Key Stakeholders In Relation Research Articles

The human right to health, inclusion and essential health care packages in low income countries: “health for all” in Malawi

PurposeHealth in low-income countries has become associated with the provision of minimum guaranteed public health services though Essential Health Packages (EHPs). How far do EHPs deliver the human right to health for all? This study addresses this question through qualitative research into access to health care for vulnerable communities, using Malawi as a case study. This study shows that there are significant accountability gaps and perceptions of weak service provision in Malawi’s EHP in relation to some particularly marginalised (and stigmatised) groups that limit the right to health and the promise of “health for all”.Design/methodology/approachThis study extends the body of qualitative work on EHPs in general and on Malawi in particular by exploring the perceptions of key stakeholders in relation to inclusivity and the delivery of health policies to particularly vulnerable groups. To do so, this study adopted an approach based on interpretive epistemologies (Scott, 2014). This study conducted largely unstructured interviews with a range of health stakeholders, speaking to stakeholders individually, rather than through focus groups due to the potentially sensitive nature of the topic.FindingsThe findings of this study are as follows: limited inclusion of civil society actors and local communities; local communities and local policymakers feel frustration with the gap between the promises of consultation in the EHP and the reality, and the difficulties of not having effective channels of communication; and exclusionary health practices for particularly vulnerable groups.Research limitations/implicationsThere are limitations based on the qualitative methodology, and in terms of the particularly vulnerable groups – the authors studied two such groups (people with disabilities and those who identify as LBTQ) but a wider survey of vulnerable groups is needed to extend and confirm the findings.Practical implicationsGreater attention to the health rights of vulnerable groups would improve access and services, even in the context of resource restrictions. This study suggests that a deeper engagement with human rights-based approaches would pay dividends in terms of increasing access to health in Malawi, even within the constraints of the EHP process. Furthermore, without this, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised.Social implicationsWithout addressing these issues, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised.Originality/valueThis paper makes an important contribution to the growing literatures on EHP in sub-Saharan Africa and Malawi in particular and to the importance of listening to stakeholder perceptions. It provides original data on stakeholder perspectives of the challenges associated with universalising health care in resource-constrained countries. To the best of the authors’ knowledge, it is one of the first papers to focus on the rights of disabled and LBTQ people in relation to EHPs.

Opinions of key stakeholders regarding the inpatient Individual Care Plan.

In Ireland, regularly reviewed Individual Care Plans (ICPs) for inpatients at all acute psychiatric inpatient units are a requirement of the Mental Health Act . In this study, we comprehensively evaluated and compared opinions of key stakeholders in relation to the ICP as a care delivery tool. We employed a descriptive survey design. Questionnaires were distributed to 123 stakeholders (patients and mental health professionals (MHPs)) to evaluate and compare opinions regarding the impact of the ICP in relation to healthcare delivery and health outcomes, and regarding the structure and frequency of use of the ICP. Ninety-eight stakeholders (80%) completed study questionnaires. Stakeholders (patients (58%) and MHPs (85%)) reported that the ICP assisted in healthcare delivery. However, different attitudes between groups were noted in relation to whether the ICPcontributed towards healthcare outcomes, with 64% of patients, but only 41% of MHPs reporting that the ICP positively contributed to mental healthcare outcomes. Some free-text comments described patient dissatisfaction with the role of the ICP for healthcare delivery, and MHP dissatisfaction that the ICP was time-consuming and did not significantly enhance standard patient care. Whilst the implementation of the ICP is generally viewed positively by both patients and MHPs, considerable dissatisfaction by MHPs was also noted with certain aspects of how the ICP was delivered in practice. Practical adjustments to the implementation of ICP in order to build more positive stakeholder experiences appear warranted and worthy of further research.

Stakeholder perceptions of curriculum design, development and delivery for continuing e-learning for nurses.

This paper reports the qualitative findings from stage 5 of an action research project which involved the redesign of continuing professional education (CPE) courses in one organisation. The aim of this study was to explore key stakeholders perceptions of the teaching, learning and outcomes of a new curriculum design for CPE involving e-learning. This project used participatory action research, involving stakeholders as participants in a process of inquiry about the change. The study took place in an academic teaching hospital and consisted of three focus group interviews with a total of 20 nurses. Participants included stakeholders who had developed curricula and managers from clinical areas where CPE courses had been undertaken. Four main themes emerged, revealing staff perceptions on the process of change and their own 'lightbulb moments' experienced during this process. Results also indicate that the change has resulted in learner-focused CPE, with a range of opportunities for continued educational development in future. Key stakeholders' experience is seldom reported in studies related to CPE. This study provides an insight into the experiences of key stakeholders in relation to the development and delivery of CPE courses. Stakeholders indicated that they were able to see the benefits of implementing new CPE curricula they had contributed to. They also commented that clinical-pertinent and competence-based courses were more learner focused as a result of combining online content with supported workshops.

AHP leadership in academia: opportunities, challenges and current positioning

ABSTRACT The aim of this research was to gain a deeper understanding of the perceptions of key stakeholders in relation to the current extent of Allied Health Professionals in leadership roles within academia. The researchers undertook an exploration of the potential barriers, challenges and opportunities that exist for AHPs to undertake leadership roles within higher education and used the findings to offer recommendations for the future. Several themes emerged from the study, the primary ones relating to lack of confidence, a lack of motivation amongst AHPs to aspire to senior leadership roles, with a preference instead to focus on gaining clinical and research expertise rather than leadership skills. In addition, fewer opportunities appear to exist for AHPs to progress into senior leadership roles outside of the AHP sphere, due to a number of reasons which are explored in more depth in this report

Facilitators and barriers to the implementation of a Mobile Health Wallet for pregnancy-related health care: A qualitative study of stakeholders' perceptions in Madagascar.

Financial barriers are a major obstacle to accessing maternal health care services in low-resource settings. In Madagascar, less than half of live births are attended by skilled health staff. Although mobile money-based savings and payment systems are often used to pay for a variety of services, including health care, data on the implications of a dedicated mobile money wallet restricted to health-related spending during pregnancy-a mobile health wallet (MHW)-are not well understood. In cooperation with the Madagascan Ministry of Health, this study aims to elicit the perceptions, experiences, and recommendations of key stakeholders in relation to a MHW amid a pilot study in 31 state-funded health care facilities. We conducted a two-stage qualitative study using semi-structured in-depth interviews with stakeholders (N = 21) representing the following groups: community representatives, health care providers, health officials and representatives from phone provider companies. Interviews were conducted in Atsimondrano and Renivohitra districts, between November and December of 2017. Data was coded thematically using inductive and deductive approaches, and found to align with a social ecological model. Key facilitators for successful implementation of the MHW, include (i) close collaboration with existing communal structures and (ii) creation of an incentive scheme to reward pregnant women to save. Key barriers to the application of the MHW in the study zone include (i) disruption of informal benefits for health care providers related to the current cash-based payment system, (ii) low mobile phone ownership, (iii) illiteracy among the target population, and (iv) failure of the MHW to overcome essential access barriers towards institutional health care services such as fear of unpredictable expenses. The MHW was perceived as a potential solution to reduce disparities in access to maternal health care. To ensure success of the MHW, direct demand-side and provider-side financial incentives merit consideration.

Private management and governance styles in a Japanese public hospital: A story of west meets east

This paper examines a case of healthcare governance reform in a Japanese hospital to demonstrate how and why physicians may resist NPM ideals in healthcare. We find that the governance reform departed significantly from its idealized form. The intended structure of decentralized governance was ruptured by the CEO, with unanticipated consequences. The power of the medical school, arising out of the ikyoku system in the context of chronic shortages of physicians and the respect afforded to physicians by wider society, was played out in the hospital, with cost management taking a back seat. We find that the general patterns of interaction between and among key stakeholders in relation to accountability and the governance process are shaped by some form of verticality, monologues rather than dialogues, indirectness and silence rooted in Japanese cultural context. Cultural political economy approach guided us to examine both semiotic and extra semiotic features and their dialectical moments with key actors in assessing the limits of NPMs in non-Western contexts.

Professional protectionism; a barrier to employing a sonographer graduate?

IntroductionThe national sonographer workforce deficit is not a new challenge and has been driven by the increasing demand for ultrasound services. The current educational models only facilitate small trainee numbers and are unable to keep abreast of the demand for trained sonographers. This is partially due to the intensive (and often one to one) sonographer training which has instigated much debate relating to alternative models of education. Alongside this, debate continues on the educational level of any future training models; one suggestion being the introduction of a graduate sonographer and the subsequent integration into the current workforce. The aim of this research was to gain a deeper understanding of the perceptions of key stakeholders in relation to potential challenges and barriers, especially associated with protectionism, and to offer recommendations to overcome these. MethodsA total of thirteen semi-structured interviews were conducted and the data analysed using a constructivist Grounded Theory approach. ResultsThe findings suggested that sonographers, as an occupational group, presented challenges and resistance to change as a mechanism for protecting their own roles. This research highlighted that responses to the concept of integrating a new sonographer graduate into the workforce were deeply rooted and centred around power and dominance. ConclusionThe findings from the research identified that tradition and professional culture created barriers for the future development of the sonography profession and that there was an urgent need for change which, it was proposed, could be achieved through clear leadership to manage and implement the changes.

Working together: Providing better information, advice and support on work engagement and cancer

Background: There is a body of evidence emerging on the importance of work following a diagnosis of cancer. There is, however, a need to provide better information, advice and support on work engagement. The challenges of work engagement and related decision-making at the more macro or systems level have been largely focused on the healthcare system and on patients' clinical pathways. This approach misses key stakeholder groups. Method: How can we meet the information and advice needs of those diagnosed with a urological cancer, and other key stakeholders in relation to cancer survival and work engagement? The project involved three key groups: individuals diagnosed with a urological cancer, relevant healthcare providers, and members of large organisations. There were three stages: in-depth interviews, modified qualitative Delphi study and expert workshops. Results: The analysis was conducted using Framework analysis. Ten key themes were identified: work engagement; decision-making and support; adaptation; communication; attitudes towards cancer; accommodation; roles and responsibilities; signposting; education and training; resources. Conclusion: Work is an important aspect of quality of life and should be recognised within cancer survivorship to improve individual and societal outcomes. This is necessarily more complex than a simple allocation of responsibility for providing information and advice to one stakeholder group, role or individual. This has to be shared across stakeholder groups across the person's journey from diagnosis to return to work and retention, non-return or retirement. This needs a system that is more easily staffed and able to deliver the information needed at an appropriate time and in a workable way according to knowledge and availability. Among other things, it also requires knowledge of and a map of the network of the groups, roles and people involved. Despite weaknesses in current practice, there is much appropriate resource available and commitment to doing things better. Working together, we can achieve this.

The Development of the Olympic Narrative in Chinese Elite Sport Discourse from Its First Successful Olympic Bid to the Post-Beijing Games Era

As a phenomenon exogenous to China, the Olympics have been proactively interpreted in the local context since China’s entry (and subsequent re-entry in 1984) into the Olympic movement. With China’s increasing involvement in promoting three bids to host the Olympic Games, two of which were successful, respectively, in 2001 and 2015, the nature of the discourse of key stakeholders in relation to Chinese elite sport has both reflected and reshaped the meaning of the Games to Chinese elite sport. This paper examines the discursive construction process of the Olympics in the Chinese elite sport system by key stakeholders through analyzing statements of political figures on sport and Olympic phenomena, Chinese elite sport policy documents, and the commentaries of leading Chinese sport academics. The analysis of discourse highlights two main features in the construction of the Games in official accounts during the period under investigation. The development of these two themes reflects the nature of the Chinese Olympic discourse, manifests the political power over the interpretation of the Olympics in Chinese context, and continues to characterize the on-going major themes in Chinese elite sport policy.

A national study of selection processes for student nurses and midwives

BackgroundThis paper presents the main findings from a project that aimed to evaluate selection processes for the recruitment of student nurses and midwives. ObjectivesThe main objectives were to:1.Explore the literature regarding the efficacy, reliability and validity of face-to-face interviewing and related selection processes as selection tools for the recruitment of student nurses and midwives.2.Ascertain the views/perceptions of key stakeholders in relation to the interview and selection process and (where possible) the outcomes of these initiatives regarding their influence on appropriate recruitment, selection and retention.3.Review existing models of face-to-face interviewing from across HEIs in Scotland against criteria using a structured method.DesignThe evaluation was designed principally to achieve explanation, with multiple case study methodology adopted as the main approach. Within this ambit mixed methods of data collection involving questionnaires and interviews were used.ParticipantsSeven of the Scotland-based Higher Education Institutions participated in the research, with participation from Admissions Tutors, clinical interviewers, academic interviewers, and students. MethodsThe methods included: a scoping questionnaire with follow-on questionnaire to elicit views on the strengths and limitations of chosen selection processes; interviews and focus groups to build on these findings. Analytical approaches were congruent with the chosen data collection approaches.FindingsHEIs typically have rationales for their various chosen approaches to selection. However, our findings indicate that there is a lack of evidence for most selection approaches particularly in relation to interviewing. There is a growing evidence-base for the use of multiple mini interviews, and emotional intelligence testing. ConclusionsThere is a need to work collectively cross-UK to bring together the evidence-base around selection so that processes and decision-making are as valid, reliable, effective and transparent as possible.

Social Responsibility as an Innovative Approach for Enhancing Competitiveness of Tourism Business Sector in Egypt

The purpose of this article is to improve the understanding of the manner in which tourism companies deal with key stakeholders in relation to corporate social responsibility (CSR) in Egypt, focusing in particular on how tourism business sector companies can handle critical issues related to CSR and utilize these experiences in enforcing their regular social responsibility for gaining more competitive edges in the global tourism markets. The article methodology is based on collecting data from the Egyptian tourism companies through questionnaire forms. Statistical Means, Z test, and analysis of variance (ANOVA) are used to measure the social responsibility criteria in the Egyptian tourism business sector and to interpret the research outcomes. The research results explained that tourism business sector managers' attitudes towards CSR criteria are positive. They actually have defined policies regarding CSR and practice activities regarding CSR issues. However, CSR should be managed by a combination of handling unexpected episodes that threaten existing social responsibility and the long-term reduction of gaps between stakeholder expectations and the tourism business sector performance. Furthermore, CSR implies building and maintaining relationships with society through interplay between actors, resources, and activities for improving the competitiveness of tourism business sector companies in Egypt.

Managing corporate social responsibility: lessons from the oil industry

PurposeThe purpose of this paper is to improve the understanding of the manner in which companies deal with key stakeholders in relation to corporate social responsibility (CSR), focusing in particular on how companies can handle critical incidents related to CSR and utilize these experiences in enforcing their regular social responsibility.Design/methodology/approachThe paper is based on a case study methodology.FindingsCSR should be managed by a combination of handling unexpected episodes that threaten existing social responsibility (incident recovery) and the long‐term reduction of gaps between stakeholder expectations and the company performance (CSR enforcement). Furthermore, CSR implies building and maintaining relationships with society through interplay between actors, resources and activities.Practical implicationsThe study contributes to managerial decision making by identifying seven types of implications and activities necessary to actively manage key aspects of social responsibility.Originality/valueThe paper integrates long‐term social responsibility enforcement with short‐term social responsibility recovery by means of a recent corporate case from the oil industry.

Chronic disease management in primary care: from evidence to policy

To review the effectiveness of chronic disease management interventions for physical health problems in the primary care setting, and to identify policy options for implementing successful interventions in Australian primary care. We conducted a systematic review with qualitative data synthesis, using the Chronic Care Model as a framework for analysis between January 1990 and February 2006. Interventions were classified according to which elements were addressed: community resources, health care organisation, self-management support, delivery system design, decision support and/or clinical information systems. Our major findings were discussed with policymakers and key stakeholders in relation to current and emerging health policy in Australia. The interventions most likely to be effective in the context of Australian primary care were engaging primary care in self-management support through education and training for general practitioners and practice nurses, and including self-management support in care plans linked to multidisciplinary team support. The current Practice Incentives Payment and Service Incentives Payment programs could be improved and simplified to encourage guideline-based chronic disease management, integrating incentives so that individual patients are not managed as if they had a series of separate chronic diseases. The use of chronic disease registers should be extended across a range of chronic illnesses and used to facilitate audit for quality improvement. Training should focus on clear roles and responsibilities of the team members. The Chronic Care Model provides a useful framework for understanding the impact of chronic disease management interventions and highlights the gaps in evidence. Consultation with stakeholders and policymakers is valuable in shaping policy options to support the implementation of the National Chronic Disease Strategy in primary care.

Towards an acceptance of performance assessment.

The utility of any assessment tool critically depends on its level of acceptance by those on whom the assessment impacts. Performance assessment impacts on three distinct groups: patients/consumers, doctors and employers. While these groups may have conflicting beliefs and expectations of performance assessment, the process must be made acceptable to all. This can happen through an exploration of the beliefs and wishes of the key stakeholders in relation to performance assessment, together with the potential rewards and costs. This paper draws on the psychology literature in describing an effective model for change management. It outlines some strategies for each of the three key elements of any successful strategy for change, i.e. getting started, facilitating the transition and ensuring consolidation. Such a practical approach will foster the acceptance of performance assessment structures among all stakeholders.