is constructed over a multi-dimensional domain, which includes various hydrologic and/or demographic variables.

Stakeholders' perspective on issues and challenges associated with care and treatment of aging-related cognitive impairment disorders in Singapore.

PubMed

Setia, Monika; Islam, Amina M; Thompson, James P; Matchar, David B

2011-11-01

An expanding elderly population poses challenges for the provision of care and treatment for age-related physical and mental disorders. Cognitive impairment (CI)/dementia is one such mental disorder that is on the rise in Singapore and has concomitant implications for social and health systems. The objective of this study is to understand the perspectives of prominent stakeholders about current and future issues and challenges associated with CI/dementia among the elderly in Singapore. Using indepth interviews, this qualitative study obtained the views of multiple stakeholders on issues and challenges associated with CI/dementia in Singapore. The 30 individuals interviewed as part of the study included clinicians, policy-makers, researchers, community workers, administrators, and caregivers. Using a framework approach, interview texts were indexed into domains and issues by utilizing NVivo 9.0 software. The stakeholders expressed concerns related to multiple domains of the CI/dementia care system: attitude and awareness, economics, education, family caregiving, inputs to care system, living arrangements, prevention, screening and diagnosis, and treatment and management of care. Within each domain, multiple issues and challenges were identified by respondents. The study identifies a complex set of inter-related issues and challenges that are associated with the care and treatment of people with CI/dementia. The results suggest that CI and dementia profoundly affect patients, families, and communities and that the issues related to the two disorders are truly system-wide. These findings lay the foundation for utilization of a systems approach to studying CI/dementia and provide an analytic framework for future research on complex health care issues.

Policy, Research and Residents' Perspectives on Built Environments Implicated in Heart Disease: A Concept Mapping Approach.

PubMed

Stankov, Ivana; Howard, Natasha J; Daniel, Mark; Cargo, Margaret

2017-02-09

An underrepresentation of stakeholder perspectives within urban health research arguably limits our understanding of what is a multi-dimensional and complex relationship between the built environment and health. By engaging a wide range of stakeholders using a participatory concept mapping approach, this study aimed to achieve a more holistic and nuanced understanding of the built environments shaping disease risk, specifically cardiometabolic risk (CMR). Moreover, this study aimed to ascertain the importance and changeability of identified environments through government action. Through the concept mapping process, community members, researchers, government and non-government stakeholders collectively identified eleven clusters encompassing 102 built environmental domains related to CMR, a number of which are underrepresented within the literature. Among the identified built environments, open space, public transportation and pedestrian environments were highlighted as key targets for policy intervention. Whilst there was substantive convergence in stakeholder groups' perspectives concerning the built environment and CMR, there were disparities in the level of importance government stakeholders and community members respectively assigned to pedestrian environments and street connectivity. These findings support the role of participatory methods in strengthening how urban health issues are understood and in affording novel insights into points of action for public health and policy intervention.

Impact of Integrated Watershed Management on Complex Interlinked Factors Influencing Health: Perceptions of Professional Stakeholders in a Hilly Tribal Area of India

PubMed Central

Nerkar, Sandeep S.; Tamhankar, Ashok J.; Johansson, Eva; Lundborg, Cecilia Stålsby

2016-01-01

Lack of access to water has a significant impact on the health of people in tribal areas, where water in households as well as for productive purposes is essential for life. In resource-limited settings such as hilly tribal areas, implementation of an integrated watershed management programme (IWMP) can have a significant impact on public health by providing a solution to water scarcity and related problems. The professional stakeholders in rural healthcare and development administration are important pillars of the system that implements various programmes and policies of government and non-government organizations, and act as facilitators for the improvement of public health in tribal areas. Information about the perceptions of these stakeholders on public health implications of the integrated watershed management programme is important in this context. A qualitative study was conducted using face to face semi-structured interviews and focus group discussions (FGDs) with stakeholders involved in healthcare provision, education and development administration. The transcripts of interviews and FGDs were analyzed using manifest and latent content analysis. The perceptions and experiences shared by healthcare and development administration stakeholders suggest that implementation of IWMP in tribal areas helps efficient water and agriculture management, which results in improved socio-economic conditions that lead to positive health outcomes. PMID:26959039

Impact of Integrated Watershed Management on Complex Interlinked Factors Influencing Health: Perceptions of Professional Stakeholders in a Hilly Tribal Area of India.

PubMed

Nerkar, Sandeep S; Tamhankar, Ashok J; Johansson, Eva; Lundborg, Cecilia Stålsby

2016-03-04

Lack of access to water has a significant impact on the health of people in tribal areas, where water in households as well as for productive purposes is essential for life. In resource-limited settings such as hilly tribal areas, implementation of an integrated watershed management programme (IWMP) can have a significant impact on public health by providing a solution to water scarcity and related problems. The professional stakeholders in rural healthcare and development administration are important pillars of the system that implements various programmes and policies of government and non-government organizations, and act as facilitators for the improvement of public health in tribal areas. Information about the perceptions of these stakeholders on public health implications of the integrated watershed management programme is important in this context. A qualitative study was conducted using face to face semi-structured interviews and focus group discussions (FGDs) with stakeholders involved in healthcare provision, education and development administration. The transcripts of interviews and FGDs were analyzed using manifest and latent content analysis. The perceptions and experiences shared by healthcare and development administration stakeholders suggest that implementation of IWMP in tribal areas helps efficient water and agriculture management, which results in improved socio-economic conditions that lead to positive health outcomes.

Onshore Wind Farms: Value Creation for Stakeholders in Lithuania

NASA Astrophysics Data System (ADS)

Burinskienė, Marija; Rudzkis, Paulius; Kanopka, Adomas

With the costs of fossil fuel consistently rising worldwide over the last decade, the development of green technologies has become a major goal in many countries. Therefore the evaluation of wind power projects becomes a very important task. To estimate the value of the technologies based on renewable resources also means taking into consideration social, economic, environmental, and scientific value of such projects. This article deals with economic evaluation of electricity generation costs of onshore wind farms in Lithuania and the key factors that have influence on wind power projects and offer a better understanding of social-economic context behind wind power projects. To achieve these goals, this article makes use of empirical data of Lithuania's wind power farms as well as data about the investment environment of the country.Based on empirical data of wind power parks, the research investigates the average wind farm generation efficiency in Lithuania. Employing statistical methods the return on investments of wind farms in Lithuania is calculated. The value created for every party involved and the total value of the wind farm is estimated according to Stakeholder theory.

Assessing value of innovative molecular diagnostic tests in the concept of predictive, preventive, and personalized medicine.

PubMed

Akhmetov, Ildar; Bubnov, Rostyslav V

2015-01-01

Molecular diagnostic tests drive the scientific and technological uplift in the field of predictive, preventive, and personalized medicine offering invaluable clinical and socioeconomic benefits to the key stakeholders. Although the results of diagnostic tests are immensely influential, molecular diagnostic tests (MDx) are still grudgingly reimbursed by payers and amount for less than 5 % of the overall healthcare costs. This paper aims at defining the value of molecular diagnostic test and outlining the most important components of "value" from miscellaneous assessment frameworks, which go beyond accuracy and feasibility and impact the clinical adoption, informing healthcare resource allocation decisions. The authors suggest that the industry should facilitate discussions with various stakeholders throughout the entire assessment process in order to arrive at a consensus about the depth of evidence required for positive marketing authorization or reimbursement decisions. In light of the evolving "value-based healthcare" delivery practices, it is also recommended to account for social and ethical parameters of value, since these are anticipated to become as critical for reimbursement decisions and test acceptance as economic and clinical criteria.

Effects of stakeholder involvement in river management

NASA Astrophysics Data System (ADS)

Buchecker, M.; Menzel, S.

2012-04-01

In the last decades, in many parts of Europe involving local stakeholders or the local public in river management has become a standard procedure. For many decision makers, the purpose of involving other interest groups is limited to achieving a sufficient local acceptance of the project, and accordingly they adopt minimal forms of involvement. Theoretical literature and first empirical studies, however, suggest that stakeholder involvement can have, if done in appropriate quality, have much more far-reaching benefits for a sustainable river management such as a better consensus, social learning and social capital building. But there is so far only little reliable evidence that and under which conditions such benefits or effects in fact result from stakeholder involvement processes. The reason for this is that such involvement processes represent very complex social interventions, and all"affordable"effect measurement methods have their weaknesses. In our project we wanted to find out which were the really robust social effects of stakeholder involvement in river management. We therefore evaluated a number of real Swiss case studies of participatory river management using three different approaches of effect measurements: a quasi-experimental approach using repeated standardized measurement of stakeholders' attitudes, a qualitative long-term ex-post measurement approach based on interviews with stakeholders of five participatory river projects, and a comparative analysis approach based on data of residents effect assessments of participatory river planning gathered in a Swiss national survey. The analysis of all three evaluation studies confirmed that stakeholder involvement in river management projects have substantive social effects. The comparison of the results of the three measurement approaches revealed that social learning and acceptance building were the most robust effects of stakeholder involvement, as they were confirmed by all the three measurement approaches. Social capital building, however, was not found to be a relevant effect in the long-term qualitative ex-post measurement of stakeholder processes in river management. The data suggested that social capital was "only" maintained or reproduced by the involvement process. The results will be discussed, and implications for the practice as well as for future research will be drawn.

Patient and Other Stakeholder Engagement in Patient-Centered Outcomes Research Institute Funded Studies of Patients with Kidney Diseases.

PubMed

Cukor, Daniel; Cohen, Lewis M; Cope, Elizabeth L; Ghahramani, Nasrollah; Hedayati, S Susan; Hynes, Denise M; Shah, Vallabh O; Tentori, Francesca; Unruh, Mark; Bobelu, Jeanette; Cohen, Scott; Dember, Laura M; Faber, Thomas; Fischer, Michael J; Gallardo, Rani; Germain, Michael J; Ghahate, Donica; Grote, Nancy; Hartwell, Lori; Heagerty, Patrick; Kimmel, Paul L; Kutner, Nancy; Lawson, Susan; Marr, Lisa; Nelson, Robert G; Porter, Anna C; Sandy, Phillip; Struminger, Bruce B; Subramanian, Lalita; Weisbord, Steve; Young, Bessie; Mehrotra, Rajnish

2016-09-07

Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases. Copyright © 2016 by the American Society of Nephrology.

Patient and Other Stakeholder Engagement in Patient-Centered Outcomes Research Institute Funded Studies of Patients with Kidney Diseases

PubMed Central

Cukor, Daniel; Cohen, Lewis M.; Cope, Elizabeth L.; Ghahramani, Nasrollah; Hedayati, S. Susan; Hynes, Denise M.; Shah, Vallabh O.; Tentori, Francesca; Unruh, Mark; Bobelu, Jeanette; Cohen, Scott; Dember, Laura M.; Faber, Thomas; Fischer, Michael J.; Gallardo, Rani; Germain, Michael J.; Ghahate, Donica; Grote, Nancy; Hartwell, Lori; Heagerty, Patrick; Kimmel, Paul L.; Kutner, Nancy; Lawson, Susan; Marr, Lisa; Nelson, Robert G.; Porter, Anna C.; Sandy, Phillip; Struminger, Bruce B.; Subramanian, Lalita; Weisbord, Steve; Young, Bessie

2016-01-01

Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is “Patient Centered-Research”, in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases. PMID:27197911

What Critical Ethical Values Guide Strategic Planning Processes in Health Care Organizations?

PubMed

Kucmanic, Matthew; Sheon, Amy R

2017-11-01

This case explores a fictitious hospital's use of co-creation to make a decision about redesign of inpatient units as a first step in incorporating stakeholder input into creation of governing policies. We apply a "procedural fairness" framework to reveal that conditions required for an ethical decision about space redesign were not met by using clinician and patient focus groups to obtain stakeholder input. In this article, we identify epistemic injustices resulting from this process that could undermine confidence in leadership decisions. Suggestions are offered for incorporating stakeholder input going forward that address prior shortcomings. The result should be conditions that are perceived as procedurally fair and decisions that engender confidence in institutional leadership. © 2017 American Medical Association. All Rights Reserved.

What Is eHealth (6): Perspectives on the Evolution of eHealth Research

PubMed Central

Kreslake, Jennifer M; Phalen, Judith M

2006-01-01

Background The field of eHealth holds promise for supporting and enabling health behavior change and the prevention and management of chronic disease. Objective In order to establish areas of congruence and controversy among contributors to the early development, evaluation, and dissemination of eHealth applications, as well as the desire to inform an evaluation research funding agenda, 38 semistructured, qualitative interviews were conducted among stakeholders in eHealth between May 2002 and September 2003. Methods Participants were asked about their perspectives on the credibility, value, and future potential of information technology for health behavior change and chronic disease management. Interviews were coded and analyzed for emergent themes using qualitative methods. Results Consistent themes were identified across stakeholder groups, with slight differences in emphasis. These topics included the following: (1) consensus and standardization—most stakeholders expressed a strong desire for a more coordinated, rigorous effort to define and integrate the field; (2) evaluation methods and challenges—demonstrating outcomes is required to establish eHealth quality and efficacy, but stakeholders were not satisfied with the sensitivity, validity, and reliability of existing outcome measures; (3) quality, value, and future potential—the intersection between eHealth’s potential cost-effectiveness, efficiency, and improved clinical status among users generated a high degree of interest; and (4) health disparities—many stakeholders contended that traditionally underserved populations will particularly benefit from eHealth applications, although others argued that the underserved are also disadvantaged in terms of access to technology. Conclusions Recommendations included the need for improvement and formalization of development and evaluation standards across private and public sectors, additional research on the technology needs and preferences of traditionally underserved populations, and long-term epidemiologic studies of the impact of eHealth on outcomes and cost-effectiveness. PMID:16585029

An end-users oriented methodology for enhancing the integration of knowledge on soil-water-sediment systems in River Basin Management: an illustration from the AquaTerra project.

PubMed

Merly, Corinne; Chapman, Antony; Mouvet, Christophe

2012-01-01

Research results in environmental and socio-economic sciences are often under-used by stakeholders involved in the management of natural resources. To minimise this gap, the FP6 EU interdisciplinary project AquaTerra (AT) developed an end-users' integration methodology in order to ensure that the data, knowledge and tools related to the soil-water-sediment system that were generated by the project were delivered in a meaningful way for end-users, thus improving their uptake. The methodology and examples of its application are presented in this paper. From the 408 project deliverables, 96 key findings were identified, 53 related to data and knowledge, and 43 describing advanced tools. River Basin Management (RBM) stakeholders workshops identified 8 main RBM issues and 25 specific stakeholders' questions related to RBM which were classified into seven groups of cross-cutting issues, namely scale, climate change, non-climatic change, the need for systemic approaches, communication and participation, international and inter-basin coordination and collaboration, and the implementation of the Water Framework Directive. The integration methodology enabled an assessment of how AT key findings meet stakeholders' demands, and for each main RBM issue and for each specific question, described the added-value of the AT project in terms of knowledge and tools generated, key parameters to consider, and recommendations that can be made to stakeholders and the wider scientific community. Added value and limitations of the integration methodology and its outcomes are discussed and recommendations are provided to further improve integration methodology and bridge the gaps between scientific research data and their potential uptake by end-users.

Bringing voice in policy building.

PubMed

Lotrecchiano, Gaetano R; Kane, Mary; Zocchi, Mark S; Gosa, Jessica; Lazar, Danielle; Pines, Jesse M

2017-07-03

Purpose The purpose of this paper is to describe the use of group concept mapping (GCM) as a tool for developing a conceptual model of an episode of acute, unscheduled care from illness or injury to outcomes such as recovery, death and chronic illness. Design/methodology/approach After generating a literature review drafting an initial conceptual model, GCM software (CS Global MAX TM ) is used to organize and identify strengths and directionality between concepts generated through feedback about the model from several stakeholder groups: acute care and non-acute care providers, patients, payers and policymakers. Through online and in-person population-specific focus groups, the GCM approach seeks feedback, assigned relationships and articulated priorities from participants to produce an output map that described overarching concepts and relationships within and across subsamples. Findings A clustered concept map made up of relational data points that produced a taxonomy of feedback was used to update the model for use in soliciting additional feedback from two technical expert panels (TEPs), and finally, a public comment exercise was performed. The results were a stakeholder-informed improved model for an acute care episode, identified factors that influence process and outcomes, and policy recommendations, which were delivered to the Department of Health and Human Services's (DHHS) Assistant Secretary for Preparedness and Response. Practical implications This study provides an example of the value of cross-population multi-stakeholder input to increase voice in shared problem health stakeholder groups. Originality/value This paper provides GCM results and a visual analysis of the relational characteristics both within and across sub-populations involved in the study. It also provides an assessment of observational key factors supporting how different stakeholder voices can be integrated to inform model development and policy recommendations.

Stakeholders' perceptions of social-ecological systems and the information they use in the management of freshwater resources in Guanacaste, Costa Rica

NASA Astrophysics Data System (ADS)

Wong-Parodi, G.; Babcock, M.; Small, M.; Grossmann, I.

2014-12-01

Climate change is expected to increase the chances of drought, and shift precipitation patterns in seasonally dry places. In some places, the heuristics or "rules of thumb" that stakeholders use may no longer be reliable for the effective management of water resources. This can have dire consequences for social and ecological systems, especially in developing countries. Scientists and policymakers view climate forecasts as one way for improving informed decision-making about freshwater resources. However, successful communication requires that stakeholders understand and are able to use such information. To develop effective communications, it is critical to characterize stakeholders' understanding of social-ecological systems as related to water, the type of information used to inform management decisions, and the perceived value of forecast information. To achieve our objective, we conducted 40 semi-structured interviews with farmers, water managers, hydroelectric utilities, local climate experts, tourism industry representatives, and members of the general public in the semi-arid region of Guanacaste, Costa Rica. People believe that they have enough water at this time however they believe that the region will become much drier in the future, which they attribute to climate change, El Nino/La Nina, and deforestation. With respect to the value of forecast information, we found that the scale of decision-making (e.g., irrigation district versus small farmer) was associated with a stakeholders' level of "technical sophistication" and trust in government. In future work, we will evaluate the prevalence of these beliefs and practices in the larger population in order to identify effective ways to tailor the presentation of forecast information for different audiences. This work provides insight into the development of forecast communications to improve the management of resources in development countries in the face of a changing climate.

Professionalism in 21st century professional practice: autonomy and accountability in orthopaedic surgery.

PubMed

Schneller, Eugene S; Wilson, Natalia A

2009-10-01

Orthopaedic surgical practice is becoming increasingly complex. The rapid change in pace associated with new information and technologies, the physician-supplier relationship, the growing costs and growing gap between costs and reimbursements for orthopaedic surgical procedures, and the influences of advertising on the patient, challenge all involved in the delivery of orthopaedic care. This paper assesses the concepts of professionalism, autonomy, and accountability in the 21st century practice of orthopaedic surgery. These concepts are considered within the context of the complex value chain surrounding orthopaedic surgery and the changing forces influencing clinical decision making by the surgeon. A leading impetus for challenge to the autonomy of the orthopaedic surgeon has been cost. Mistrust and lack of understanding have characterized the physician-hospital relationship. Resource dependency has characterized the physician-supplier relationship. Accountability for the surgeon has increased. We suggest implant surgery involves shared decision making and "coproduction" between the orthopaedic surgeon and other stakeholders. The challenge for the profession is to redefine professionalism, accountability, and autonomy in the face of these changes and challenges.

Contested Technologies and Design for Values: The Case of Shale Gas.

PubMed

Dignum, Marloes; Correljé, Aad; Cuppen, Eefje; Pesch, Udo; Taebi, Behnam

2016-08-01

The introduction of new energy technologies may lead to public resistance and contestation. It is often argued that this phenomenon is caused by an inadequate inclusion of relevant public values in the design of technology. In this paper we examine the applicability of the value sensitive design (VSD) approach. While VSD was primarily introduced for incorporating values in technological design, our focus in this paper is expanded towards the design of the institutions surrounding these technologies, as well as the design of stakeholder participation. One important methodological challenge of VSD is to identify the relevant values related to new technological developments. In this paper, we argue that the public debate can form a rich source from which to retrieve the values at stake. To demonstrate this, we have examined the arguments used in the public debate regarding the exploration and exploitation of shale gas in the Netherlands. We identified two important sets of the underlying values, namely substantive and procedural values. This paper concludes with two key findings. Firstly, contrary to what is often suggested in the literature, both proponents and opponents seem to endorse the same values. Secondly, contestation seems to arise in the precise operationalization of these values among the different stakeholders. In other words, contestation in the Dutch shale gas debate does not arise from inter-value conflict but rather from intra-value conflicts. This multi-interpretability should be incorporated in VSD processes.

Healthcare service quality: towards a broad definition.

PubMed

Mosadeghrad, Ali Mohammad

2013-01-01

The main purpose of this study is to define healthcare quality to encompass healthcare stakeholder needs and expectations because healthcare quality has varying definitions for clients, professionals, managers, policy makers and payers. This study represents an exploratory effort to understand healthcare quality in an Iranian context. In-depth individual and focus group interviews were conducted with key healthcare stakeholders. Quality healthcare is defined as "consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical guidelines and standards, which meet the patient's needs and satisfies providers". Healthcare quality definitions common to all stakeholders involve offering effective care that contributes to the patient well-being and satisfaction. This study helps us to understand quality healthcare, highlighting its complex nature, which has direct implications for healthcare providers who are encouraged to regularly monitor healthcare quality using the attributes identified in this study. Accordingly, they can initiate continuous quality improvement programmes to maintain high patient-satisfaction levels. This is the first time a comprehensive healthcare quality definition has been developed using various healthcare stakeholder perceptions and expectations.

Is it Worth It? Benefits in Research with Adults with Intellectual Disability

PubMed Central

McDonald, Katherine E.; Conroy, Nicole E.; Olick, Robert S.

2017-01-01

Including adults with intellectual disability in research promotes direct benefits to participants and larger societal benefits. Stakeholders may have different views of what count as benefits, and their importance. We compared views on benefits in research with adults with intellectual disability among adults with intellectual disability, family and friends, service providers, researchers, and Institutional Review Board members. We found that adults with intellectual disability value direct and indirect research benefits, and want to participate in research that offers them. Other stakeholders generally see less value in direct benefits and predict more tempered interest in research participation as compared to adults with intellectual disability. To promote respectful research participation, research policy and practice should incorporate the views of adults with intellectual disability. PMID:27893316

Is It Worth It? Benefits in Research With Adults With Intellectual Disability.

PubMed

McDonald, Katherine E; Conroy, Nicole E; Olick, Robert S

2016-12-01

Including adults with intellectual disability in research promotes direct benefits to participants and larger societal benefits. Stakeholders may have different views of what count as benefits and their importance. We compared views on benefits in research with adults with intellectual disability among adults with intellectual disability, family and friends, service providers, researchers, and institutional review board members. We found that adults with intellectual disability value direct and indirect research benefits, and want to participate in research that offers them. Other stakeholders generally see less value in direct benefits and predict more tempered interest in research participation as compared to adults with intellectual disability. To promote respectful research participation, research policy and practice should incorporate the views of adults with intellectual disability.

Medicaid's Complex Goals: Challenges for Managed Care and Behavioral Health

PubMed Central

Gold, Marsha; Mittler, Jessica

2000-01-01

The Medicaid program has become increasingly complex as policymakers use it to address various policy objectives, leading to structural tensions that surface with Medicaid managed care. In this article, we illustrate this complexity by focusing on the experience of three States with behavioral health carveouts—Maryland, Oregon, and Tennessee. Converting to Medicaid managed care forces policymakers to confront Medicaid's competing policy objectives, multiplicity of stakeholders, and diverse patients, many with complex needs. Emerging Medicaid managed care systems typically represent compromises in which existing inequities and fragmentation are reconfigured rather than eliminated. PMID:12500322

The HPT Value Proposition in the Larger Improvement Arena.

ERIC Educational Resources Information Center

Wallace, Guy W.

2003-01-01

Discussion of human performance technology (HPT) emphasizes the key variable, which is the human variable. Highlights include the Ishikawa Diagram; human performance as one variable of process performance; collaborating with other improvement approaches; value propositions; and benefits to stakeholders, including real return on investments. (LRW)

Collaboration, negotiation, and coalescence for interagency-collaborative teams to scale-up evidence-based practice.

PubMed

Aarons, Gregory A; Fettes, Danielle L; Hurlburt, Michael S; Palinkas, Lawrence A; Gunderson, Lara; Willging, Cathleen E; Chaffin, Mark J

2014-01-01

Implementation and scale-up of evidence-based practices (EBPs) is often portrayed as involving multiple stakeholders collaborating harmoniously in the service of a shared vision. In practice, however, collaboration is a more complex process that may involve shared and competing interests and agendas, and negotiation. The present study examined the scale-up of an EBP across an entire service system using the Interagency Collaborative Team approach. Participants were key stakeholders in a large-scale county-wide implementation of an EBP to reduce child neglect, SafeCare. Semistructured interviews and/or focus groups were conducted with 54 individuals representing diverse constituents in the service system, followed by an iterative approach to coding and analysis of transcripts. The study was conceptualized using the Exploration, Preparation, Implementation, and Sustainment framework. Although community stakeholders eventually coalesced around implementation of SafeCare, several challenges affected the implementation process. These challenges included differing organizational cultures, strategies, and approaches to collaboration; competing priorities across levels of leadership; power struggles; and role ambiguity. Each of the factors identified influenced how stakeholders approached the EBP implementation process. System-wide scale-up of EBPs involves multiple stakeholders operating in a nexus of differing agendas, priorities, leadership styles, and negotiation strategies. The term collaboration may oversimplify the multifaceted nature of the scale-up process. Implementation efforts should openly acknowledge and consider this nexus when individual stakeholders and organizations enter into EBP implementation through collaborative processes.

Collaboration, Negotiation, and Coalescence for Interagency-Collaborative Teams to Scale-up Evidence-Based Practice

PubMed Central

Aarons, Gregory A.; Fettes, Danielle; Hurlburt, Michael; Palinkas, Lawrence; Gunderson, Lara; Willging, Cathleen; Chaffin, Mark

2014-01-01

Objective Implementation and scale-up of evidence-based practices (EBPs) is often portrayed as involving multiple stakeholders collaborating harmoniously in the service of a shared vision. In practice, however, collaboration is a more complex process that may involve shared and competing interests and agendas, and negotiation. The present study examined the scale-up of an EBP across an entire service system using the Interagency Collaborative Team (ICT) approach. Methods Participants were key stakeholders in a large-scale county-wide implementation of an EBP to reduce child neglect, SafeCare®. Semi-structured interviews and/or focus groups were conducted with 54 individuals representing diverse constituents in the service system, followed by an iterative approach to coding and analysis of transcripts. The study was conceptualized using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Results Although community stakeholders eventually coalesced around implementation of SafeCare, several challenges affected the implementation process. These challenges included differing organizational cultures, strategies, and approaches to collaboration, competing priorities across levels of leadership, power struggles, and role ambiguity. Each of the factors identified influenced how stakeholders approached the EBP implementation process. Conclusions System wide scale-up of EBPs involves multiple stakeholders operating in a nexus of differing agendas, priorities, leadership styles, and negotiation strategies. The term collaboration may oversimplify the multifaceted nature of the scale-up process. Implementation efforts should openly acknowledge and consider this nexus when individual stakeholders and organizations enter into EBP implementation through collaborative processes. PMID:24611580

Psychosocial drivers for change: Understanding and promoting stakeholder engagement in local adaptation to climate change in three European Mediterranean case studies.

PubMed

Luís, Sílvia; Lima, Maria Luísa; Roseta-Palma, Catarina; Rodrigues, Nuno; P Sousa, Lisa; Freitas, Fabiana; L Alves, Fátima; Lillebø, Ana I; Parrod, Camille; Jolivet, Vincent; Paramana, Theodora; Alexandrakis, George; Poulos, Serafim

2018-06-18

Stakeholder engagement in the processes of planning local adaptation to climate change faces many challenges. The goal of this work was to explore whether or not the intention of engaging could be understood (Study 1) and promoted (Study 2), by using an extension of the theory of planned behaviour. In Study 1, stakeholders from three European Mediterranean case studies were surveyed: Baixo Vouga Lagunar (Portugal), SCOT Provence Méditerranée (France), and the island of Crete (Greece) (N = 115). Stakeholders' intention of engaging was significantly predicted by subjective norm (which was predicted by injunctive normative beliefs towards policy-makers and stakeholders) and by perceived behavioural control (which was predicted by knowledge of policy and instruments). Study 2 was conducted in the Baixo Vouga Lagunar case study and consisted of a two-workshop intervention where issues on local and regional adaptation, policies, and engagement were presented and discussed. A within-participants comparison of initial survey results with results following the workshops (N T1  = 12, N T2  = 15, N T3  = 12) indicated that these were successful in increasing stakeholders' intention of engaging. This increase was paired with a) an increase in injunctive normative beliefs towards policy-makers and consequently in subjective norm, and to b) a decrease in perceived complexity of planning local adaptation and an increase in knowledge regarding adaptation to climate change. Copyright © 2018 Elsevier Ltd. All rights reserved.

Future directions: Integrated resource planning

NASA Astrophysics Data System (ADS)

Bauer, D. C.; Eto, J.

Integrated resource planning or IRP is the process for integrating supply- and demand-side resources to provide energy services at a cost that balances the interests of all stakeholders. It now is the resource planning process used by electric utilities in over 30 states. The goals of IRP have evolved from least cost planning and encouragement of demand-side management to broader, more complex issues including core competitive business activity, risk management and sharing, accounting for externalities, and fuel switching between gas and electricity. IRP processes are being extended to other interior regions of the country, to non-investor owned utilities, and to regional (rather than individual utility) planning bases, and to other fuels (natural gas). The comprehensive, multi-valued, and public reasoning characteristics of IRP could be extended to applications beyond energy, e.g., transportation, surface water management, and health care in ways suggested.

Crossing and creating boundaries in healthcare innovation.

PubMed

Ingerslev, Karen

2016-06-20

Purpose - This paper reports from a qualitative case study of a change initiative undertaken in a Danish public hospital setting during national healthcare reforms. The purpose of this paper is to challenge understandings of innovations as defined by being value-adding per se. Whether the effects of attempting to innovate are positive or negative is in this paper regarded as a matter of empirical investigation. Design/methodology/approach - Narrative accounts of activities during the change initiative are analysed in order to elucidate the effects of framing the change initiative as innovation on which boundaries are created and crossed. Findings - Framing change initiatives as innovation leads to intended as well as unanticipated boundary crossings where healthcare practitioners from different organizations recognize a shared problem and task. It also leads to unintended boundary reinforcements between "us and them" that may exclude the perspectives of patients or stakeholders when confronting complex problems in healthcare. This boundary reinforcement can lead to further fragmentation of healthcare despite the stated intention to create more integrated services. Practical implications - The paper suggests that researchers as well as practitioners should not presume that intentions to innovate will by themselves enhance creativity and innovation. When analysing the intended, unintended as well as unanticipated consequences of framing change initiatives as innovation, researchers and practitioner gain nuanced knowledge about the effects of intending to innovate in complex settings such as healthcare. Originality/value - This paper suggests the need for an analytical move from studying the effects of innovation to studying the effects of framing complex problems as a call for innovation.

Planning to Execution Earned Value Risk Management Tool

DTIC Science & Technology

2015-09-01

Experiments ............................................................24 b. Result Analysis ...31 B. STAKEHOLDER ANALYSIS .....................................................................33 C. OPERATIONAL-BASED SCENARIO...42 c. Simulation and Analysis Activity ............................................43 2. Project Management Phase

Stratum Electricity Markets: Toward Multi-temporal Distributed Risk Management for Sustainable Electricity Provision

NASA Astrophysics Data System (ADS)

Wu, Zhiyong (Richard)

Motivated by the overall challenge of ensuring long-term sustainable electricity service, we view this challenge as a long-term decision making problem under uncertainties. We start by recognizing that, independent of the industry organization, the uncertainties are enormous and often exogenous to the energy service providers. They are multi-dimensional and are result of fundamental drivers, ranging from the supply side, through the demand side, to the regulatory and policy sides. The basic contribution of this thesis comes from the recognition that long-term investments for ensuring reliable and stable electricity service critically depend on how these uncertainties are perceived, valued and managed by the different stakeholders within the complex industry organization such as the electric power industry. We explain several reasons why price signals obtained from current short-term electricity markets alone are not sufficient enough for long-term sustainable provision. Some enhancements are presented in the thesis to improve the short-term electricity market price signals to reflect the true cost of operation. New market mechanisms and instruments are needed to facilitate the stakeholders to better deal with long-term risks. The problems of ensuring long-term stable reliable service in the sense of the traditional resource adequacy requirements are revisited in both the restructuring industry and regulated industry. We introduce a so-called Stratum Electricity Market (SEM) design as the basic market mechanism for solving the problem of long-term reliable electricity service through a series of interactive multi-lateral market exchange platforms for risks communication, management and evaluations over various time horizons and by the different groups of stakeholders. In other words, our proposed SEM is a basic IT-enabled framework for the decision making processes by various parties over different time. Because of the uniqueness of electricity as a commodity, the values for the same amount of energy during different time and at different location can vary dramatically. Moreover, for the same hour, the values for the same amount of power at base load level or at peak load level are different due to the different generation technologies and other non-convex constraints like unit commitment. The multiple market products at zonal/nodal levels with different time horizon and time of use categories are designed to reflect more realistic demand and supply conditions at various temporal and spatial granularities. Detailed market rules, rights and regulations (3Rs) concerning the sub-markets interactions, product hierarchy and financial settlements are also examined.

Exploring Scientific Information for Policy Making under Deep Uncertainty

NASA Astrophysics Data System (ADS)

Forni, L.; Galaitsi, S.; Mehta, V. K.; Escobar, M.; Purkey, D. R.; Depsky, N. J.; Lima, N. A.

2016-12-01

Each actor evaluating potential management strategies brings her/his own distinct set of objectives to a complex decision space of system uncertainties. The diversity of these objectives require detailed and rigorous analyses that responds to multifaceted challenges. However, the utility of this information depends on the accessibility of scientific information to decision makers. This paper demonstrates data visualization tools for presenting scientific results to decision makers in two case studies, La Paz/ El Alto, Bolivia, and Yuba County,California. Visualization output from the case studies combines spatiotemporal, multivariate and multirun/multiscenario information to produce information corresponding to the objectives defined by key actors and stakeholders. These tools can manage complex data and distill scientific information into accessible formats. Using the visualizations, scientists and decision makers can navigate the decision space and potential objective trade-offs to facilitate discussion and consensus building. These efforts can support identifying stable negotiatedagreements between different stakeholders.

Harvesting Social Signals to Inform Peace Processes Implementation and Monitoring

PubMed Central

Nigam, Aastha; Dambanemuya, Henry K.; Joshi, Madhav; Chawla, Nitesh V.

2017-01-01

Abstract Peace processes are complex, protracted, and contentious involving significant bargaining and compromising among various societal and political stakeholders. In civil war terminations, it is pertinent to measure the pulse of the nation to ensure that the peace process is responsive to citizens' concerns. Social media yields tremendous power as a tool for dialogue, debate, organization, and mobilization, thereby adding more complexity to the peace process. Using Colombia's final peace agreement and national referendum as a case study, we investigate the influence of two important indicators: intergroup polarization and public sentiment toward the peace process. We present a detailed linguistic analysis to detect intergroup polarization and a predictive model that leverages Tweet structure, content, and user-based features to predict public sentiment toward the Colombian peace process. We demonstrate that had proaccord stakeholders leveraged public opinion from social media, the outcome of the Colombian referendum could have been different. PMID:29235916

Harvesting Social Signals to Inform Peace Processes Implementation and Monitoring.

PubMed

Nigam, Aastha; Dambanemuya, Henry K; Joshi, Madhav; Chawla, Nitesh V

2017-12-01

Peace processes are complex, protracted, and contentious involving significant bargaining and compromising among various societal and political stakeholders. In civil war terminations, it is pertinent to measure the pulse of the nation to ensure that the peace process is responsive to citizens' concerns. Social media yields tremendous power as a tool for dialogue, debate, organization, and mobilization, thereby adding more complexity to the peace process. Using Colombia's final peace agreement and national referendum as a case study, we investigate the influence of two important indicators: intergroup polarization and public sentiment toward the peace process. We present a detailed linguistic analysis to detect intergroup polarization and a predictive model that leverages Tweet structure, content, and user-based features to predict public sentiment toward the Colombian peace process. We demonstrate that had proaccord stakeholders leveraged public opinion from social media, the outcome of the Colombian referendum could have been different.

Dentists with extended skills: the challenge of innovation.

PubMed

Al-Haboubi, M; Eliyas, S; Briggs, P F A; Jones, E; Rayan, R R; Gallagher, J E

2014-08-01

The aim was to obtain stakeholders' views on the former London Deanery's joint educational service development initiative to train dentists with a special interest (DwSIs) in endodontics in conjunction with the National Health Services (NHS) and examine the models of care provided. A convergent parallel mixed methods design including audit of four different models of care, semi-structured interviews of a range of key stakeholders (including the DwSI trainees) and questionnaire surveys of patients and primary care dentists. Eight dentists treated over 1,600 endodontic cases of moderate complexity over a two year training period. A retrospective audit of four schemes suggested that first molars were the most commonly treated tooth (57%; n = 341). Patients who received care in the latter stages of the initiative were 'satisfied' or 'very satisfied' with the service (89%; n = 98). Most dental practitioners agreed that having access to such services would support the care of their patients (89%; n = 215) with 88%; (n = 214) supporting the view that DwSIs should accept referrals from outside of their practice. This initiative, developed to provide endodontic care of medium complexity in a primary care setting, received wide support from stakeholders including patients and primary care dentists. The implications for care pathways, commissioning and further research are discussed.

Collaborative Visual Analytics: A Health Analytics Approach to Injury Prevention

PubMed Central

Fisher, Brian; Smith, Jennifer; Pike, Ian

2017-01-01

Background: Accurate understanding of complex health data is critical in order to deal with wicked health problems and make timely decisions. Wicked problems refer to ill-structured and dynamic problems that combine multidimensional elements, which often preclude the conventional problem solving approach. This pilot study introduces visual analytics (VA) methods to multi-stakeholder decision-making sessions about child injury prevention; Methods: Inspired by the Delphi method, we introduced a novel methodology—group analytics (GA). GA was pilot-tested to evaluate the impact of collaborative visual analytics on facilitating problem solving and supporting decision-making. We conducted two GA sessions. Collected data included stakeholders’ observations, audio and video recordings, questionnaires, and follow up interviews. The GA sessions were analyzed using the Joint Activity Theory protocol analysis methods; Results: The GA methodology triggered the emergence of ‘common ground’ among stakeholders. This common ground evolved throughout the sessions to enhance stakeholders’ verbal and non-verbal communication, as well as coordination of joint activities and ultimately collaboration on problem solving and decision-making; Conclusions: Understanding complex health data is necessary for informed decisions. Equally important, in this case, is the use of the group analytics methodology to achieve ‘common ground’ among diverse stakeholders about health data and their implications. PMID:28895928

Capturing Ecosystem Services, Stakeholders' Preferences and Trade-Offs in Coastal Aquaculture Decisions: A Bayesian Belief Network Application

PubMed Central

Schmitt, Laetitia Helene Marie; Brugere, Cecile

2013-01-01

Aquaculture activities are embedded in complex social-ecological systems. However, aquaculture development decisions have tended to be driven by revenue generation, failing to account for interactions with the environment and the full value of the benefits derived from services provided by local ecosystems. Trade-offs resulting from changes in ecosystem services provision and associated impacts on livelihoods are also often overlooked. This paper proposes an innovative application of Bayesian belief networks - influence diagrams - as a decision support system for mediating trade-offs arising from the development of shrimp aquaculture in Thailand. Senior experts were consulted (n = 12) and primary farm data on the economics of shrimp farming (n = 20) were collected alongside secondary information on ecosystem services, in order to construct and populate the network. Trade-offs were quantitatively assessed through the generation of a probabilistic impact matrix. This matrix captures nonlinearity and uncertainty and describes the relative performance and impacts of shrimp farming management scenarios on local livelihoods. It also incorporates export revenues and provision and value of ecosystem services such as coastal protection and biodiversity. This research shows that Bayesian belief modeling can support complex decision-making on pathways for sustainable coastal aquaculture development and thus contributes to the debate on the role of aquaculture in social-ecological resilience and economic development. PMID:24155876

Market-Based Health Care in Specialty Surgery: Finding Patient-Centered Shared Value.

PubMed

Smith, Timothy R; Rambachan, Aksharananda; Cote, David; Cybulski, George; Laws, Edward R

2015-10-01

: The US health care system is struggling with rising costs, poor outcomes, waste, and inefficiency. The Patient Protection and Affordable Care Act represents a substantial effort to improve access and emphasizes value-based care. Value in health care has been defined as health outcomes for the patient per dollar spent. However, given the opacity of health outcomes and cost, the identification and quantification of patient-centered value is problematic. These problems are magnified by highly technical, specialized care (eg, neurosurgery). This is further complicated by potentially competing interests of the 5 major stakeholders in health care: patients, doctors, payers, hospitals, and manufacturers. These stakeholders are watching with great interest as health care in the United States moves toward a value-based system. Market principles can be harnessed to drive costs down, improve outcomes, and improve overall value to patients. However, there are many caveats to a market-based, value-driven system that must be identified and addressed. Many excellent neurosurgical efforts are already underway to nudge health care toward increased efficiency, decreased costs, and improved quality. Patient-centered shared value can provide a philosophical mooring for the development of health care policies that utilize market principles without losing sight of the ultimate goals of health care, to care for patients.

Community Stakeholders’ Perceptions of Barriers to Childhood Obesity Prevention in Low-Income Families, Massachusetts 2012–2013

PubMed Central

Chuang, Emmeline; Aftosmes-Tobio, Alyssa; Blaine, Rachel E.; Giannetti, Mary; Land, Thomas; Davison, Kirsten K.

2015-01-01

Introduction The etiology of childhood obesity is multidimensional and includes individual, familial, organizational, and societal factors. Policymakers and researchers are promoting social–ecological approaches to obesity prevention that encompass multiple community sectors. Programs that successfully engage low-income families in making healthy choices are greatly needed, yet little is known about the extent to which stakeholders understand the complexity of barriers encountered by families. The objective of this study was to contextually frame barriers faced by low-income families reported by community stakeholders by using the Family Ecological Model (FEM). Methods From 2012 through 2013, we conducted semistructured interviews with 39 stakeholders from 2 communities in Massachusetts that were participating in a multisector intervention for childhood obesity prevention. Stakeholders represented schools; afterschool programs; health care; the Special Supplemental Nutrition Program for Women, Infants, and Children; and early care and education. Interviews were audio-recorded, transcribed, coded, and summarized. Results Stakeholder reports of the barriers experienced by low-income families had a strong degree of overlap with FEM and reflected awareness of the broader contextual factors (eg, availability of community resources, family culture, education) and social and emotional dynamics within families (eg, parent knowledge, social norms, distrust of health care providers, chronic life stressors) that could affect family adoption of healthy lifestyle behaviors. Furthermore, results illustrated a level of consistency in stakeholder awareness across multiple community sectors. Conclusion The congruity of stakeholder perspectives with those of low-income parents as summarized in FEM and across community sectors illustrates potential for synergizing the efforts necessary for multisector, multilevel community interventions for the prevention of childhood obesity. PMID:25811497

Developing dimensions for a multicomponent multidisciplinary approach to obesity management: a qualitative study.

PubMed

Cochrane, Anita J; Dick, Bob; King, Neil A; Hills, Andrew P; Kavanagh, David J

2017-10-16

There have been consistent recommendations for multicomponent and multidisciplinary approaches for obesity management. However, there is no clear agreement on the components, disciplines or processes to be considered within such an approach. In this study, we explored multicomponent and multidisciplinary approaches through an examination of knowledge, skills, beliefs, and recommendations of stakeholders involved in obesity management. These stakeholders included researchers, practitioners, educators, and patients. We used qualitative action research methods, including convergent interviewing and observation, to assist the process of inquiry. The consensus was that a multicomponent and multidisciplinary approach should be based on four central meta-components (patient, practitioner, process, and environmental factors), and specific components of these factors were identified. Psychologists, dieticians, exercise physiologists and general practitioners were nominated as key practitioners to be included. A complex condition like obesity requires that multiple components be addressed, and that both patients and multiple disciplines are involved in developing solutions. Implementing cycles of continuous improvement to deal with complexity, instead of trying to control for it, offers an effective way to deal with complex, changing multisystem problems like obesity.

One size doesn't fit all: ethics of international nurse recruitment from the conceptual framework of stakeholder interests.

PubMed

Xu, Yu; Zhang, Jianhui

2005-11-01

This theoretical study examines the ethics of international nurse recruitment from the conceptual framework of stakeholder interests. It argues that there are stakeholders at individual, institutional, national and international levels, with overlapping but, more often, different or even conflicting interests. Depending on the interests of given stakeholders, different conclusions regarding the ethics of international nurse recruitment may be reached. There is no right or wrong with these varying ethical positions because they reflect different beliefs and philosophies that are not amenable to value judgment. To illustrate and support this line of argument, this article analyzes the underpinnings of two ethical standards published by the International Council of Nurses and the UK Department of Health. In addition, a case study on China augments the argument by demonstrating limitations of the one-size-fits-all approach to the issue. The most important question in understanding and evaluating the ethical standards of international nurse recruitment is to know whose interests they are designed to represent and protect.

Legitimacy of hospital reconfiguration: the controversial downsizing of Kidderminster hospital.

PubMed

Oborn, Eivor

2008-04-01

This paper examines the contested organizational legitimacy of hospital reconfiguration, which continues to be a central issue in health care management. A qualitative study which focuses on the controversial downsizing of Kidderminster Hospital, a highly publicized landmark case of district general hospital closure. Rhetorical strategies are analysed to examine how legitimacy was constructed by stakeholder groups and how these strategies were used to support or resist change. Stakeholders promoting change legitimized re-organization pragmatically and morally arguing the need for centralization as a rational necessity. Stakeholders resisting change argued for cognitive and moral legitimacy in current service arrangements, contrasting local versus regionalized aspects of safety and provision. Groups managed to talk past each other, failing to establish a dialogue, which led to significant conflict and political upheaval. Stakeholders value hospitals in different ways and argue for diverse accounts of legitimacy. Broader discourses of medical science and democratic participation were drawn into rhetorical texts concerning regionalization to render them more powerful.

Recording and accounting for stakeholder involvement in systematic reviews.

PubMed

Saan, Marieke C; Boeije, Hennie R; Sattoe, Jane N T; Bal, Marjolijn I; Missler, Marjolein; van Wesel, Floryt

2015-06-01

The use of stakeholders in systematic reviews is increasingly valued, but their influence on the systematicity of the review is often unclear. The aim of this study was to describe some of the processes of involvement of stakeholders and to demonstrate a Tool for Recording and Accounting for Stakeholder Involvement (TRASI). We demonstrate the TRASI in two worked examples. In one project, the reviewers collaborated with the end-user and an expert during the literature search. In the other project, experts were consulted to generate keywords before searching the literature. In the first project, disagreements about keywords to identify studies for the research topic were solved by informal discussion. In the second project, difficulties arose in reaching agreement between experts and reviewers about the core construct and the meaningful keywords associated with it. The TRASI aids researchers to systematically and transparently account for the decisions taken. The TRASI supports information specialists and librarians to shape the search strategy to match the objectives of the review. We propose the TRASI as a first step in resolving the challenges of detecting and reconstructing stakeholder influences. Potential new applications of the TRASI are discussed. © 2015 Health Libraries Group.

A Good Idea May Not Be Good Enough: Stakeholder Buy In to QuitConnect, a National Smokers' Registry.

PubMed

Macauda, Mark M; Thrasher, James F; Saul, Jessie E; Celestino, Paula; Cummings, K Michael; Strayer, Scott M

2017-01-01

To examine interest and concerns among those who fund and operate state-run smoking cessation helplines (quitlines) about the concept of creating a centralized smokers' registry that could be used to reengage smokers after they receive initial quitline support services. We conducted 3, hour-long focus groups with stakeholders, covering the perceived benefits and barriers to creating a smokers' registry. The focus groups were conducted via telephone. Three groups participated: quitline service providers (n = 14), quitline funders (n = 9), and national quitline partners (n = 8). Data collection: Focus groups were recorded, transcribed, and coded for major relevant themes. Analysis Strategies: We used a grounded theory approach. Stakeholders were generally positive about the concept of a centralized smokers' registry (ie, QuitConnect), especially with its potential to link relapsed smokers to ongoing research studies designed to help smokers achieve abstinence from tobacco. However, stakeholders expressed concern about QuitConnect duplicating services already offered by state quitlines. Despite a common goal, many state quitline stakeholders had strong reservations about the creation of a centralized smokers' registry unless they could see clear evidence that the registry added value and was not duplicative of their existing services.

Defining Value in Cancer Care: AVBCC 2012 Steering Committee Report

PubMed Central

Beed, Gene; Owens, Gary M.; Benson, Al B.; Klein, Ira M.; Silver, Samuel M.; Beveridge, Roy A.; Malin, Jennifer; Sprandio, John D.; Deligdish, Craig K.; Mitchell, Matthew; Vogenberg, F. Randy; Fox, John; Newcomer, Lee N.

2012-01-01

Approximately 200 oncologists, payers, employers, managed care executives, pharmacy benefit managers, and other healthcare stakeholders convened in Houston, TX, on March 28–31, 2012, for the Second Annual Conference of the Association for Value-Based Cancer Care (AVBCC). The mission of the conference was to align the various perspectives around the growing need of defining value in cancer care and developing strategies to enhance patient outcomes. The AVBCC conference presented a forum for the various viewpoints from all the stakeholders across the cancer care continuum, featuring more than 20 sessions and symposia led by nearly 30 oncology leaders. The discussions focused on current trends and challenges in optimizing value in oncology by reducing or controlling cost while improving care quality and patient outcomes, introducing emerging approaches to management and tools that providers and payers are using to enhance cancer care collaboratively. The AVBCC Second Annual Conference was opened by a Steering Committee discussion of 11 panel members who attempted to define value in cancer care and articulated action steps that can help to implement value into cancer care delivery. The following summary represents highlights from the Steering Committee discussion, which was moderated by Gene Beed, MD, and Gary M. Owens, MD. PMID:24991320

Defining Value in Cancer Care: AVBCC 2012 Steering Committee Report.

PubMed

Beed, Gene; Owens, Gary M; Benson, Al B; Klein, Ira M; Silver, Samuel M; Beveridge, Roy A; Malin, Jennifer; Sprandio, John D; Deligdish, Craig K; Mitchell, Matthew; Vogenberg, F Randy; Fox, John; Newcomer, Lee N

2012-07-01

Approximately 200 oncologists, payers, employers, managed care executives, pharmacy benefit managers, and other healthcare stakeholders convened in Houston, TX, on March 28-31, 2012, for the Second Annual Conference of the Association for Value-Based Cancer Care (AVBCC). The mission of the conference was to align the various perspectives around the growing need of defining value in cancer care and developing strategies to enhance patient outcomes. The AVBCC conference presented a forum for the various viewpoints from all the stakeholders across the cancer care continuum, featuring more than 20 sessions and symposia led by nearly 30 oncology leaders. The discussions focused on current trends and challenges in optimizing value in oncology by reducing or controlling cost while improving care quality and patient outcomes, introducing emerging approaches to management and tools that providers and payers are using to enhance cancer care collaboratively. The AVBCC Second Annual Conference was opened by a Steering Committee discussion of 11 panel members who attempted to define value in cancer care and articulated action steps that can help to implement value into cancer care delivery. The following summary represents highlights from the Steering Committee discussion, which was moderated by Gene Beed, MD, and Gary M. Owens, MD.

Appetite for health-related food taxes: New Zealand stakeholder views.

PubMed

Signal, Louise N; Watts, Carolyn; Murphy, Celia; Eyles, Helen; Ni Mhurchu, Cliona

2017-05-05

There is increasing discussion globally of the value of health-related food taxes and subsidies to address obesity and noncommunicable diseases. In order for such policies to be successful it is important to understand the positions of key stakeholders. This research investigated New Zealand (NZ) stakeholders' views on the feasibility and acceptability of selected health-related food taxes and subsidies over the next 5 to 10 years. Twenty semi-structured interviews were undertaken by telephone from November 2014 to May 2015. The purposive sample of key stakeholders included politicians, bureaucrats, public health experts, food industry leaders and consumer representatives. Prior to interviews participants were sent summary information on the estimated impacts of a range of health-related food taxes and subsidies on dietary intake and mortality. According to key stakeholders there appears to be little appetite for taxes on foods high in saturated fat or salt in NZ. Stakeholders largely agreed that a tax on sugar-sweetened beverages (SSBs) and a subsidy on fruit and vegetables were both feasible and likely acceptable. There was strong support for starting with a SSBs tax, possibly framed around protecting children and dental health. Addressing obesity and noncommunicable diseases is a multidimensional challenge. A tax on SSBs and a subsidy on fruit and vegetables, possibly in tandem, could be part of the solution in NZ. There is growing interest in, and evidence for, health-related taxes and subsidies internationally. Given the critical role of stakeholder support for such policies similar research on stakeholders' views may assist the implementation of health-related food taxes and subsidies in other jurisdictions. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Stakeholders' perceptions of rehabilitation services for individuals living with disability: a survey study.

PubMed

Darzi, Andrea J; Officer, Alana; Abualghaib, Ola; Akl, Elie A

2016-01-08

The World Health Organization (WHO) was tasked with developing health system guidelines for the implementation of rehabilitation services. Stakeholders' perceptions are an essential factor to take into account in the guideline development process. The aim of this study was to assess stakeholders' perceived feasibility and acceptability of eighteen rehabilitation services and the values they attach to ten rehabilitation outcomes. We disseminated an online self-administered questionnaire through a number of international and regional organizations from the different WHO regions. Eligible individuals included persons with disability, caregivers of persons with disability, health professionals, administrators and policy makers. The answer options consisted of a 9-point Likert scale. Two hundred fifty three stakeholders participated. The majority of participants were health professional (64 %). In terms of outcomes, 'Increasing access' and 'Optimizing utilization' were the top service outcomes rated as critical (i.e., 7, 8 or 9 on the Likert scale) by >70 % of respondents. 'Fewer hospital admissions', 'Decreased burden of care' and 'Increasing longevity' were the services rated as least critical (57 %, 63 % and 58 % respectively). In terms of services, 'Community based rehabilitation' and 'Home based rehabilitation' were found to be both definitely feasible and acceptable (75 % and 74 % respectively). 'Integrated and decentralized rehabilitation services' was found to be less feasible than acceptable according to stakeholders (61 % and 71 % respectively). As for 'Task shifting', most stakeholders did not appear to find task shifting as either definitely feasible or definitely acceptable (63 % and 64 % respectively). The majority of stakeholder's perceived 'Increasing access' and 'Optimizing utilization' as most critical amongst rehabilitation outcomes. The feasibility of the 'Integrated and decentralized rehabilitation services' was perceived to be less than their acceptability. The majority of stakeholders found 'Task shifting' as neither feasible nor acceptable.

Corporate social responsibility practices in the Nigerian oil sector: The case of Royal Dutch Shell

NASA Astrophysics Data System (ADS)

Rwabizambuga, Alexis

The thesis contributes to the perspective on the role of stakeholder engagement in negotiating corporate social responsibility (CSR) policies and practices in developing country context. It critically examines the role of societal pressures as drivers of Shell's CSR agenda, and explores the forms of relationships existing between Shell and its stakeholders in Nigeria, as the company implements its CSR programme, both in the light of its strategic business objectives and of its social responsibilities and environmental liabilities. Furthermore, it examines the role of government in the oil MNCs' CSR agenda, and explores the conditions under which the government, in its dual role as business partner and as state authority, promotes CSR policies and practices in Nigeria. Shell's CSR policies and practices in Nigeria were examined under the theoretical lenses of the resource-based view perspective extended to notions of legitimacy and the licence to operate. Additionally, the stakeholder engagement perspective was applied as the theoretical framework for examining Shell's stakeholder engagement, and the role of the company's stakeholders in negotiating its current CSR policies and practices in Nigeria. Data collection was undertaken during field research in Nigeria. The evidence presented is drawn from individual interviews with corporate executives at Shell Nigeria, Shell International, several stakeholders in the Nigerian oil sector, and from an online survey conducted in 2005 on Shell Nigeria's stakeholders. Both quantitative and qualitative methods were used throughout the analysis presented in the thesis. The research findings suggest that the relationship between the firm's pursuit of the social licence to operate through CSR initiatives and stakeholder engagement is more complex than assumed. It adds to the understanding of the dynamics of a MNC's stakeholder engagement in the local context. It highlights the various interdependencies that develop between stakeholder groups and the company at the institutional level as well as within the context of the organisation, as the corporation develops and implements its CSR agenda. As such, the research invites an examination not just of the differences and barriers existing between the firm and its stakeholders, home and host country practices, but also of the ways in which they are embedded in each other, and how this affects their collaboration.

Civilizing the Conversation? Using Surveys to Inform Water Management and Science in the Sacramento-San Joaquin Delta

NASA Astrophysics Data System (ADS)

Hanak, E.; Phillips Chappelle, C.

2013-12-01

Improving ecosystem outcomes in California's Sacramento-San Joaquin Delta is a complex, high-stakes water resource management challenge. The Delta is a major hub for water supply conveyance and a valued ecological resource. Yet long-term declines in native fish populations have resulted in severe legal constraints on water exports and fueled growing public debates about the roles and responsibilities of flow modification and other sources of ecosystem stress. Meanwhile, scientific uncertainty, and the inability of the scientific community to effectively communicate what *is* known, has frustrated policymakers and encouraged 'combat science' - the commissioning and use of competing scientific opinions in the courtroom. This paper summarizes results from a study designed to inform the policy process through the use of confidential surveys of scientific researchers (those publishing in peer-reviewed journals, n=122) and engaged stakeholders and policymakers (n=240). The surveys, conducted in mid-2012, sought respondents' views on the sources of ecosystem stress and priority ecosystem management actions. The scientist survey is an example of the growing use of expert elicitation to address gaps in the scientific literature, particularly where there is uncertainty about priorities for decisionmaking (e.g., Cvitanovic et al. 2013, J. of Env. Mgmt; McDaniels et al. 2012, Risk Analysis). The stakeholder survey is a useful complement, enabling the identification of areas of consensus and divergence among stakeholder groups and between these groups and scientific experts. The results suggest such surveys are a promising tool for addressing complex water management problems. We found surprisingly high agreement among scientists on the relative roles of stressors and the most promising management actions; they emphasized restoring more natural processes through habitat and flow actions within the watershed, consistent with 'reconciliation ecology' approaches (Rosenzweig 2003, Oxford Univ. Press). In contrast, scientific consensus was far lower on the potential of relatively low-cost infrastructure and technology tools (e.g. gates, hatcheries) - underscoring the importance of building knowledge on such efforts. Surprisingly, and positively, stakeholders from groups with widely diverging public positions broadly agreed with scientists that multiple stressors are responsible for the Delta's plight. And most agreed with scientists on management priorities. However, individual groups were more likely to prioritize actions unrelated to their own uses of Delta resources and to shy away from actions that would be costly for them. The results point to the need for building shared understanding on Delta science for a more constructive policy process. To this end, the study proposed changes in the organization of Delta science drawing on 'common pool' models that have been effective for water quality research in both northern and southern California.

Systems and context modeling approach to requirements analysis

NASA Astrophysics Data System (ADS)

Ahuja, Amrit; Muralikrishna, G.; Patwari, Puneet; Subhrojyoti, C.; Swaminathan, N.; Vin, Harrick

2014-08-01

Ensuring completeness and correctness of the requirements for a complex system such as the SKA is challenging. Current system engineering practice includes developing a stakeholder needs definition, a concept of operations, and defining system requirements in terms of use cases and requirements statements. We present a method that enhances this current practice into a collection of system models with mutual consistency relationships. These include stakeholder goals, needs definition and system-of-interest models, together with a context model that participates in the consistency relationships among these models. We illustrate this approach by using it to analyze the SKA system requirements.

The Value of Medicines: A Crucial but Vague Concept.

PubMed

Antoñanzas, Fernando; Terkola, Robert; Postma, Maarten

2016-12-01

Health Technology Assessment is increasingly used to evaluate the value of healthcare products and to prioritize resources; however, defining exactly what value is and how it should be measured remains a challenge. In this article, we report the results of a literature review, focusing on nine European countries, with the aim of investigating how value is defined from the perspective of different stakeholders, how definitions of value are used, and how value is incorporated into decision making. Only three articles were identified that presented definitions of value, and there was no single shared definition of value in healthcare, which appears to be a highly subjective concept. The majority of the countries investigated combine clinical assessment with economic evaluation to make reimbursement recommendations; the quality-adjusted life-year is the most commonly used measure of value but does not capture broader aspects of value that may be important to patients and healthcare systems. We describe the use of value-based pricing and multi-criteria decision analysis, two approaches to the incorporation of broader aspects of value into decision making. Overall, we have identified considerable variation in how a product's value is defined by different stakeholders. Although a universal understanding of value in healthcare is important, it is clear that current definitions are insufficient, potentially leading to inconsistent reimbursement decisions. Ultimately, the establishment of clearer policies for defining and measuring value in healthcare is needed, and is likely to lead to improvements in the consistency of decision making.

Adding Value by Hospital Real Estate: An Exploration of Dutch Practice.

PubMed

van der Zwart, Johan; van der Voordt, Theo J M

2016-01-01

To explore how hospital real estate can add value to the healthcare organization, which values are prioritized in practice, and why. Dutch healthcare organizations are self-responsible for the costs and benefits of their accommodation. Meanwhile, a lively debate is going on about possible added values of corporate and public real estate in the fields of corporate real estate management and facility management. This article connects both worlds and compares insights from literature with experiences from practice. Added values extracted from literature have been discussed with 15 chief executive officers and project leaders of recently newly built hospitals in the Netherlands. Interviewees were asked (1) which values are included in the design and management of their hospital and why, (2) to prioritize most important values from a list of nine predefined values, and (3) to explain how the chosen real estate decisions are supposed to support organizational objectives. Stimulating innovation, user satisfaction, and improving organizational culture are most highly valued, followed by improving productivity, reducing building costs, and creating building flexibility. Image, risk control, and financing possibilities got lower rankings. The findings have been used to develop a value-impact matrix that connects nine values to various stakeholders and possible interventions. The findings and the value-impact matrix can make different stakeholders aware of many possible added values of hospital real estate, potential synergy and conflicts between different values, and how to steer on value add in different phases of the life cycle. © The Author(s) 2015.

Peer Reviewers' Dilemmas: Values Antinomies when Evaluating Higher Education Institutions

ERIC Educational Resources Information Center

Patry, Jean-Luc; Gastager, Angela

2012-01-01

Whenever evaluations are done, there are antinomies of interests both within and between stakeholders. To account for such antinomies, taxonomy has been developed which will be presented and discussed using the peer review processes in university evaluations as example. The taxonomy contains four dimensions: a) seven values domains are…

An Investigation Into the Challenges of Joint Basing

DTIC Science & Technology

2014-06-19

including legal entities, accounting systems, and strategic business unit ( profit center) (Shrivastava, 1986). Physical integration involves bringing...59 ix List of Tables Page Table 1. Military Value Factors and...commercial sector has transformed itself as products become obsolete, competition intensifies, and stakeholders continue to demand that value be maximized

Sustaining alliances for integrity.

PubMed

Werhane, P H

2000-01-01

Research in business ethics has shown that value-grounded organizations outperform their counterparts in business terms and that industries can successfully regulate themselves. The market in health care, systems theory, and stakeholder analysis are used to generate a set of five potential core values to sustain an Ethics Alliance of Oral Health Organizations.

Managing "Academic Value": The 360-Degree Perspective

ERIC Educational Resources Information Center

Wilson, Margaret R.; Corr, Philip J.

2018-01-01

The "raison d'etre" of all universities is to create and deliver "academic value", which we define as the sum total of the contributions from the 360-degree "angles" of the academic community, including all categories of staff, as well as external stakeholders (e.g. regulatory, commercial, professional and community…

Integrated planning and spatial evaluation of megasite remediation and reuse options.

PubMed

Schädler, Sebastian; Morio, Maximilian; Bartke, Stephan; Finkel, Michael

2012-01-01

Redevelopment of large contaminated brownfields (megasites) is often hampered by a lack of communication and harmonization among diverse stakeholders with potentially conflicting interests. Decision support is required to provide integrative yet transparent evaluation of often complex spatial information to stakeholders with different areas of expertise. It is considered crucial for successful redevelopment to identify a shared vision of how the respective contaminated site could be remediated and redeveloped. We describe a framework of assessment methods and models that analyzes and visualizes site- and land use-specific spatial information at the screening level, with the aim to support the derivation of recommendable land use layouts and to initiate further and more detailed planning. The framework integrates a GIS-based identification of areas to be remediated, an estimation of associated clean-up costs, a spatially explicit market value appraisal, and an assessment of the planned future land use's contribution to sustainable urban and regional development. Case study results show that derived options are potentially favorable in both a sustainability and an economic sense and that iterative re-planning is facilitated by the evaluation and visualization of economic, ecological and socio-economic aspects. The framework supports an efficient early judgment about whether and how abandoned land may be assigned a sustainable and marketable land use. Copyright © 2011 Elsevier B.V. All rights reserved.

Mixed strategy to allocate resources with air pollution treatment in China: based on the analytic network process and large-group decision-making method.

PubMed

Chen, Xi; Zhao, Liu; Özdemir, Mujgan Sagir; Liang, Haiming

2018-04-05

The resource allocation of air pollution treatment in China is a complex problem, since many alternatives are available and many criteria influence mutually. A number of stakeholders participate in this issue holding different opinions because of the benefits they value. So a method is needed, based on the analytic network process (ANP) and large-group decision-making (LGDM), to rank the alternatives considering interdependent criteria and stakeholders' opinions. In this method, the criteria related to air pollution treatment are examined by experts. Then, the network structure of the problem is constructed based on the relationships between the criteria. Further, every participant in each group provide comparison matrices by judging the importance between criteria according to dominance, regarding a certain criteria (or goal), and the geometric average comparison matrix of each group is obtained. The decision weight of each group is derived by combining the subjective weight and the objective weight, in which the subjective weight is provided by organizers, while the objective weight is determined by considering the consensus levels of groups. The final comparison matrices are obtained by the geometric average of comparison matrices and the decision weights. Next, the resource allocation is made according to the priorities of the alternatives using the super decision software. Finally, an example is given to illustrate the use of the proposed method.

Cultural background, gender, and institutional status have an effect on the evaluation of multi-disciplinary participatory action research.

PubMed

Graef, Frieder; Sieber, Stefan

2018-01-01

Research and development increasingly apply participatory approaches that involve both stakeholders and scientists. This article presents an evaluation of German and Tanzanian researchers' perceptions during their activities as part of a large interdisciplinary research project in Tanzania. The project focused on prioritizing and implementing food-securing upgrading strategies across the components of rural food value chains. The participants involved during the course of the project were asked to provide feedback on 10 different research steps and to evaluate eight core features related to the functioning and potential shortcomings of the project. The study discriminated among evaluation differences linked to culture, gender, and institutional status. Perceptions differed between Tanzanian and German participants depending on the type and complexity of the participatory research steps undertaken and the intensity of stakeholder participation. There were differences in perception linked to gender and hierarchical status; however, those differences were not as concise and significant as those linked to nationality. These findings indicate that participatory action research of this nature requires more targeted strategies and planning tailored to the type of activity. Such planning would result in more efficient and satisfactory communication, close collaboration, and mutual feedback to avoid conflicts and other problems. We further conclude that it would be advisable to carefully incorporate training on these aspects into future project designs.

Partnerships in obesity prevention: maximising co-benefits.

PubMed

Jones, Michelle; Verity, Fiona

2017-03-01

Issue addressed Partnerships were used to increase healthy eating and active living in children for the Obesity Prevention and Lifestyle (OPAL) program, a systems-wide, community-based childhood obesity prevention program in South Australia. This part of the multi-component evaluation examines stakeholders' perceptions of how OPAL staff worked in partnership and factors contributing to strong partnerships. Methods Pre- and post-interviews and focus groups with multi-sector stakeholders (n=131) across six OPAL communities were analysed using NVivo8 qualitative data analysis software. Results Stakeholders reflected positively on projects developed in partnership with OPAL, reporting that staff worked to establish co-benefits. They identified several factors that contributed to the strengthening of partnerships: staff skills, visibility, resources and sustainability. Conclusions Rather than implementing projects with stakeholders with shared organisational goals, local shared projects were implemented that included a breadth of co-benefits, allowing multi-sector stakeholders to meet their own organisational goals. Practitioners who have the capacity to be flexible, persistent, knowledgeable and skilled communicators are required to negotiate projects, achieving benefit for both health and stakeholders' organisational goals. So what? Engaging in partnership practice to broker co-benefits at the micro or program level has been an effective model for community engagement and change in OPAL. It foregrounds the need for the inclusion of value to partners, which differs from situations in which organisations come together around common goals.

Developing a spinal cord injury research strategy using a structured process of evidence review and stakeholder dialogue. Part II: Background to a research strategy.

PubMed

Bragge, P; Piccenna, L; Middleton, J; Williams, S; Creasey, G; Dunlop, S; Brown, D; Gruen, R

2015-10-01

Literature review/semi-structured interviews. To develop a spinal cord injury (SCI) research strategy for Australia and New Zealand. Australia. The National Trauma Research Institute Forum approach of structured evidence review and stakeholder consultation was employed. This involved gathering from published literature and stakeholder consultation the information necessary to properly consider the challenge, and synthesising this into a briefing document. A research strategy 'roadmap' was developed to define the major steps and key planning questions to consider; next, evidence from published SCI research strategy initiatives was synthesised with information from four one-on-one semi-structured interviews with key SCI research stakeholders to create a research strategy framework, articulating six key themes and associated activities for consideration. These resources, combined with a review of SCI prioritisation literature, were used to generate a list of draft principles for discussion in a structured stakeholder dialogue meeting. The research strategy roadmap and framework informed discussion at a structured stakeholder dialogue meeting of 23 participants representing key SCI research constituencies, results of which are published in a companion paper. These resources could also be of value in other research strategy or planning exercises. This project was funded by the Victorian Transport Accident Commission and the Australian and New Zealand Spinal Cord Injury Network.

Understanding the complex needs of automotive training at final assembly lines.

PubMed

Hermawati, Setia; Lawson, Glyn; D'Cruz, Mirabelle; Arlt, Frank; Apold, Judith; Andersson, Lina; Lövgren, Maria Gink; Malmsköld, Lennart

2015-01-01

Automobile final assembly operators must be highly skilled to succeed in a low automation environment where multiple variants must be assembled in quick succession. This paper presents formal user studies conducted at OPEL and VOLVO Group to identify assembly training needs and a subset of requirements; and to explore potential features of a hypothetical game-based virtual training system. Stakeholder analysis, timeline analysis, link analysis, Hierarchical Task Analysis and thematic content analysis were used to analyse the results of interviews with various stakeholders (17 and 28 participants at OPEL and VOLVO, respectively). The results show that there is a strong case for the implementation of virtual training for assembly tasks. However, it was also revealed that stakeholders would prefer to use a virtual training to complement, rather than replace, training on pre-series vehicles. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Clinical simulation as a boundary object in design of health IT-systems.

PubMed

Rasmussen, Stine Loft; Jensen, Sanne; Lyng, Karen Marie

2013-01-01

Healthcare organizations are very complex, holding numerous stakeholders with various approaches and goals towards the design of health IT-systems. Some of these differences may be approached by applying the concept of boundary objects in a participatory IT-design process. Traditionally clinical simulation provides the opportunity to evaluate the design and the usage of clinical IT-systems without endangering the patients and interrupting clinical work. In this paper we present how clinical simulation additionally holds the potential to function as a boundary object in the design process. The case points out that clinical simulation provides an opportunity for discussions and mutual learning among the various stakeholders involved in design of standardized electronic clinical documentation templates. The paper presents and discusses the use of clinical simulation in the translation, transfer and transformation of knowledge between various stakeholders in a large healthcare organization.

Ocean Research Priorities: Similarities and Differences among Scientists, Policymakers, and Fishermen in the United States

PubMed Central

Mason, Julia G.; Rudd, Murray A.; Crowder, Larry B.

2017-01-01

Abstract Understanding and solving complex ocean conservation problems requires cooperation not just among scientific disciplines but also across sectors. A recently published survey that probed research priorities of marine scientists, when provided to ocean stakeholders, revealed some agreement on priorities but also illuminated key differences. Ocean acidification, cumulative impacts, bycatch effects, and restoration effectiveness were in the top 10 priorities for scientists and stakeholder groups. Significant priority differences were that scientists favored research questions about ocean acidification and marine protected areas; policymakers prioritized questions about habitat restoration, bycatch, and precaution; and fisheries sector resource users called for the inclusion of local ecological knowledge in policymaking. These results quantitatively demonstrate how different stakeholder groups approach ocean issues and highlight the need to incorporate other types of knowledge in the codesign of solutions-oriented research, which may facilitate cross-sectoral collaboration. PMID:28533565

U.S. Patent Pending, Cyberspace Security System for Complex Systems, U.S. Patent Application No.: 14/134,949

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abercrombie, Robert K; Sheldon, Frederick T; Mili, Ali

A computer implemented method monetizes the security of a cyber-system in terms of losses each stakeholder may expect to lose if a security break down occurs. A non-transitory media stores instructions for generating a stake structure that includes costs that each stakeholder of a system would lose if the system failed to meet security requirements and generating a requirement structure that includes probabilities of failing requirements when computer components fails. The system generates a vulnerability model that includes probabilities of a component failing given threats materializing and generates a perpetrator model that includes probabilities of threats materializing. The system generatesmore » a dot product of the stakes structure, the requirement structure, the vulnerability model and the perpetrator model. The system can further be used to compare, contrast and evaluate alternative courses of actions best suited for the stakeholders and their requirements.« less

Stakeholder Meeting: Integrated Knowledge Translation Approach to Address the Caregiver Support Gap.

PubMed

Holroyd-Leduc, Jayna M; McMillan, Jacqueline; Jette, Nathalie; Brémault-Phillips, Suzette C; Duggleby, Wendy; Hanson, Heather M; Parmar, Jasneet

2017-03-01

Family caregivers are an integral and increasingly overburdened part of the health care system. There is a gap between what research evidence shows is beneficial to caregivers and what is actually provided. Using an integrated knowledge translation approach, a stakeholder meeting was held among researchers, family caregivers, caregiver associations, clinicians, health care administrators, and policy makers. The objectives of the meeting were to review current research evidence and conduct multi-stakeholder dialogue on the potential gaps, facilitators, and barriers to the provision of caregiver supports. A two-day meeting was attended by 123 individuals. Three target populations of family caregivers were identified for discussion: caregivers of seniors with dementia, caregivers in end-of-life care, and caregivers of frail seniors with complex health needs. The results of this meeting can and are being used to inform the development of implementation research endeavours and policies targeted at providing evidence-informed caregiver supports.

A Doctor is in the House: Stakeholder Focus Groups About Expanded Scope of Practice of Community Psychiatrists.

PubMed

Mangurian, Christina; Modlin, Chelsea; Williams, Lindsey; Essock, Susan; Riano, Nicholas S; Shumway, Martha; Newcomer, John W; Dilley, James W; Schillinger, Dean

2017-11-28

We sought to understand stakeholder perspectives on barriers to metabolic screening for people with severe mental illness. We additionally assessed the feasibility of expanding psychiatrists' scope of practice to include treatment of cardiometabolic abnormalities. We conducted four focus groups among patients with severe mental illness, community psychiatrists, primary care providers, and public health administrators. Focus group transcripts were thematically analyzed. Three domains emerged: challenges with patient navigation of the complex health care system, problem list prioritization difficulties, and concern that treatment of cardiometabolic abnormalities were beyond the scope of practice of psychiatrists. Stakeholders agreed that navigating the health care system was challenging for this population and led to undertreatment of cardiometabolic risk factors. Expansion of psychiatrists' scope of practice within community mental health appears acceptable to patients and may be a mechanism to improve cardiometabolic care among people with severe mental illness.

Questioning Stakeholder Legitimacy: A Philanthropic Accountability Model.

PubMed

Kraeger, Patsy; Robichau, Robbie

2017-01-01

Philanthropic organizations contribute to important work that solves complex problems to strengthen communities. Many of these organizations are moving toward engaging in public policy work, in addition to funding programs. This paper raises questions of legitimacy for foundations, as well as issues of transparency and accountability in a pluralistic democracy. Measures of civic health also inform how philanthropic organizations can be accountable to stakeholders. We propose a holistic model for philanthropic accountability that combines elements of transparency and performance accountability, as well as practices associated with the American pluralistic model for democratic accountability. We argue that philanthropic institutions should seek stakeholder and public input when shaping any public policy agenda. This paper suggests a new paradigm, called philanthropic accountability that can be used for legitimacy and democratic governance of private foundations engaged in policy work. The Philanthropic Accountability Model can be empirically tested and used as a governance tool.

Ocean Research Priorities: Similarities and Differences among Scientists, Policymakers, and Fishermen in the United States.

PubMed

Mason, Julia G; Rudd, Murray A; Crowder, Larry B

2017-05-01

Understanding and solving complex ocean conservation problems requires cooperation not just among scientific disciplines but also across sectors. A recently published survey that probed research priorities of marine scientists, when provided to ocean stakeholders, revealed some agreement on priorities but also illuminated key differences. Ocean acidification, cumulative impacts, bycatch effects, and restoration effectiveness were in the top 10 priorities for scientists and stakeholder groups. Significant priority differences were that scientists favored research questions about ocean acidification and marine protected areas; policymakers prioritized questions about habitat restoration, bycatch, and precaution; and fisheries sector resource users called for the inclusion of local ecological knowledge in policymaking. These results quantitatively demonstrate how different stakeholder groups approach ocean issues and highlight the need to incorporate other types of knowledge in the codesign of solutions-oriented research, which may facilitate cross-sectoral collaboration.

Governance of environmental risk: new approaches to managing stakeholder involvement.

PubMed

Benn, Suzanne; Dunphy, Dexter; Martin, Andrew

2009-04-01

Disputes concerning industrial legacies such as the disposal of toxic wastes illustrate changing pressures on corporations and governments. Business and governments are now confronted with managing the expectations of a society increasingly aware of the social and environmental impacts and risks associated with economic development and demanding more equitable distribution and democratic management of such risks. The closed managerialist decision-making of the powerful bureaucracies and corporations of the industrial era is informed by traditional management theory which cannot provide a framework for the adequate governance of these risks. Recent socio-political theories have conceptualised some key themes that must be addressed in a more fitting approach to governance. We identify more recent management and governance theory which addresses these themes and develop a process-based approach to governance of environmental disputes that allows for the evolving nature of stakeholder relations in a highly complex multiple stakeholder arena.

An afterword. HUMANING … (Anti-)DOPING; looking at "doping" sideways.

PubMed

Einstein, Stan

2014-07-01

This trek and quest explores a range of man-made anomalies and challenges which are rarely considered by their stakeholders in the complex, dynamic, nonlinear, multi-dimensionalities of both "doping" and antidoping, closure-driven certitudes.

Regional Geograhpic Network Partnerships Supporting Sustainable Landscapes - An Example: The North Atlantic Landscape Conservation Cooperative

EPA Science Inventory

Natural resource management agencies, conservation organizations and other stakeholders are facing increasingly complex environmental challenges that require coordinated management actions at regional and landscape levels. To address these challenges, integrated multi-disciplina...

Value-informed space systems design and acquisition

NASA Astrophysics Data System (ADS)

Brathwaite, Joy

Investments in space systems are substantial, indivisible, and irreversible, characteristics that make them high-risk, especially when coupled with an uncertain demand environment. Traditional approaches to system design and acquisition, derived from a performance- or cost-centric mindset, incorporate little information about the spacecraft in relation to its environment and its value to its stakeholders. These traditional approaches, while appropriate in stable environments, are ill-suited for the current, distinctly uncertain, and rapidly changing technical and economic conditions; as such, they have to be revisited and adapted to the present context. This thesis proposes that in uncertain environments, decision-making with respect to space system design and acquisition should be value-based, or at a minimum value-informed. This research advances the value-centric paradigm by providing the theoretical basis, foundational frameworks, and supporting analytical tools for value assessment of priced and unpriced space systems. For priced systems, stochastic models of the market environment and financial models of stakeholder preferences are developed and integrated with a spacecraft-sizing tool to assess the system's net present value. The analytical framework is applied to a case study of a communications satellite, with market, financial, and technical data obtained from the satellite operator, Intelsat. The case study investigates the implications of the value-centric versus the cost-centric design and acquisition choices. Results identify the ways in which value-optimal spacecraft design choices are contingent on both technical and market conditions, and that larger spacecraft for example, which reap economies of scale benefits, as reflected by their decreasing cost-per-transponder, are not always the best (most valuable) choices. Market conditions and technical constraints for which convergence occurs between design choices under a cost-centric and a value-centric approach are identified and discussed. In addition, an innovative approach for characterizing value uncertainty through partial moments, a technique used in finance, is adapted to an engineering context and applied to priced space systems. Partial moments disaggregate uncertainty into upside potential and downside risk, and as such, they provide the decision-maker with additional insights for value-uncertainty management in design and acquisition. For unpriced space systems, this research first posits that their value derives from, and can be assessed through, the value of information they provide. To this effect, a Bayesian framework is created to assess system value in which the system is viewed as an information provider and the stakeholder an information recipient. Information has value to stakeholders as it changes their rational beliefs enabling them to yield higher expected pay-offs. Based on this marginal increase in expected pay-offs, a new metric, Value-of-Design (VoD), is introduced to quantify the unpriced system’s value. The Bayesian framework is applied to the case of an Earth Science satellite that provides hurricane information to oil rig operators using nested Monte Carlo modeling and simulation. Probability models of stakeholders’ beliefs, and economic models of pay-offs are developed and integrated with a spacecraft payload generation tool. The case study investigates the information value generated by each payload, with results pointing to clusters of payload instruments that yielded higher information value, and minimum information thresholds below which it is difficult to justify the acquisition of the system. In addition, an analytical decision tool, probabilistic Pareto fronts, is developed in the Cost-VoD trade space to provide the decision-maker with additional insights into the coupling of a system's probable value generation and its associated cost risk.

Acceptability and Perceived Benefits and Risks of Public and Patient Involvement in Health Care Policy: A Delphi Survey in Belgian Stakeholders.

PubMed

Cleemput, Irina; Christiaens, Wendy; Kohn, Laurence; Léonard, Christian; Daue, François; Denis, Alain

2015-06-01

In systems with public health insurance, coverage decisions should reflect social values. Deliberation among stakeholders could achieve this goal, but rarely involves patients and citizens directly. This study aimed at evaluating the acceptability, and the perceived benefits and risks, of public and patient involvement (PPI) in coverage decision making to Belgian stakeholders. A two-round Delphi survey was conducted among all stakeholder groups. The survey was constructed on the basis of interviews with 10 key stakeholders and a review of the literature on participation models. Consensus was defined as 65% or more of the respondents agreeing with a statement and less than 15% disagreeing. Eighty stakeholders participated in both rounds. They were defined as the Delphi panel. Belgian stakeholders are open toward PPI in coverage decision processes. Benefits are expected to exceed risks. The preferred model for involvement is to consult citizens or patients, within the existing decision-making structures and at specific milestones in the process. Consulting citizens and patients is a higher level of involvement than merely informing them and a lower level than letting them participate actively. Consultation involves asking nonbinding advice on (parts of) the decision problem. According to the Delphi panel, the benefits of PPI could be increasing awareness among members of the general public and patients about the challenges and costs of health care, and enriched decision processes with expertise by experience from patients. Potential risks include subjectivity, insufficient resources to participate and weigh on the process, difficulties in finding effective ways to express a collective opinion, the risk of manipulation, and lobbying or power games of other stakeholders. PPI in coverage decision-making processes is acceptable to Belgian stakeholders, be it in different ways for different types of decisions. Benefits are expected to outweigh risks. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

One exhibition, many goals. A case study on how to combine scientific questions with stakeholder views on effective communication of risks.

NASA Astrophysics Data System (ADS)

Charriere, M. K. M.; Junier, S.; Bogaard, T.; Mostert, E.; Malet, J. P.

2014-12-01

How effective is visual communication to increase awareness of natural hazards and risks? To answer this research question, we developed a research design that was at the same time an experimental setting and an actual communication effort. This contribution will address the scientists-stakeholders interaction that was involved, the resulting exhibition, the lessons learned and the value it had for the researchers and for the other stakeholders. Throughout the full length of the 2-years project held in the Ubaye valley (southeastern France) we collaborated with local and regional stakeholders (politicians and technicians). Informal meetings with local stakeholders were organized to determine what they perceived as the needs in term of risk communication and to investigate the potential to develop activities that would benefit both them and us. We were offered the opportunity to design an exhibition for the local public library. We proposed the content and this was adjusted in interaction with the stakeholders. Later local technicians and inhabitants contributed to the content of the exhibition and regional stakeholders helped with the funding of the exhibition. Finally, employees of the public library took the lead in advertising the activity, gathering participants and they helped designing the scientific survey. This survey was the key activity from a scientific point of view as it allowed us to measure the impact of this communication activity on risk awareness. Moreover, the principal scientist was present during all opening hours of the exhibition. This allowed direct and indirect contact with the visitors. The benefits of this exhibition for the community included triggering memories, encouraging exchanges, especially inter-generational, reinforcing stakeholders-to-stakeholders relationships and promote further communication on the topic. The scientific benefits are that we have an experiment that allows us to measure the impact of a communication effort, not in a laboratory situation but in real life.

A Stakeholder Survey on Live Bird Market Closures Policy for Controlling Highly Pathogenic Avian Influenza in Vietnam

PubMed Central

Nguyen, Thi Thanh Thuy; Fearnley, Lyle; Dinh, Xuan Tung; Tran, Thi Tram Anh; Tran, Trong Tung; Nguyen, Van Trong; Tago, Damian; Padungtod, Pawin; Newman, Scott H.; Tripodi, Astrid

2017-01-01

Extensive research in Vietnam and elsewhere has shown that live bird markets (LBMs) play a significant role in the ecology and zoonotic transmission of avian influenzas (AIs) including H5N1 and H7N9. Vietnam has a large number of LBMs reflecting the consumer preferences for live poultry. Under pressure to mitigate risks for H7N9 and other zoonotic AIs, Vietnam is considering, among other mitigation measures, temporary closures of LBMs as a policy to reduce risk of AI outbreaks. However, the efficacy of market closure is debated, particularly because little is known about how poultry traders may react, and whether trading may emerge outside formal marketplaces. Combining efforts of anthropologists, economists, sociologists, and veterinarians can be useful to elucidate the drivers behind poultry traders’ reactions and better understanding the barriers to implementing risk mitigation measures. In this paper, we present results from a stakeholder survey of LBM stakeholders in Vietnam. Our qualitative data show that trading outside formal markets is very likely to occur in the event of a temporary LBM market closure. Our data show that the poultry value chain in Vietnam remains highly flexible, with traders willing and able to trade poultry in many possible locations. Our results indicate that simplification of the poultry value chain along with strict enforcement, engagement of stakeholders, and adequate communication would be a necessary prerequisite before market closure could be an effective policy. PMID:28879203

A Stakeholder Survey on Live Bird Market Closures Policy for Controlling Highly Pathogenic Avian Influenza in Vietnam.

PubMed

Nguyen, Thi Thanh Thuy; Fearnley, Lyle; Dinh, Xuan Tung; Tran, Thi Tram Anh; Tran, Trong Tung; Nguyen, Van Trong; Tago, Damian; Padungtod, Pawin; Newman, Scott H; Tripodi, Astrid

2017-01-01

Extensive research in Vietnam and elsewhere has shown that live bird markets (LBMs) play a significant role in the ecology and zoonotic transmission of avian influenzas (AIs) including H5N1 and H7N9. Vietnam has a large number of LBMs reflecting the consumer preferences for live poultry. Under pressure to mitigate risks for H7N9 and other zoonotic AIs, Vietnam is considering, among other mitigation measures, temporary closures of LBMs as a policy to reduce risk of AI outbreaks. However, the efficacy of market closure is debated, particularly because little is known about how poultry traders may react, and whether trading may emerge outside formal marketplaces. Combining efforts of anthropologists, economists, sociologists, and veterinarians can be useful to elucidate the drivers behind poultry traders' reactions and better understanding the barriers to implementing risk mitigation measures. In this paper, we present results from a stakeholder survey of LBM stakeholders in Vietnam. Our qualitative data show that trading outside formal markets is very likely to occur in the event of a temporary LBM market closure. Our data show that the poultry value chain in Vietnam remains highly flexible, with traders willing and able to trade poultry in many possible locations. Our results indicate that simplification of the poultry value chain along with strict enforcement, engagement of stakeholders, and adequate communication would be a necessary prerequisite before market closure could be an effective policy.

The International Finance Facility for Immunisation: stakeholders’ perspectives

PubMed Central

Mounier-Jack, Sandra

2016-01-01

Abstract Objective To evaluate stakeholders’ understanding and opinions of the International Finance Facility for Immunisation (IFFIm); to identify factors affecting funding levels; and to explore the future use of IFFIm. Methods Between July and September 2015, we interviewed 33 individuals from 25 organizations identified as stakeholders in IFFIm. In total 22.5 hours of semi-structured interviews were recorded, transcribed and analysed using a framework method. Findings Stakeholders’ understanding of IFFIm’s financing mechanism and its outcomes varied and many stakeholders wanted more information. Participants highlighted that the change in the macro-economic environment following the 2008 financial crisis affected national policy in donor countries and subsequently the number of new commitments IFFIm received. Since Gavi is now seen as a successful and mature organization, participants stated that donors prefer to donate directly to Gavi. The pharmaceutical industry valued IFFIm for providing funding stability and flexibility. Other stakeholders valued IFFIm’s ability to access funds early and enable Gavi to increase vaccine coverage. Overall, stakeholders thought IFFIm was successful, but they had divergent views about IFFIm’s on-going role. Participants listed two issues where bond financing mechanisms may be suitable: emergency preparedness and outcome-based time-limited interventions. Conclusion The benefit of pledging funds through IFFIm needs to be re-evaluated. There are potential uses for bond financing to raise funds for other global health issues, but these must be carefully considered against criteria to establish effectiveness, with quantifiable pre-defined outcome indicators to evaluate performance. PMID:27708474

Priority setting: what constitutes success? A conceptual framework for successful priority setting

PubMed Central

Sibbald, Shannon L; Singer, Peter A; Upshur, Ross; Martin, Douglas K

2009-01-01

Background The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. Methods Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries). Results This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. Conclusion The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts. PMID:19265518

The GEOSS Science and Technology Stakeholder Network and Service Suite: Linking S&T Communities and GEOSS

NASA Astrophysics Data System (ADS)

Plag, Hans-Peter; Jules-Plag, Shelley

2015-04-01

The Global Earth Observation System of Systems (GEOSS) developed by the Group on Earth Observations (GEO) aims to provide practice-relevant knowledge in support of decision making in a wide range of societal benefit areas. Generating this practice-relevant knowledge based on Earth observations, socio-economic data and models often depends on research, and utilization of the societal benefits of EOs requires the involvement of science and research communities. Building a GEOSS responding to the needs of a wide range of users necessitates contributions from many science and technology (S&T) communities. In particular, a strong engagement of science and technology (S&T) communities in both the development and use of GEOSS is necessary to address the complex issues associated with the on-going transition out of the Holocene. S&T support is needed to improve interoperability between global observing, modeling, and information systems; to enable data integration across disciplinary boundaries; to facilitate data sharing, archiving, dissemination, and reanalysis; to optimize the recording of observations, assimilation of data into models, and generation of data products; to enhance the value of observations from individual observing systems through their integration in the SBAs; and to harmonize well-calibrated, highly accurate, stable, sustained in-situ and satellite observations of the same variable recorded by different sensors and different agencies. Consequently, the GEO Work Plan includes several Tasks focusing on outreach to S&T communities, and most of the GEO Community of Practice have a strong S&T component. The GEOSS S&T Stakeholder Network facilitates input from S&T communities to GEO. Infrastructure serving and linking S&T users communities and GEOSS has been developed and is integrated into a GEOSS S&T Service Suite (GSTSS). The GSTSS has several outreach components for the demonstration of GEOSS and its value for S&T communities, and for services supporting S&T communities in their linkage to, and use of GEOSS. At the core of the GSTSS, the GEOSS S&T Portfolio includes examples showing GEOSS at work for S&T communities and provides an avenue for S&T groups to feature their contribution to GEOSS. The assessment of datasets is supported through an extensive feedback system. The User Requirements Registry (URR) allows users to publish what they do, how they do it, and what information and observations they need to do it. The URR is currently transitioned into a Socio-Economic and Environmental Information Needs Knowledge Base (SEE IN KB), which focuses on the linkage between societal goals and benefits on the one side and essential earth observations on the other side. The S&T Meeting Web Portal provides a workspace to coordinate and document GEO and GEOSS participation, side events, and presentations at relevant S&T meetings. The GEOSS S&T Stakeholder Network provides an umbrella for all S&T user and provider communities. The idea of a Stakeholder Network bringing together relevant S&T communities was developed by the EC-funded EGIDA project, and the underlying concept assumes that successful outreach to S&T communities requires demonstration of a benefit for these communities. The mission of the GEOSS S&T Stakeholder Network is twofold: to provide a voice for the needs and guidance of S&T communities to GEO, and to promote the use of GEOSS in these stakeholder communities. Workshops of the GEOSS S&T Stakeholder Network are organized within the GSTSS, among others with the goal to link societal goals, such as the Millennium Development Goals and the Sustainable Development Goals, and associated targets to a metric that then can be tied to essential variables to be provided by GEOSS.

The PCORI Engagement Rubric: Promising Practices for Partnering in Research

PubMed Central

Sheridan, Susan; Schrandt, Suzanne; Forsythe, Laura; Hilliard, Tandrea S.; Paez, Kathryn A.

2017-01-01

PURPOSE Engaging patients, caregivers, and other health care stakeholders as partners in planning, conducting, and disseminating research is a promising way to improve clinical decision making and outcomes. Many researchers, patients, and other stakeholders, however, lack clarity about when and how to engage as partners within the clinical research process. To address the need for guidance on creating meaningful stakeholder partnerships in patient-centered clinical comparative effectiveness research, the Patient-Centered Outcomes Research Institute (PCORI) developed the PCORI Engagement Rubric (Rubric). METHODS PCORI developed the Rubric drawing from a synthesis of the literature, a qualitative study with patients, a targeted review of engagement plans from PCORI-funded project applications, and a moderated discussion and review with PCORI’s Advisory Panel on Patient Engagement. RESULTS The Rubric provides a framework for operationalizing engagement to incorporate patients and other stakeholders in all phases of research. It includes: principles of engagement; definitions of stakeholder types; key considerations for planning, conducting, and disseminating engaged research; potential engagement activities; and examples of promising practices from PCORI-funded projects. CONCLUSIONS PCORI designed the Rubric to illustrate opportunities for engagement to researchers interested in applying for PCORI funding and to patients and other stakeholders interested in greater involvement in research. By encouraging PCORI applicants, awardees, and others to apply the rubric, PCORI hopes to shift the research paradigm from one of conducting research on patients as subjects to a pursuit carried out in collaboration with patients and other stakeholders to better reflect the values, preferences, and outcomes that matter to the patient community. PMID:28289118

The PCORI Engagement Rubric: Promising Practices for Partnering in Research.

PubMed

Sheridan, Susan; Schrandt, Suzanne; Forsythe, Laura; Hilliard, Tandrea S; Paez, Kathryn A

2017-03-01

Engaging patients, caregivers, and other health care stakeholders as partners in planning, conducting, and disseminating research is a promising way to improve clinical decision making and outcomes. Many researchers, patients, and other stakeholders, however, lack clarity about when and how to engage as partners within the clinical research process. To address the need for guidance on creating meaningful stakeholder partnerships in patient-centered clinical comparative effectiveness research, the Patient-Centered Outcomes Research Institute (PCORI) developed the PCORI Engagement Rubric (Rubric). PCORI developed the Rubric drawing from a synthesis of the literature, a qualitative study with patients, a targeted review of engagement plans from PCORI-funded project applications, and a moderated discussion and review with PCORI's Advisory Panel on Patient Engagement. The Rubric provides a framework for operationalizing engagement to incorporate patients and other stakeholders in all phases of research. It includes: principles of engagement; definitions of stakeholder types; key considerations for planning, conducting, and disseminating engaged research; potential engagement activities; and examples of promising practices from PCORI-funded projects. PCORI designed the Rubric to illustrate opportunities for engagement to researchers interested in applying for PCORI funding and to patients and other stakeholders interested in greater involvement in research. By encouraging PCORI applicants, awardees, and others to apply the rubric, PCORI hopes to shift the research paradigm from one of conducting research on patients as subjects to a pursuit carried out in collaboration with patients and other stakeholders to better reflect the values, preferences, and outcomes that matter to the patient community. © 2017 Annals of Family Medicine, Inc.

Conventional and New Ways of Governing Forest Threats: A Study of Stakeholder Coherence in Sweden.

PubMed

Eriksson, Louise

2018-01-01

Based on a framework for analyzing stakeholder coherence horizontally and vertically, the present study examined the governance of forest threats in Sweden. Opinions of forest risk governance in stakeholder groups with and without a connection to private forestry were compared (n = 2496) and the opinions were analyzed in relation to current governance practices. More specifically, forest threat appraisals, trust in the Swedish Forest Agency (SFA), and the acceptability of forest risk policy measures directed at private forest owners were assessed. Results revealed an overall coherence between different stakeholders in this context. However, the groups differed in, for example, the acceptability of the hypothetical regulative measure aiming to reduce damages threatening the forest long-term (e.g., climate change). Furthermore, an extensive use of advice for a fee may challenge particularly the internal, but also the external, legitimacy of forest risk governance. The forest owner stakeholder group showed lower threat appraisals when evaluating threat to one's own forest rather than to the Swedish forest, except regarding browsing by animals. Regulations were not disapproved of in any of the stakeholder groups, although the forest owner group generally displayed higher acceptability of encouraging measures compared to the general public. Trust in the SFA was furthermore confirmed as an important driver of policy acceptability, and higher threat appraisals of novel threats, such as climate change and fire, resulted in a higher acceptability of measures less central or new in this context. The value of analyzing stakeholder coherence for natural resource management and governance is discussed.

Conventional and New Ways of Governing Forest Threats: A Study of Stakeholder Coherence in Sweden

NASA Astrophysics Data System (ADS)

Eriksson, Louise

2018-01-01

Based on a framework for analyzing stakeholder coherence horizontally and vertically, the present study examined the governance of forest threats in Sweden. Opinions of forest risk governance in stakeholder groups with and without a connection to private forestry were compared ( n = 2496) and the opinions were analyzed in relation to current governance practices. More specifically, forest threat appraisals, trust in the Swedish Forest Agency (SFA), and the acceptability of forest risk policy measures directed at private forest owners were assessed. Results revealed an overall coherence between different stakeholders in this context. However, the groups differed in, for example, the acceptability of the hypothetical regulative measure aiming to reduce damages threatening the forest long-term (e.g., climate change). Furthermore, an extensive use of advice for a fee may challenge particularly the internal, but also the external, legitimacy of forest risk governance. The forest owner stakeholder group showed lower threat appraisals when evaluating threat to one's own forest rather than to the Swedish forest, except regarding browsing by animals. Regulations were not disapproved of in any of the stakeholder groups, although the forest owner group generally displayed higher acceptability of encouraging measures compared to the general public. Trust in the SFA was furthermore confirmed as an important driver of policy acceptability, and higher threat appraisals of novel threats, such as climate change and fire, resulted in a higher acceptability of measures less central or new in this context. The value of analyzing stakeholder coherence for natural resource management and governance is discussed.

An Ecosystem Service Evaluation Tool to Support Ridge-to-Reef Management and Conservation in Hawaii

NASA Astrophysics Data System (ADS)

Oleson, K.; Callender, T.; Delevaux, J. M. S.; Falinski, K. A.; Htun, H.; Jin, G.

2014-12-01

Faced with increasing anthropogenic stressors and diverse stakeholders, local managers are adopting a ridge-to-reef and multi-objective management approach to restore declining coral reef health state. An ecosystem services framework, which integrates ecological indicators and stakeholder values, can foster more applied and integrated research, data collection, and modeling, and thus better inform the decision-making process and realize decision outcomes grounded in stakeholders' values. Here, we describe a research program that (i) leverages remotely sensed and empirical data to build an ecosystem services-based decision-support tool geared towards ridge-to-reef management; and (ii) applies it as part of a structured, value-based decision-making process to inform management in west Maui, a NOAA coral reef conservation priority site. The tool links terrestrial and marine biophysical models in a spatially explicit manner to quantify and map changes in ecosystem services delivery resulting from management actions, projected climate change impacts, and adaptive responses. We couple model outputs with localized valuation studies to translate ecosystem service outcomes into benefits and their associated socio-cultural and/or economic values. Managers can use this tool to run scenarios during their deliberations to evaluate trade-offs, cost-effectiveness, and equity implications of proposed policies. Ultimately, this research program aims at improving the effectiveness, efficiency, and equity outcomes of ecosystem-based management. This presentation will describe our approach, summarize initial results from the terrestrial modeling and economic valuations for west Maui, and highlight how this decision support tool benefits managers in west Maui.

The islands are different: human perceptions of game species in Hawaii.

PubMed

Lohr, Cheryl A; Lepczyk, Christopher A; Johnson, Edwin D

2014-10-01

Hawaii's game animals are all non-native species, which provokes human-wildlife conflict among stakeholders. The management of human-wildlife conflict in Hawaii is further complicated by the discrete nature of island communities. Our goal was to understand the desires and perceived values or impacts of game held by residents of Hawaii regarding six game species [pigs (Sus scrofa), goats (Capra hircus), mouflon (Ovis musimon), axis deer (Axis axis), turkeys (Melagris gallopavo), and doves (Geopelia striata)]. We measured the desired abundance of game on the six main Hawaiian Islands using the potential for conflict index and identified explanatory variables for those desires via recursive partitioning. In 2011 we surveyed 5,407 residents (2,360 random residents and 3,047 pre-identified stakeholders). Overall 54.5 and 27.6 % of the emailed and mailed surveys were returned (n = 1,510). A non-respondent survey revealed that respondents and non-respondents had similar interest in wildlife, and a similar education level. The desired abundance of game differed significantly among stakeholders, species, and islands. The desired abundance scores were higher for axis deer, mouflon, and turkeys compared to pigs, goats or doves. Enjoyment at seeing game and the cultural value of game were widespread explanatory variables for desired abundance. Models for Lanai emphasized the economic value of game, whereas models for Maui identified the potential for game to contaminate soil and water. Models for Oahu and Kauai revealed concern for human health and safety. Given our findings we recommend managers design separate management plans for each island taking into consideration the values of residents.

How do medical device manufacturers' websites frame the value of health innovation? An empirical ethics analysis of five Canadian innovations.

PubMed

Lehoux, P; Hivon, M; Williams-Jones, B; Miller, F A; Urbach, D R

2012-02-01

While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology, there is often a disconnect in the perception of value between a technology's promoters and those responsible for the ultimate decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five Canadian medical device manufacturers, via their websites, frame the corporate "value proposition" of their innovation and seek to respond to what they consider the key expectations of their customers. Our analysis shows that the manufacturers' framing strategies combine claims that relate to valuable socio-technical goals and features such as prevention, efficiency, sense of security, real-time feedback, ease of use and flexibility, all elements that likely resonate with a large spectrum of health care system stakeholders. The websites do not describe, however, how the innovations may impact health care delivery and tend to obfuscate the decisional trade-offs these innovations represent from a health care system perspective. Such framing strategies, we argue, tend to bolster physicians' and patients' expectations and provide a large set of stakeholders with powerful rhetorical tools that may influence the health policy arena. Because these strategies are difficult to counter given the paucity of evidence and its limited use in policymaking, establishing sound collective health care priorities will require solid critiques of how certain kinds of medical devices may provide a better (i.e., more valuable) response to health care needs when compared to others.

The Islands Are Different: Human Perceptions of Game Species in Hawaii

NASA Astrophysics Data System (ADS)

Lohr, Cheryl A.; Lepczyk, Christopher A.; Johnson, Edwin D.

2014-10-01

Hawaii's game animals are all non-native species, which provokes human-wildlife conflict among stakeholders. The management of human-wildlife conflict in Hawaii is further complicated by the discrete nature of island communities. Our goal was to understand the desires and perceived values or impacts of game held by residents of Hawaii regarding six game species [pigs ( Sus scrofa), goats ( Capra hircus), mouflon ( Ovis musimon), axis deer ( Axis axis), turkeys ( Melagris gallopavo), and doves ( Geopelia striata)]. We measured the desired abundance of game on the six main Hawaiian Islands using the potential for conflict index and identified explanatory variables for those desires via recursive partitioning. In 2011 we surveyed 5,407 residents (2,360 random residents and 3,047 pre-identified stakeholders). Overall 54.5 and 27.6 % of the emailed and mailed surveys were returned ( n = 1,510). A non-respondent survey revealed that respondents and non-respondents had similar interest in wildlife, and a similar education level. The desired abundance of game differed significantly among stakeholders, species, and islands. The desired abundance scores were higher for axis deer, mouflon, and turkeys compared to pigs, goats or doves. Enjoyment at seeing game and the cultural value of game were widespread explanatory variables for desired abundance. Models for Lanai emphasized the economic value of game, whereas models for Maui identified the potential for game to contaminate soil and water. Models for Oahu and Kauai revealed concern for human health and safety. Given our findings we recommend managers design separate management plans for each island taking into consideration the values of residents.

Common ground: An environmental ethic for Los Alamos National Laboratory

DOE Office of Scientific and Technical Information (OSTI.GOV)

Menlove, F.L.

1991-01-01

Three predominant philosophies have characterized American business ethical thinking over the past several decades. The first phase is the ethics of self-interest'' which argues that maximizing self-interest coincidentally maximizes the common good. The second phase is legality ethics.'' Proponents argue that what is important is knowing the rules and following them scrupulously. The third phase might be called stake-holder ethics.'' A central tenant is that everyone affected by a decision has a moral hold on the decision maker. This paper will discuss one recent initiative of the Los Alamos National Laboratory to move beyond rules and regulations toward an environmentalmore » ethic that integrates the values of stakeholder ethics'' into the Laboratory's historical culture and value systems. These Common Ground Principles are described. 11 refs.« less

Using social network and stakeholder analysis to help evaluate infectious waste management: A step towards a holistic assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Caniato, Marco, E-mail: marcocaniato@gmail.com; Vaccari, Mentore, E-mail: mentore.vaccari@unibs.it; Visvanathan, Chettiyappan, E-mail: visu@ait.ac.th

Highlights: • Assessment of infectious waste management in Bangkok, in particular incineration. • Integration of social network and stakeholder analysis assessment methods. • Assessment of stakeholder characteristics, role, interaction and communication. • Interviewees self-evaluate their own characteristics and the system. • Non-technical aspects are important for system acceptability, and sustainability. - Abstract: Assessing the strengths and weaknesses of a solid waste management scheme requires an accurate analysis and integration of several determining features. In addition to the technical aspects, any such system shows a complex interaction of actors with varying stakes, decision-making power and influence, as well as a favourablemore » or disabling environment. When capitalizing on the knowledge and experience from a specific case, it is also crucial that experts do not “forget” or underestimate the importance of such social determinants and that they are familiar with the methods and tools to assess them. Social network analysis (SNA) and stakeholder analysis (SA) methods can be successfully applied to better understand actors’ role and actions, analyse driving forces and existing coordination among stakeholders, as well as identify bottlenecks in communication which affect daily operations or strategic planning for the future way forward. SNA and SA, appropriately adjusted for a certain system, can provide a useful integration to methods by assessing other aspects to ensure a comprehensive picture of the situation. This paper describes how to integrate SNA and SA in order to survey a solid waste management system. This paper presents the results of an analysis of On-Nuch infectious waste incinerator in Bangkok, Thailand. Stakeholders were interviewed and asked to prioritize characteristics and relationships which they consider particularly important for system development and success of the scheme. In such a way, a large quantity of information about organization, communication between stakeholders and their perception about operation, environmental and health impact, and potential alternatives for the system was collected in a systematic way. The survey results suggest that stakeholders are generally satisfied with the system operation, though communication should be improved. Moreover, stakeholders should be strategically more involved in system development planning, according to their characteristics, to prevent negative reactions.« less

The value of health care--a matter of discussion in Germany.

PubMed

Porzsolt, Franz; Ackermann, Moritz; Amelung, Volker

2007-01-02

Interest in assessing the value of health-care services in Germany has considerably increased since the foundation of the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG (Institute for Quality and Efficiency in Health Care). The practical application of value assessment illustrates how problematic the process can be. In all decisions made for the provision of health care, data concerning the measurable dimensions (quantity and quality of efficacy and effectiveness, validity of the results and costs) flow into a complex and not yet standardized decision-making process concerning public financing. Some of these decisions are based on data of uncertain validity, unknown reproducibility and unclear appropriateness. In this paper we describe the theoretical aspects of value from psychological and economic viewpoints and discuss national and international approaches. Methodic details and difficulties in assessing the value of health-care services are analysed. A definition of the intangible value of health-care services will be proposed which contains only three factors: the absolute risk reduction (usually a measure of efficacy), the validity of the scientific papers examined and the type of the expected effectiveness (prevention of death and disability, restitution of well-being). The intangible value describes the additional benefit when comparing two possible actions, like treatment or observation only. The description of intangible value from the viewpoint of different stakeholders is a useful measure for subsequent steps (not discussed here) - the evaluation of costs and of patient benefit. A standardised, transparent, fair and democratic evaluation is essential for the definition of a basic benefit package.

The value of health care – a matter of discussion in Germany

PubMed Central

Porzsolt, Franz; Ackermann, Moritz; Amelung, Volker

2007-01-01

Background Interest in assessing the value of health-care services in Germany has considerably increased since the foundation of the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG (Institute for Quality and Efficiency in Health Care). The practical application of value assessment illustrates how problematic the process can be. In all decisions made for the provision of health care, data concerning the measurable dimensions (quantity and quality of efficacy and effectiveness, validity of the results and costs) flow into a complex and not yet standardized decision-making process concerning public financing. Some of these decisions are based on data of uncertain validity, unknown reproducibility and unclear appropriateness. Discussion In this paper we describe the theoretical aspects of value from psychological and economic viewpoints and discuss national and international approaches. Methodic details and difficulties in assessing the value of health-care services are analysed. A definition of the intangible value of health-care services will be proposed which contains only three factors: the absolute risk reduction (usually a measure of efficacy), the validity of the scientific papers examined and the type of the expected effectiveness (prevention of death and disability, restitution of well-being). The intangible value describes the additional benefit when comparing two possible actions, like treatment or observation only. Conclusion The description of intangible value from the viewpoint of different stakeholders is a useful measure for subsequent steps (not discussed here) – the evaluation of costs and of patient benefit. A standardised, transparent, fair and democratic evaluation is essential for the definition of a basic benefit package. PMID:17199886

Barriers to and facilitators of implementing complex workplace dietary interventions: process evaluation results of a cluster controlled trial.

PubMed

Fitzgerald, Sarah; Geaney, Fiona; Kelly, Clare; McHugh, Sheena; Perry, Ivan J

2016-04-21

Ambiguity exists regarding the effectiveness of workplace dietary interventions. Rigorous process evaluation is vital to understand this uncertainty. This study was conducted as part of the Food Choice at Work trial which assessed the comparative effectiveness of a workplace environmental dietary modification intervention and an educational intervention both alone and in combination versus a control workplace. Effectiveness was assessed in terms of employees' dietary intakes, nutrition knowledge and health status in four large manufacturing workplaces. The study aimed to examine barriers to and facilitators of implementing complex workplace interventions, from the perspectives of key workplace stakeholders and researchers involved in implementation. A detailed process evaluation monitored and evaluated intervention implementation. Interviews were conducted at baseline (27 interviews) and at 7-9 month follow-up (27 interviews) with a purposive sample of workplace stakeholders (managers and participating employees). Topic guides explored factors which facilitated or impeded implementation. Researchers involved in recruitment and data collection participated in focus groups at baseline and at 7-9 month follow-up to explore their perceptions of intervention implementation. Data were imported into NVivo software and analysed using a thematic framework approach. Four major themes emerged; perceived benefits of participation, negotiation and flexibility of the implementation team, viability and intensity of interventions and workplace structures and cultures. The latter three themes either positively or negatively affected implementation, depending on context. The implementation team included managers involved in coordinating and delivering the interventions and the researchers who collected data and delivered intervention elements. Stakeholders' perceptions of the benefits of participating, which facilitated implementation, included managers' desire to improve company image and employees seeking health improvements. Other facilitators included stakeholder buy-in, organisational support and stakeholder cohesiveness with regards to the level of support provided to the intervention. Anticipation of employee resistance towards menu changes, workplace restructuring and target-driven workplace cultures impeded intervention implementation. Contextual factors such as workplace structures and cultures need to be considered in the implementation of future workplace dietary interventions. Negotiation and flexibility of key workplace stakeholders plays an integral role in overcoming the barriers of workplace cultures, structures and resistance to change. Current Controlled Trials: ISRCTN35108237. Date of registration: 02/07/2013.

A web-based system for the integrated water management

NASA Astrophysics Data System (ADS)

Giordano, R.; Passarella, G.; Uricchio, V. F.; Lopez, N.

2003-04-01

The success of complexity theory has posed new challenges also in the environmental resources management. From the complexity point of view, in fact, the environment has to be considered as a system with numerous parts interrelated each other by strongly and no-linear feedback relationships. In this perspective, when an action is performed its results become difficult to control. Therefore, to construct and to select the most suitable alternatives for environmental resources management, an holistic approach has to be adopted. In water resources management domain, increasing interest is posed to the integrated management, in which the total system of biotic and a-biotic elements of certain water environment is taken into account. Our contribution moves from the idea that the term integrated has to be referred also to human agents which take decisions influencing the water environment. In other words, Integrated Water Management (IWM) considers how different action affect, and can reinforce, each other and it promotes the coordinated development and management of water, land and related resources. The IWM stresses the interrelationships among the actions at different types, working at different levels of influence, coordinating stakeholders' actions. The coordination requires an appropriate information level about the strategies used by each stakeholder. To improve the information flow inside a watershed and therefore the coordination among agents, a web-based system is proposed. It could be defined as an electronic agora where a set of stakeholders can be involved both in information exchange and in conflicts resolution. More in detail, to improve the coordination process, the proposed system allows the stakeholders to find someone with similar or conflicting interests to collaborate with; to make contact with selected people; to build a common understanding (that is the identification of a common goal, the negotiation about the way this goal should be reached); to communicate with other co-workers in order to coordinate activities and work plans. The proposed system, therefore, is able to understand the interaction among stakeholders at different scales and to use that knowledge to support the process of defining policies that result in a sustainable water management. The validation phase is made applying the system to a watershed in Apulia region, selecting different stakeholders with their management tasks and interests.