Multiple Stakeholder Approach Research Articles

Determining and regulating scope of practice for health care professionals: A participatory, multiple stakeholder approach.

Scope of practice varies between health professions and states. To explore stakeholders' preferences for determining and regulating health care professionals' scopes of practice. Stakeholders in medicine, nursing, and pharmacy, including practitioners, leaders of professional associations, regulatory board members, and healthcare executives, were recruited via professional organizations, social media, and snowball sampling. Stakeholder preferences were collected using concept mapping, an integrated mixed methods approach which includes 1) brainstorming of statements and 2) sorting and rating of statements. Multidimensional scaling, hierarchical cluster analysis, and Mann Whitney-U tests were used for analysis. Thirty participants generated and sorted statements regarding preferences for scope of practice, creating eight clusters: 1) accountability to prioritize patient safety, 2) standardization, 3) collaborative regulation, 4) intra-professional regulation, 5) federal versus state, 6) role of non-health care professionals, 7) prioritization of patient outcomes, and 8) health care professional training and education. Fifty-seven participants rated statements in terms of importance and feasibility. Physicians and non-physicians held similar views on 68.5% (n=37) and 81.5% (n=44) of statements, respectively for importance and feasibility. The statements in the standardization and health care professional training and education clusters were perceived as the most important and feasible across stakeholder types.

A medicine adoption model for assessing the expected effects of additional real-world evidence (RWE) at product launch

Introduction The optimal launch and adoption of novel medicines require effective navigation of the commercial and regulatory landscape, including three key gatekeeper groups: regulators, payors, and prescribers. Traditionally, despite lacking generalisability, the pharmaceutical industry provides Phase III randomized controlled trial evidence to gatekeepers. Despite additional real-world evidence (RWE) improving the generalisability of evidence, the provision of RWE remains in its infancy. The industry may use a multiple stakeholder approach to RWE generation to address each group's priorities and expectations effectively. Methods The Jandhyala Method observed a consensus of expert opinion on the expected effects of supplementing randomised controlled trial evidence (RCTE) with RWE on the depth and time to maximal adoption. The study recruited participants from two of the three gatekeeper stakeholder groups (prescribers and payors) and their four aligned industry stakeholder groups (market access, commercial, medical affairs, and regulatory affairs) groups involved in the approval or adoption of investigational medicines. Results The observed consensus predicted a shortened time to maximal adoption by 22% and increased maximal adoption by 31% of a new medicine with additional RWE at launch. The suggested rationales for these effects varied across stakeholder groups and between specific effects. The results found the prescriber gatekeeper to be dominant in driving the predicted shortening of adoption. No such dominant subsystem was identified for the expected increase in adoption depth, although a potential rationale was the broader population observed in the supplementary RWE. Conclusions The proposed model provides an intuitive temporal framework within which subsystem logic can be further researched to identify and address stakeholder groups’ needs and weigh those needs. Preliminary results appear to support adopting a multiple stakeholder approach to RWE for augmenting the uptake of novel medicines.

Freedom camping in Aotearoa New Zealand: an exploration of stakeholder perceptions

The global COVID-19 health pandemic has shaken the most stable political systems, and left deep economic scars across industries. With global and national travel at a standstill, the tourism industry is among the most heavily hit. The gradual lifting of restrictions has already fuelled tourism demand, and previous hopes of rebuilding and transforming tourism more sustainably are vanishing. To ensure that pre-COVID-19 situations of unsustainable development do not resurface, it is of critical importance to go beyond economically driven crisis recovery. Instead, governments need to reconsider pre-crisis challenges, such as imbalances between tourists and residents, infrastructure shortages, and questions around the efficiency of regulations and policies. In New Zealand, issues related to freedom camping have fuelled these debates, with headlines relating to tourists defecating in public space, dropping garbage, and being ‘freeloaders’ with little economic value. Adopting a multiple stakeholder approach, this research note empirically explores stakeholder perceptions of challenges associated with freedom camping in the context of New Zealand. Semi-structured interviews were conducted with 20 stakeholders representing host communities, local councils, national agencies, tourism businesses, and regional tourism organisations. Qualitative data analysis reveals positive changes and reduced impacts as results of additional infrastructure funding, educational measures, and locally enforced bylaws. However, participants also noted the need for a national framework, and clear statements and messages regarding domestic demand. Considering that nature-based experiences that allow for social distancing, such as (freedom) camping, have grown significantly during the pandemic and that domestic tourists will be crucial to post-COVID tourism recovery, this original multiple stakeholder approach delivers policy-relevant insights and provides avenues for future research with regard to a responsible and sustainable tourism restart.

The multiple stakeholder approach to real-world evidence (RWE) generation: observing multidisciplinary expert consensus on quality indicators of rare disease patient registries (RDRs)

Introduction Those invested in the outcome of specific decisions may seek to inform the decision-maker by generating relevant evidence. With multiple decision-makers, the evidence generator benefits from understanding whether their needs differ. This was explored using relevant stakeholders’ preferences on quality indicators (QIs) of rare disease patient registries (RDRs), a common vehicle for generating evidence, to support the adoption of new medicines. Methods The Jandhyala method was used to compare the observed consensus on RDR quality indicators from each stakeholder group (SHG) and between the combined pharmaceutical (pharma) and non-pharmaceutical (non-pharma) SHG population. Results All non-pharmaceutical stakeholder groups were equally unique – suggesting QIs peculiar to themselves – Patients (13/102; 12.75%); Payors (5/102; 4.90%); Prescribers (7/102; 6.86%) to the same degree. Non-pharmaceutical stakeholders generated 31/102 (30.39%) unique QIs. Pharma stakeholder generated 25/102 (24.51%). This totals 56/102 (54.90%) QIs without a match. Two QIs were unanimously suggested and agreed upon by all SHGs (7/7; 100%) – “Engages with patients and gains their buy-in” and “Includes a core data set as part of outcomes”. There was homogenous consensus on common QIs between: Commercial – Market Access (13/52; 25%; p = .005) SHGs; Commercial – Medical Affairs (9/47; 19.15%; p = .001) SHGs; Commercial – Payor (11/41; 21.15%; p = .012) SHGs, and Market Access – Regulatory Affairs (10/41; 19.61%; p = .008) SHGs. Conclusions A multiple stakeholder approach for generating real-world evidence can be justified. The potential mismatch of 54.9% between pharma and non-pharma stakeholders indicates a critical misalignment between generator and consumer of its RWE. Pharmaceutical SHG’s were highlighted for greater alignment with Patients and Payor (non-pharma) groups.

A Strategic Approach for implementing A Smart Pedestrian Network (SPN) System

Abstract This paper presents a strategic approach for implementing a Smart Pedestrian Network (SPN) navigation System that is geared towards promoting sustainable mobility. The SPN system is being designed to reach multiple market segments by providing information on suitable walking routes aiming to satisfy potential users’ needs, but also multiple stakeholder demands. The paper presents the main objectives of the SPN system as well as its system structure, application features, functions, and relevant data sources. The proposed strategic implementation framework deems necessary for scaling up so that the SPN system is successfully implemented in a variety of urban conditions. The framework emphasizes the element of adaptability, so that SPN can be adjusted where and when necessary, to deal with a variety of contexts and specific sustainable mobility issues, depending on the particular municipality conditions. The proposed framework combines elements of both the waterfall and agile software development methods, as well as, aspects of Open Innovation, Customer Involvement and Co-Creation taking a multiple stakeholder approach.

Governance challenges of marine renewable energy developments in the U.S. – Creating the enabling conditions for successful project development

Increasingly, marine renewable energy developments are viewed as an opportunity to meet climate change obligations, with the added benefit of powering the economy and the creation of jobs. Technical, economic and engineering challenges co-exist with governance challenges in the development of large-scale marine renewable energy projects. This paper addresses the question, if the prerequisites for sustainable project development are evident in selected case studies. It also asks what lessons can be learned from current practice in the context of energy governance at the local level. The authors argue that these lessons can be central enablers to support decision makers in future programmes, to better understand how to build the enabling conditions for programme implementation towards renewable energy at higher spatial scales of governance, importantly the national level. The study builds on a multiple stakeholder approach involving interviews and group discussions with key individuals from industry, government and civil society in emerging pilot programmes along the East Coast of the United States (U.S.). New policy windows were opening at the time of the analysis and ambitious development was underway by a range of actors who are driving progress in the sector and positioning the area to become a major provider of blue energy.

Repatriation and (perceived) organisational support (POS)

PurposeThe purpose of this paper is to explore the role of and interaction between (potential) repatriation supporters to develop understanding of how this affects the repatriate experience.Design/methodology/approachA (single) case study strategy was employed, using a multiple stakeholder approach, involving 21 in-depth interviews in a large UK-based institution with repatriates, home and host HR managers, international human resource (IHR) practitioners and line managers from both home and host locations.FindingsAlthough line managers, senior managers, family members and third party providers (e.g. relocation agencies, tax advisors) are important for repatriation support, the case study evidence highlights that HR professionals are mainly responsible for the quality of the support delivered by other repatriation supporters. Inadequate support from the headquarters IHR department caused by a lack and unclear information about repatriation procedures and related responsibilities results in insufficient support for home and host HR managers. This negatively impacts repatriates line managers (perceptions of) HR support. Weaknesses in the support chain (headquarter IHR, home and host HR and line managers) are responsible for repatriates (perceived) limited or non-support.Research limitations/implicationsThe small size of our sample, the single case study design and the method precludes generalisation of the findings. However, the authors’ “look inside” increased the understanding of repatriation support and in particular the support quality. By linking this information to the knowledge of previous studies on organisational support and the devolution of human resource management, the authors are able to identify several topics future studies in the field of repatriation management.Practical implicationsIHRM policies have to reflect the role of multiple stakeholders including home and host line managers and HR professionals as well as third party providers and assign clear lines of responsibility to provide a transparent and consistent experience. Repatriates family has to be acknowledged as a stakeholder that has a major influence on repatriation success and failure. Excluding partners and children issues from international career policies has to be considered as a serious HR shortcoming. Second, ensuring timely information regarding return positions. Providing debriefing interviews upon repatriation can help to identify future roles within the organisation. Equally important is exit interviews to explore whether the person has completed an assignment within the previous 24 months and whether this experience has contributed to their decision to leave the organisation. Opportunities to ensure repatriates are being considered for positions as part of the talent pool is crucial. Finally, the authors emphasise the need to acknowledge that third party vendors are part of the repatriation process and must be considered in terms of (perceived) organisational support.Originality/valueThis is one of the first studies that highlights the role and interaction of (potential) repatriation supporters. Specifically, this study contributes to addressing three knowledge gaps: it identifies a lack of communication among HR professionals and between them and line managers as a potential source of insufficient organisational support; the findings highlight HR professionals responsibility for supporting line managers and other repatriation supporters in operational repatriation management; and finally, the results support the assumption that HR professionals and line managers own (non-)experience with working abroad might affect the quality of support policies and practices for repatriates.

Implementing school nursing strategies to reduce LGBTQ adolescent suicide: a randomized cluster trial study protocol.

BackgroundReducing youth suicide in the United States (U.S.) is a national public health priority, and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth are at elevated risk. The Centers for Disease Control and Prevention (CDC) endorses six evidence-based (EB) strategies that center on meeting the needs of LGBTQ youth in schools; however, fewer than 6 % of U.S. schools implement all of them. The proposed intervention model, “RLAS” (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools. The DAP accounts for the multilevel context of school settings and uses Implementation Resource Teams (IRTs) to facilitate appropriate expertise, advise on acceptable adaptations, and provide data feedback to make schools implementation ready and prepared to sustain changes.Methods/DesignMixed methods will be used to examine individual, school, and community factors influencing both implementation process and youth outcomes. A cluster randomized controlled trial will assess whether LGBTQ students and their peers in RLAS intervention schools (n = 20) report reductions in suicidality, depression, substance use, bullying, and truancy related to safety concerns compared to those in usual care schools (n = 20). Implementation progress and fidelity for each EB strategy in RLAS intervention schools will be examined using a modified version of the Stages of Implementation Completion checklist. During the implementation and sustainment phases, annual focus groups will be conducted with the 20 IRTs to document their experiences identifying and advancing adaptation supports to facilitate use of EB strategies and their perceptions of the DAP.DiscussionThe DAP represents a data-informed, collaborative, multiple stakeholder approach to progress from exploration to sustainment and obtain fidelity during the implementation of EB strategies in school settings. This study is designed to address the real-world implications of enabling the use of EB strategies by school nurses with the goal of decreasing suicide and youth risk behaviors among LGBTQ youth. Through its participatory processes to refine and sustain EB strategies in high schools, the RLAS represents a novel contribution to implementation science.Trial registrationClinicalTrials.gov, NCT02875535 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0507-2) contains supplementary material, which is available to authorized users.

A multiple stakeholder approach to nonprofit board effectiveness: the employee perspective

Although the multiple stakeholder approach is a well-known theory of board evaluation, employees are an understudied but important stakeholder group. This study seeks to understand the ways in which employees' perception of the effectiveness of their board of directors can influence employee attitudes and behaviour. Using responses from 166 employees in a nonprofit registered club, the study shows that employees do form an impression of the effectiveness of their board. Furthermore, employees' perception of effectiveness of the board was positively related to their perception of the quality of their relationship with the organisation and negatively related to their intention to leave. These findings offer the potential for improved organisational performance and productivity. The study provides empirical support for broadening the stakeholders when considering board performance and suggests board-staff perspectives as a new avenue for research. The paper offers insights on potential policy and management of the board of directors.

Addressing noncommunicable disease at the population level: a focus on diabetes

SUMMARY The prevalence of both noncommunicable disease and Type 2 diabetes is increasing worldwide, and much of this increase is explained by lifestyle factors and obesity. There is now robust evidence from randomized, controlled trials in high-risk individuals that lifestyle interventions, including diet and physical activity, can reduce both obesity and progression to Type 2 diabetes. There is some evidence of translation of these trials to the wider community, but most local and national programs utilize the high-risk approach and fail to address noncommunicable disease and Type 2 diabetes prevention at the population level. This review addresses the measures needed to introduce Type 2 prevention at the community level, summarizes the multiple stakeholder approach and reviews the evidence for efficacy of population-based prevention.

The Mutually Reinforcing Roles of Trust and Reputation: A Multiple Stakeholder Approach

Trust and reputation are fundamental concepts in understanding relationships between organizations and key stakeholder groups. These concepts have always been studied separately in the past. Anchored on a literature review conducted on the concepts of trust and reputation, the present article focuses on the mutually reinforcing relationships between these two key concepts. The article aims to bring to the forefront the importance of trust and reputation for stakeholder management and purports to build a conceptual framework that acknowledges the nature of that relationship and its implications to organizations and to their stakeholders.

Effective governance in nonprofit organizations: A literature based multiple stakeholder approach

Summary Nonprofit organizations (NPOs) are increasingly required to become (more) effective. This review summarizes and integrates the results of studies focusing on NPOs’ governance effectiveness. It proposes an extension of stakeholder theory to NPOs concerning governance involving diverse stakeholder groups. What makes this paper innovative is that it aims to identify more than effective board governance, and takes the perspectives of multiple nonprofit key stakeholders into account. This approach is particularly valuable as numerous researchers argue that the likelihood of NPOs being perceived as effective increases when they manage to align the, possibly very diverse, expectations of stakeholders on good governance. We consequently focus on the relationship between (1) the needs and objectives of key stakeholders and (2) (expected) governance (structures) in NPOs. The stakeholders we consider are government, beneficiaries, private donors, board members, management, volunteers, and non-managerial staff members. Results not only show the lack of attention some stakeholders have received in the literature, but also the governance related conflicting needs and objectives between stakeholder groups. In addition, even in the same stakeholder groups it is not rare that opposing findings are reported. Several studies indicate the (unforeseen) negative impact on (being accountability to) other stakeholders when NPOs try to be responsive to the needs and objectives of a particular stakeholder group. The value of this review lies in the fact that it reveals both the complexity of and the need for stakeholder management in NPOs, if they want to be perceived as (more) effective by their numerous stakeholders, and related to that gain insight in how to improve their governance practices. Numerous directions for further research are suggested.

Dynamic adaptation process to implement an evidence-based child maltreatment intervention

BackgroundAdaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process. The degree to which core elements of an EBP can be maintained while allowing for local adaptation is unclear. In addition, adaptations may also be needed at the system, policy, or organizational levels to facilitate EBP implementation and sustainment. This paper describes a study of the feasibility and acceptability of an implementation approach, the Dynamic Adaptation Process (DAP), designed to allow for EBP adaptation and system and organizational adaptations in a planned and considered, rather than ad hoc, way. The DAP involves identifying core elements and adaptable characteristics of an EBP, then supporting implementation with specific training on allowable adaptations to the model, fidelity monitoring and support, and identifying the need for and solutions to system and organizational adaptations. In addition, this study addresses a secondary concern, that of improving EBP model fidelity assessment and feedback in real-world settings.MethodsThis project examines the feasibility, acceptability, and utility of the DAP; tests the degree to which fidelity can be maintained using the DAP compared to implementation as usual (IAU); and examines the feasibility of using automated phone or internet-enabled, computer-based technology to assess intervention fidelity and client satisfaction. The study design incorporates mixed methods in order to describe processes and factors associated with variations in both how the DAP itself is implemented and how the DAP impacts fidelity, drift, and adaptation. The DAP model is to be examined by assigning six regions in California (USA) to either the DAP (n = 3) or IAU (n = 3) to implement an EBP to prevent child neglect.DiscussionThe DAP represents a data-informed, collaborative, multiple stakeholder approach to maintain intervention fidelity during the implementation of EBPs in the field by providing support for intervention, system, and organizational adaptation and intervention fidelity to meet local needs. This study is designed to address the real-world implications of EBP implementation in public sector service systems and is relevant for national, state, and local service systems and organizations.

Stakeholders’ Influence and Contribution to Social Standards Development: The Case of Multiple Stakeholder Approach to ISO 26000 Development

We present an empirical investigation on how multiple stakeholders can influence and contribute to a standard development process. Based on the analysis of comments submitted by stakeholders developing ISO 26000 standard for social responsibility, we found no significant differences between the ratio of accepted and non-accepted comments among various stakeholder groups; however, we conclude that industry is the most influential stakeholder due to the volume of the comments. We also present a set of processes that stakeholders follow to influence and contribute to standards development, namely to (1) eliminate issues that are controversial and undesirable; (2) link and integrate the standard into a network of other documents and ISO standards; (3) seek consensus by highlighting areas for further dialogue or by addressing their exclusion from the standards development, (4) reinforce issues that are important; and (5) improve the content of the new standard. In conclusion, we provide a set of propositions about multi-stakeholder standards development and compare multi-stakeholder involvement in standards developed through a new committee established in existing standards setting organization [i.e., Committees within the International Organization for Standardization (ISO)] and through new standards setting organizations established for one specific task (i.e., Forest Stewardship Council). We envisage that our study will be a useful platform to monitor and evaluate future developments of ISO 26000 and other multi-stakeholder standards.

Marketing and societal welfare: A multiple stakeholder approach

This manuscript provides insights to help identify the nature, scope and domain of the business strategy–consumer behavior–societal welfare link, and ways to explore the trade-offs between individual and societal gains. In this manuscript, stakeholder theory serves as a lens to analyze these issues in the context of a case study of direct-to-consumer advertising (DTCA) for prescription drugs. The case study adds support to the Wilkie and Moore (1999, 2003) premise that the marketing system, unlike many other institutions, is thoroughly embedded in the routines and expectations of our society. Marketing, and in particular, advertising, not only reflects the assumptions and priorities of society, but also influences the way individuals and organizations understand and act upon contemporary social issues. A discussion of insights and implications emerging from the analysis suggests several potential areas for future research.

Corporate Governance, Internal Decision Making, and the Invisible Hand

Proponents of the dominant contemporary model of corporate governance maintain that the shareholder is the primary constituent of the firm. The responsibility for managerial decision makers in this governance system is to maximize shareholder wealth. Neoclassical economists ethically justify this objective with their interpretation of Adam Smith's notion of the Invisible Hand. Using a famous quotation from The Wealth of Nations, they interpret the Invisible Hand as Smith's (An Inquiry into the Nature and Causes of the Wealth of Nations, Methuen & Co., London) assertion that market participants, in pursuing their own self-interests without regard to the interests of others, will collectively provide the optimal economic benefit to society. We argue that the traditional interpretation of Smith is too narrow and potentially harmful to society. In order to fully understand Smith's notion of the influence of the Invisible Hand on human behavior, one must also consider The Theory of Moral Sentiments. In that work, Smith (The Theory of Moral Sentiments, A. Millar, London) portrays the pursuit of self-interest as only one of several potential motivations for human action. He also acknowledged the existence of a “sympathy principle,” which refers to the ability and propensity of human beings to consider the interests of others. Heilbroner (The Essential Adam Smith, W.W. Norton, New York, p. 59) suggests that Smith's sympathy principle allows one to “determine the appropriate degree of self-interest, the proper display of benevolence, the desirable strictness of justice.” In fact, Smith indicates that (1) a society whose members pursue self-interest without a sense of justice will eventually collapse; (2) a society whose members pursue self-interest checked by their sense of justice alone will survive; (3) a society whose members pursue self-interest, justice, and the interests of others will flourish. Since a more complete reading of Smith indicates that human beings, in considering their own interests, also reflexively consider the interests of others when making decisions, then the traditional corporate governance model appears to be lacking. A broader, multiple stakeholder approach to corporate governance that considers the interests of other constituencies may be more consistent with Smith's views. In particular, Smith's sympathy principle provides a theoretical foundation for a shift away from the narrow, yet dominant, shareholder-based corporate governance model and toward multiple stakeholder models of corporate governance [e.g., Business and Society: A Strategic Approach to Corporate Citizenship, Houghton Mifflin, Boston, MA] and internal decision-making [e.g., Sloan Management Review 38, (1997) 25–37].

The impact of ada on the selection process: Applicant and organizational issues

Abstract In this article we adopt a multiple stakeholder approach to examine the impact of ADA on the selection process. Specifically, we dissect the selection process into its component steps and for each step identify the potential impediments to hiring the disabled. In addition, we discuss the intended effects of the ADA, and its implications for organizations and job applicants. We also offer suggestions for research on ADA and selection in order to stimulate additional research on the topic.

Persuasion or Information? The Economics of Prescription Drug Advertising

THE economic and welfare effects of advertising have been extensively studied over the last half-century. However, these efforts have not led to a consensus either as to the effects or the value of advertising. Economists continue to reach polar conclusions that appear to be derived mainly from preconceptions of the social desirability of advertising. On the one hand is research that emphasizes promotion's ability to create "artificial" product differentiation and thereby produce informational confusion.1 This line of research stresses the empirical association of extensive advertising with high concentration and high accounting profits-evidence judged to support increased market power and entry barrier effects.2 A contrary body of research emphasizes the value of advertising in providing information and, hence, in promoting competition.3 The empirical findings most consistent with this view are that prices paid by consumers in (selected) markets are lower with advertising than without it.4