Shared Plan Research Articles

Shared governance strategic plan creation and implementation.

Shared governance strategic plan creation and implementation.

Obituary in Memory of Professor Dr. Luc Missotten

Professor Missotten was born in Hasselt, Belgium, on the 9th of October 1931. He passed away on Thursday, 27 June 2019. He is survived by his wife Marie-Helene Verhamme, his sons Pieter and Jan, his daughters Anne and Kathleen and his grandson Wolf. Professor Missotten graduated and received his medical degree from KU Leuven, Belgium, in 1955. He obtained his PhD degree in 1965, with a thesis entitled ‘The Ultrastructure of the Retina’. He was promoted to professor in 1975 and became the chair of the Department of Ophthalmology, College of Medicine, KU Leuven in 1978. Under his leadership, the Department of Ophthalmology progressed into an international centre for basic and translational research, establishing strong connections and productive international collaborations. As a research leader and mentor, Professor Missotten established a group of clinician–scientists at the KU Leuven with an outstanding contribution to translational science. His passion for research motivated many young Belgian and international ophthalmologists to pursue a research career. His scientific career was outstanding as he was the leading author or co-author of over 240 national and international publications. Professor Missotten had an encyclopedic knowledge of basic science, engineering, optics and clinical practice of Ophthalmology, which allowed him to lead in many areas of ophthalmic research. Many generations of ophthalmologists, to whom he served as a role model and mentor, will remember him as a very kind, open-minded, honest, dedicated and committed clinician–scientist. Professor Missotten has been my mentor and friend for the last 36 years, with whom I shared my research ideas and plans. Our friendship was deep, and his loss will be unforgettable. In addition to his contributions to clinical practice and research, Professor Missotten served as the editor of international research journals and was involved in several research societies. His efforts were instrumental to unite ophthalmic research groups in Europe and to establish European Association for Vision and Eye Research (EVER) in 1997. From 1997 to 2002, he served as the secretary-general of EVER. He was also very important for the European Society of Ophthalmology (SOE). He was Secretary General from 1984 to 1996 and then became the President and elder statesman of SOE from 1996 to 1998. His efforts transformed SOE from a club to a scientific society. He was honored by the Society with both the Helmholtz Medal and the Henkes Medal. Professor Missotten received many awards to his work, including the degree of ‘Doctor Honoris Causa’ from the University of Mansoura, Egypt, in 1996 for his efforts to supervise the research of many young Egyptian ophthalmologists to obtain PhD degrees. Professor Missotten, ‘you shall be remembered forever’.

Developing a safety-netting intervention for the earlier diagnosis of cancer in primary care: the Shared Safety Net Action Plan (SSNAP)

BackgroundDiagnosing cancer earlier broadens treatment options and improves survival outcomes. When symptoms do not indicate a cancer diagnosis referral, evidence suggests patients could play an important role in achieving a faster cancer diagnosis by assisting with symptom follow-up and review. Little is known about how to engage patients in diagnosis and what a safety-netting intervention involving patients in primary care might entail.AimStage 1 assessed components considered important for patient involvement in diagnosing cancer earlier in primary care and explored three possible strategies. Stage 2 aimed to co-design a safety-netting intervention with and for primary care patients and professionals.MethodStage 1 involved a systematic review, thematic analysis of 15 interviews with GPs, nurse practitioners and patients and a dissemination workshop with 18 stakeholders. For intervention development and refinement, stage 2 involved 3 stakeholder workshops using co-design processes; five focus groups with patients and primary care practices, underpinned by COM-B Framework.ResultsStage 1: the systematic review found no interventions involving patients. Interviews identified three key themes for patient involvement: keeping the door open; roles and responsibilities; and fear of cancer. Ideally, safety-netting should involve verbal discussion and plan, written information, and optional post-consultation prompt. Stage 2: barriers and facilitators of capability, opportunity and motivation to use the intervention were identified. A safety-netting intervention for primary care was co-produced, the Shared Safety Net Action Plan (SSNAP).ConclusionKey components for patient involvement and safety-netting were identified. SSNAP is acceptable to patients and health professionals and assessment of feasibility in practice is now required.

Optimal shared mobility planning for electric vehicles in the distribution network

Shared electric vehicle (EV) is an emerging component across interdependent power and transportation networks that affect economic, environmental and societal benefits. Studies on how to collaboratively enable the optimal planning of these interacted networks is less explored. In this work, a joint distribution network expansion planning framework integrated with a shared EV charging station is proposed. One of the objectives is to minimise overall investment cost considering operational waiting cost of shared EV charging service and power loss, while the other aims to maximise the utilisation of charging infrastructures. To overcome the difficulties in solving the multi-objective mixed-integer non-linear problem, Tchebycheff decomposition based evolutionary algorithm is modified to find the Pareto front showing the trade-offs between goals above. Besides, stochastic traffic assignment model is used to obtain traffic distribution and travel demand. The final optimal solution is decided by the fuzzy satisficing method. The performance of the proposed approach is evaluated on a 54-node test system. Sensitivity analysis is performed to assess the impact of key parameters from the perspectives of transportation and distribution network sectors. The numerical results demonstrate the capability and feasibility of the proposed method.

Survey of Patient-Centered Coordination of Care for Diabetes with Cardiovascular and Mental Health Comorbidities in the Department of Veterans Affairs.

Multiple comorbidities thought to be associated with poor coordination due to the need for shared treatment plans and active involvement of patients, among other factors. Cardiovascular and mental health comorbidities present potential coordination challenges relative to diabetes. To determine how cardiovascular and mental health comorbidities relate to patient-centered coordinated care in the Department of Veterans Affairs. This observational study used a 2 × 2 factorial design to determine how cardiovascular and mental health comorbidities are associated with patient perceptions of coordinated care among patients with type 2 diabetes mellitus as a focal condition. Five thousand eight hundred six patients attributed to 262 primary care providers, from a national sample of 29 medical centers, who had completed an online survey of patient-centered coordinated care in the Department of Veterans Affairs (VA). Eight dimensions from the Patient Perceptions of Integrated Care (PPIC) survey, a state-of-the-art measure of patients' perspective on coordinated and patient-centered care. Mental health conditions were associated with significantly lower patient experiences of coordinated care. Hypotheses for disease severity were not supported, with associations in the hypothesized direction for only one dimension. Results suggest that VA may be adequately addressing coordination needs related to cardiovascular conditions, but more attention could be placed on coordination for mental health conditions. While specialized programs for more severe conditions (e.g., heart failure and serious mental illness) are important, coordination is also needed for more common, less severe conditions (e.g., hypertension, depression, anxiety). Strengthening coordination for common, less severe conditions is particularly important as VA develops alternative models (e.g., community care) that may negatively impact the degree to which care is coordinated.

Disrupting Perspectives on Civic Education for Children and Youth in a Multicultural Society

In November 2016, the National Association for Multicultural Education (NAME) and Kappa Delta Pi (KDP) cofacilitated an Education Summit with eminent scholars to develop a shared plan of action com...

Intensive management for moderate rheumatoid arthritis: a qualitative study of patients\u2019 and practitioners\u2019 views

BackgroundThe TITRATE trial seeks to test whether intensive management is valuable in achieving disease remission in moderately active rheumatoid arthritis. Intensive management is a complex intervention consisting of: 1) 12 x monthly appointments, 2) tailored ‘treatment support’ based on motivational interviewing techniques, 3) optimised medication (including the opportunity for biologics), 4) provision of a Patient Handbook, and 5) shared treatment planning. This study aims to understand: a) patients’ and practitioners’ views on the feasibility and acceptability of intensive management, and b) patients’ and practitioners’ experience of receiving/providing intensive management.MethodsA qualitative study, nested within a randomised controlled trial. Participants were patients (n = 15) in the intensive management arm of the trial and rheumatology practitioners (n = 16) providing the intensive management intervention, from 18/42 clinics across England. Data were collected via semi-structured interviews and analysed using thematic analysis and iterative categorization.ResultsMonthly appointments were largely acceptable to both groups who cited several treatment benefits (e.g. regular review of medication, practitioners built close relationships with patients). Practitioners were ‘fairly confident’ using the motivational interviewing techniques. Learning to pace was the most commonly reported self-management technique that patients and healthcare professionals worked on together, followed by gaining control over pain and fatigue. Practitioners liked having the option to offer biologics to patients with moderate RA. Most patients found the optimised medication (following monthly joint assessment) helpful and side-effects experienced were resolved. Variation existed in the extent to which patients engaged with the Patient Handbook and shared treatment planning, with those who did engage doing so in the early stages.ConclusionsFeedback from patient participants about the intensive management intervention was positive. They found increased medication helpful. Continuity of care with the same healthcare professional at regular intensive management sessions, and the treatment support provided, were highly rated. Feedback from practitioners indicated that intensive management training is feasible. Evidence from the interviews showed that some practitioners applied motivational interviewing techniques during standard care appointments and they would like the opportunity to address lifestyle issues with patients.

Recreational Leasing of Alaska Commercial Halibut Quota: The Early Years of the GAF Program in Alaska

The Pacific Halibut Catch Sharing Plan formalized the process for allocating halibut between the Alaska commercial and recreational charter sectors. It included a new program intended to allow for “flexibility” through inter-sectoral trading, permitting charter operators to lease commercial halibut pounds to relax client harvest restrictions. Here we evaluate the first two years of lease market activity and participation. Participation from some commercial quota holders in the lease market suggests that the program provided beneficial flexibility; in fact, the number of transfers to the charter sector was greater than transfers within the commercial sector for some quota types. We also identified a high proportion of self-leasers. However, transfers to the charter sector were on average smaller than within-sector commercial transfers, and total poundage leased by the charter sector was low compared with commercial transfers. Usage of leased quota by the recreational charter sector enables the harvest of larger fish or additional fish, and provides flexibility in catch composition on halibut closure days. Finally, the value-per-pound may be higher in the charter sector, as commercial-to-charter transfer prices approached the commercial ex-vessel price.

Enhancing Situational Awareness to Prevent Infectious Disease Outbreaks from Becoming Catastrophic.

Catastrophic epidemics, if they occur, will very likely start from localized and far smaller (non-catastrophic) outbreaks that grow into much greater threats. One key bulwark against this outcome is the ability of governments and the health sector more generally to make informed decisions about control measures based on accurate understanding of the current and future extent of the outbreak. Situation reporting is the activity of periodically summarizing the state of the outbreak in a (usually) public way. We delineate key classes of decisions whose quality depends on high-quality situation reporting, key quantities for which estimates are needed to inform these decisions, and the traditional and novel sources of data that can aid in estimating these quantities. We emphasize the important role of situation reports as providing public, shared planning assumptions that allow decision makers to harmonize the response while making explicit the uncertainties that underlie the scenarios outlined for planning. In this era of multiple data sources and complex factors informing the interpretation of these data sources, we describe four principles for situation reporting: (1) Situation reporting should be thematic, concentrating on essential areas of evidence needed for decisions. (2) Situation reports should adduce evidence from multiple sources to address each area of evidence, along with expert assessments of key parameters. (3) Situation reports should acknowledge uncertainty and attempt to estimate its magnitude for each assessment. (4) Situation reports should contain carefully curated visualizations along with text and tables.

987. Repeated Exposure to an Adjuvanted Quadrivalent Subunit Influenza Virus Vaccine (aQIV): A Randomized, Observer Blind, Multicenter Study

BackgroundThe safety, immunogenicity, and efficacy associated with administration of of aQIV in children 6 months through 5 years of age was investigated.1 Although enhanced immunogenicity in children was demonstrated for MF59-adjuvanted influenza vaccines after first administration, the impact of repeated vaccination on immunogenicity and safety has not been evaluated.MethodsA total of 607 subjects who participated in parent study, now aged 12 months through 6 years, were enrolled the subsequent year and received a single dose of study vaccine. Enrolled subjects received the same type of influenza vaccine administered in the parent study (aQIV or nonadjuvanted comparator). Blood samples were taken for immunogenicity assessment prior to the second year vaccination, and 21 and 180 days after vaccination.ResultsAt baseline, approximately 12 months after vaccination in the parent study, subjects in the aQIV group had significantly greater geometric mean titer (GMT) values against all four homologous strains compared with subjects in the nonadjuvanted vaccine group. After year 2 vaccination, CBER criteria for seroconversion and hemagglutination inhibition (HI) titer ≥1:40 were met for the aQIV group for all four homologous strains tested at Day 22. At both Day 22 and Day 181, subjects who received aQIV had significantly greater GMT values for HI against all four homologous strains compared with those who received nonadjuvanted vaccine. Increased immune response of aQIV vs. nonadjuvanted vaccine was also observed for the selected heterologous strains tested at baseline, Day 22 and Day 181. In terms of safety, transient and generally mild to moderate reactogenicity was more commonly observed in the aQIV group vs. the nonadjuvanted group, but overall safety profiles were similar and comparable to the parent study.ConclusionThis first-year revaccination study in young children confirms enhanced immunogenicity and similar safety profile after repeat aQIV vaccination compared with repeat nonadjuvanted influenza vaccination.Reference1.Vesikari T et al. Lancet Respir Med 2018;6:345–356.Disclosures K. Ramsey, Seqirus: Investigator, Research support. Novartis: Investigator, Research support. E. Heijnen, Seqirus: Employee and Shareholder, Global Employee Share Plan and Salary. B. Leav, Seqirus: Employee and Shareholder, Salary. J. Oberye, Seqirus: Employee and Shareholder, Global Employee Share Plan and Salary. B. Zhang, Seqirus: Employee and Shareholder, Company stock and Salary. T. Vesikari, Seqirus: Consultant, Consulting fee.

Coordinating invasive plant management among conservation and rural stakeholders

Collective action among conservation and rural land managers is required to protect natural and rural ecosystems from the spread of invasive plants. Achieving such tenure-blind collective action is a considerable policy challenge and social research on this topic is in its infancy, is rural-focused and rarely addresses multiple species concurrently. This study explores the nature and extent of collective action among conservation and rural stakeholders managing multiple invasive plant species in south-west Alberta, Canada. Thirty telephone interviews were conducted with staff of national and provincial parks, non-government organisations and government agencies, as well as ranchers and consultants operating within the Oldman Watershed. The results showed three key types of collective action—participatory, linked and collaborative—occurring across the landscape. Collaborative invasive plant management (IPM) was the most likely to bring rural and conservation land managers together to address multiple species but was highly resource intensive and confined to public lands. A polycentric system of governance may enable landscape-wide IPM to be achieved if it can link existing collaborative efforts as well as establish and maintain new relationships among rural and conservation stakeholders. Organisations that encompass multiple land uses, such as watershed councils and municipal districts, may be best placed to bring diverse stakeholders together to develop a shared plan, facilitate social learning and demonstrate on-ground action at multiple scales across land uses.

Care Coordination Using a Shared Plan of Care Approach: From Model to Practice

IntroductionChildren and youth with special health care needs (CYSHCN) need, but do not have, adequate care coordination (CC); CC leads to better pediatric care, improved family/professional experience of care, and enhanced population health. Current CC initiatives are promising but lack adherence to emerging definitions/standards. A Lucile Packard Report provides guidelines for using a Shared Plan of Care (SPoC) as a CC approach; studied implementation is needed. PurposeThe studied implementation of the Riley Care Coordination Program (RCCP) set out to: 1) illuminate components of family-centered, interdisciplinary, team-based care/coordination and SPoC, use 2) underscore family participation/engagement 3) reveal implementation processes/lessons learned. MethodsChildren (ages 2–10) with neurodevelopmental disabilities were referred by subspecialists; families agreed to participate in RCCP from a children's hospital ambulatory care setting. RCCP team used a five-phase workflow to implement CC: (1) Family Outreach/Engagement 2) Family and Team Pre-Visit Work, 3) Population-Based Teamwork, 4) Planned-Care Visits/SPOC “Co-Production”, 5) Ongoing Care Coordination and Community Transfer. Family surveys and SPoC goals informed an evaluation. ResultsChildren (268) with neurodevelopmental disabilities enrolled/completed the 6-month RCCP; it was a feasible endeavor. The co-produced SPoC supported families/care neighborhood partners to meet goals/unmet needs. Team plan-do-study-act improvement cycles informed RCCP enhancements. Discussion/ConclusionEliciting/using family goals to drive CC emphasized family priorities; children/families gained interventions, treatments, confidence and navigation skills. Going beyond episodic, reactive care, RCCP achieved better CC with care neighborhood learning partnerships. Investing in this quality care coordination with fidelity to national standards holds promise.

Shared planning and control for mobile robots with integral haptic feedback

This paper presents a novel bilateral shared framework for online trajectory generation for mobile robots. The robot navigates along a dynamic path, represented as a B-spline, whose parameters are jointly controlled by a human supervisor and an autonomous algorithm. The human steers the reference (ideal) path by acting on the path parameters that are also affected, at the same time, by the autonomous algorithm to ensure: (i) collision avoidance, (ii) path regularity, and (iii) proximity to some points of interest. These goals are achieved by combining a gradient descent-like control action with an automatic algorithm that re-initializes the traveled path (replanning) in cluttered environments to mitigate the effects of local minima. The control actions of both the human and the autonomous algorithm are fused via a filter that preserves a set of local geometrical properties of the path to ease the tracking task of the mobile robot. The bilateral component of the interaction is implemented via a force feedback that accounts for both human and autonomous control actions along the whole path, thus providing information about the mismatch between the reference and traveled path in an integral sense. The proposed framework is validated by means of realistic simulations and actual experiments deploying a quadrotor unmanned aerial vehicle (UAV) supervised by a human operator acting via a force-feedback haptic interface. Finally, a user study is presented to validate the effectiveness of the proposed framework and the usefulness of the provided force cues.

Shared governance strategic planning retreat: A best practice.

Shared governance strategic planning retreat: A best practice.

Serious gaming for participatory planning of multi-hazard mitigation

ABSTRACTCollaborative, holistic, and proactive planning for basin-wide water management solutions addressing multiple water-related hazards is challenging. Shared vision planning (SVP) and decision support systems (DSSs) are two approaches that have been used to address the challenges described. SVP is a participatory planning process. DSSs can efficiently support the integration of multiple and vast amounts of information and interactively illustrate the trade-offs between alternative mitigation plans. While SVP and DSS have been previously used to help stakeholders to better understand watershed processes and how to arrive at collaborative basin-wide decisions, coupling these tools with serious gaming is an emerging effort. The multi-hazard tournament (MHT) framework is an example of the integration of serious gaming, DSS and SVP. The MHT is based on the premise that almost all cultures and individuals understand and enjoy sports, teams and structured games. This paper first introduces a new approach called the MHT which couples serious gaming via the use of DSS with the traditional SVP concepts of (1) collaborative computer modelling, (2) traditional water resources planning, and (3) structured public participation through a case study of the Cedar Rapids, Iowa MHT. Second, it examines and discusses the effectiveness of this combined approach in achieving objectives often established in collaborative, watershed scale: decision-making, social learning, and relationship building. An analysis of the Cedar Rapids MHT survey results show that the integration of the Iowa watershed decision support system, SVP, and serious gaming framework served as a valuable tool for examining trade-offs between mitigation options and their impacts. The Cedar Rapids MHT survey results indicated this was also an adequate means of capacity building, social learning, and meaningfully engaging the community in mitigating hazards posed in their watersheds. The paper also explores how the integration of SVP, DSS, and serious gaming with some refinements could be used to practically support watershed scale planning and decision-making processes.

The Effect of Individual and Pooled Profit Sharing Plans on Honesty in Managerial Reporting

ABSTRACTMany organizations offer profit sharing plans to motivate increased effort and goal congruence. However, an unintended consequence of such plans may be to reduce honesty in managerial reporting. We investigate two commonly observed profit sharing plans (individual and pooled) in a laboratory experiment where multiple agents with private cost information submit budget requests to an employer. Consistent with our prediction based on crowding theory, our findings suggest that honesty is reduced in the presence of an individual profit sharing plan. However, when a pooled profit sharing plan is used, the adverse effects on honesty are partially mitigated. Our results suggest that an unintended consequence of profit sharing (decreased honesty) can be mitigated through interdependency from pooled plans. The results have practical implications, given that organizations have flexibility in establishing both the size and scope of their profit sharing plans. Our study also contributes to our understanding of reporting behavior, particularly in multi‐agent settings.

Codesigned Shared Decision-Making Diabetes Management Plan Tool for Adolescents With Type 1 Diabetes Mellitus and Their Parents: Prototype Development and Pilot Test.

BackgroundAdolescents with type 1 diabetes mellitus have difficulty achieving optimal glycemic control, partly due to competing priorities that interfere with diabetes self-care. Often, significant diabetes-related family conflict occurs, and adolescents’ thoughts and feelings about diabetes management may be disregarded. Patient-centered diabetes outcomes may be better when adolescents feel engaged in the decision-making process.ObjectiveThe objective of our study was to codesign a clinic intervention using shared decision making for addressing diabetes self-care with an adolescent patient and parent advisory board.MethodsThe patient and parent advisory board consisted of 6 adolescents (teens) between the ages 12 and 18 years with type 1 diabetes mellitus and their parents recruited through our institution’s Pediatric Diabetes Program. Teens and parents provided informed consent and participated in 1 or both of 2 patient and parent advisory board sessions, lasting 3 to 4 hours each. Session 1 topics were (1) patient-centered outcomes related to quality of life, parent-teen shared diabetes management, and shared family experiences; and (2) implementation and acceptability of a patient-centered diabetes care plan intervention where shared decision making was used. We analyzed audio recordings, notes, and other materials to identify and extract ideas relevant to the development of a patient-centered diabetes management plan. These data were visually coded into similar themes. We used the information to develop a prototype for a diabetes management plan tool that we pilot tested during session 2.ResultsSession 1 identified 6 principal patient-centered quality-of-life measurement domains: stress, fear and worry, mealtime struggles, assumptions and judgments, feeling abnormal, and conflict. We determined 2 objectives to be principally important for a diabetes management plan intervention: (1) focusing the intervention on diabetes distress and conflict resolution strategies, and (2) working toward a verbalized common goal. In session 2, we created the diabetes management plan tool according to these findings and will use it in a clinical trial with the aim of assisting with patient-centered goal setting.ConclusionsPatients with type 1 diabetes mellitus can be effectively engaged and involved in patient-centered research design. Teens with type 1 diabetes mellitus prioritize reducing family conflict and fitting into their social milieu over health outcomes at this time in their lives. It is important to acknowledge this when designing interventions to improve health outcomes in teens with type 1 diabetes mellitus.

Combining local fishers' and scientific ecological knowledge: Implications for comanagement

This study was conducted in the fishing community of the Cabedelo municipality (NE Brazil, Paraíba) and characterized the socioeconomic profile of the fishers, their local ecological knowledge and their main usage of fish species. Overall, 80 fishers were interviewed. Snowball, direct observation, guided tours, free interviews and structured and semi-structured questionnaires were used for data collection, which occurred from December 2010 to June 2011 in fortnightly visits to the city of Cabedelo. Most fishers ranged from 36 to 45 years, with low education and low income levels, and approximately 87% fished in the municipality. At least 33 fish species were recorded as important for family consumption and trade. The most commonly caught fish families were Carangidae, Mugilidae, Lutjanidae and Scombridae. The fishes most used for commerce were Lutjanidae, Scombridae, and Serranidae. Fishers demonstrated a high knowledge about the temporal distribution of fishes and categorized them as “fishes of summer”, “fishes of winter” and “fishes around all year”; fishes' vertical distributions were categorized as either “bottom fish” or “water flower”. Fishers also classified eating habits, some types of behavior and reproduction of most exploited species. Fishermen's understanding of the fish stocks distribution and fish ecology is potentially imperative for scientific knowledge and future shared management plans.

Photovoice: method experiment research with adolescent mothers

Abstract Objective: To report on the development of the phases of the photovoice method in qualitative research with adolescent mothers who were experiencing or experienced breastfeeding and/or weaning. Method: Twelve individual interviews and one focus group were conducted. Results: The photovoice was developed in the phases: Identification of the political decision makers in the community with some community leadership profile; Recruitment of participants; Introduction of the methodology to the participants; Obtaining informed consent; Identification of the theme (s) for the photographs; Distribution of cameras and review of their handling; Provision of time for the registration of photographs; Meeting (s) for discussion on photographs and identification of community resources and issues; Shared planning of the dissemination formats of the images and stories produced. Final considerations and implications for the practice: Photovoice stands out as a way to approach health professionals with the life circumstances of adolescent mothers, in order to promote and support breastfeeding.

Participatory processes and support tools for planning in complex dynamic environments: a case study on web-GIS based participatory water resources planning in Almeria, Spain

Democratization of water resources management through the involvement of stakeholders has been widely advocated over the past two decades. In light of mediocre results of such processes and severe criticism of the claimed benefits of stakeholder involvement, there is continued need for improving these processes and for supportive tools through which stakeholders can collaborate in decision making. In response to new European legal requirements, an innovative planning process was initiated to facilitate a productive dialog among stakeholders to develop a shared river basin management plan. This paper presents and discusses the results of action research on this participatory planning process in a semiarid river basin in Spain. We discuss: (1) to what extent participatory processes and tools address the needs of stakeholders and planners, (2) what enables or disables implementation in a complex socioeconomic reality, (3) to what extent the participatory approach leads to alignment with policy embodying a new water management paradigm, and (4) how tools can be flexible and their use adapted to changing contextual dynamics. Research results confirm the potential for increased participation assisted by web and GIS tools, however, such processes are highly sensitive to changing contexts as well as the mandate and continuity in support from management authorities. Fragmentation of responsibilities in the water arena and the weak interpretation of the coordinating role of the water administration undermine the democratic ruling sought for by public participation. Improved methodologies to evaluate and improve the effectiveness of participation are required, and tools need to be flexible in design and used in a facilitated participatory process, adaptable to changing contextual dynamics.