Stakeholder Discussions Research Articles

Advancing the state of energy equity metrics

Multiple stakeholders—ranging from regulators and developers to customer and community advocates—have roles to play in the transition to an equitable energy system. Metrics are an emerging area of importance for the operationalization of energy equity as they may guide investment and policy decisions that shape the energy system along this transition. This paper aims to advance energy equity metrics for use in regulation, planning, and operations of the electricity system within the United States. Metrics were surveyed from the literature and distilled to a set that identifies which stakeholders may be associated with which metrics. Established tenets of energy justice—distributive, procedural, recognition, restorative—were also identified for each metric, providing a link between energy equity in study and in practice. This means of organization is intended to enable discussion and collaboration among stakeholders, as the objectives embodied in energy equity metrics are often beyond the control of individual stakeholders. Further stakeholder discussion is necessary to determine which metrics are practicable, who will use them, and how they will be used to support energy equity.

A General Surgery Resident Active Learning Curriculum for Quality Education

INTRODUCTION: Formal resident education regarding quality improvement (QI) and process improvement (PI) is limited in general surgery, nationwide. Development and delivery of an active learning QI curriculum increased general surgery resident education and participation in quality initiatives. METHODS: A total of 60 general surgery residents participated in monthly active learning lecture and workshop sessions. Sessions progressed through the selection and completion of a PI project, including scope, key stakeholder buy-in, data collection, process mapping, implementation, standardization, and auditing. A focused framework based on an adapted Lean methodology for healthcare QI was used. RESULTS: Before curriculum development, no active QI learning was integrated into the educational curriculum and 1 of 60 residents were engaged in scholarly activity related to PI. Project ideas derived from resident workflow hardships contributing to burnout and resident dissatisfaction. Next, residents were divided into 4 implementation teams, each tasked with completing components of the project, including preliminary data, stakeholder discussions, process mapping, and implementation. Monthly group sessions discussed completed tasks. Engagement in process improvement education yielded all residents participating in at least 1 QI project, and 13% of residents engaged in a second QI initiative. Overall, residents initiated 6 QI projects across 2 institutions during the process of the QI curriculum (Table). Table. - Curriculum Sessions and Objectives Session number Topic Workshop activity 1 Identify Opportunity Focus groups Root cause analysis 2 Process Selection Project scope Stakeholder engagement Preliminary data 3 Process Mapping Process map current and ideal workflows 4 Intervention Ideate interventions Implementation plan 5 Barriers Overcoming barriers 6 Data Collection Metrics Data analysis 7 Standardization and Auditing Internal standardization Audit sheet creation Identify auditing frequency 8 Continuous Improvement Identify opportunities for further improvement CONCLUSION: An active, ongoing learning curriculum model for QI education is an effective methodology for designing and engaging surgery residents in QI initiatives. Additionally, this model provides residents with the necessary tools to identify and change areas in need of improvement in their daily work.

Towards a Holistic Perspective on Future Transportation Systems: A Swedish Case and a Conceptual Framework

Critical infrastructure systems—such as transportation—are the backbone of society. Infrastructure development can thus be acknowledged as a common societal concern in the field of governance, and its recognition as a policy problem is crucial to proper decision making. This study aims to build an in-depth understanding of the multi-level system concerned with transportation and applies a soft systems methodology to structure the investigation. The system analysis and conceptual modelling rests on publicly available documents and policies, group meetings and a workshop with stakeholders from the local, regional and national levels. The paper provides a thorough analysis of the Swedish transportation system through public policy and the perceptions of municipal officials. In addition, it proposes a novel conceptual framework of the transportation system, including a detailed discussion of stakeholders, activities and perspectives. Although transportation is vital for many stakeholders, improving only transport infrastructure does not guarantee regional growth. Therefore, the proposed framework constitutes a novel basis for constructive dialogue among concerned parties regarding improvements to transportation. Thereby, the paper provides an understanding of a society’s transportation system that can be used to inform agenda setting for critical infrastructure governance. Further discussion in the scientific community and with officials entrusted with public administration could further validate and deepen the proposed understanding of the perspectives and constraints in the examined context and beyond.

The double burden of COVID-19 and Israeli military rule on persons with disabilities in the West Bank of the occupied Palestinian territory.

BackgroundThe COVID-19 pandemic has enormous negative effects on people’s lives. People with disabilities (PWDs) who have been made vulnerable and who tend to face significant barriers in accessing public services are likely to be affected even more. This study aims to shed light on the impact of the COVID-19 pandemic on PWDs with special attention to their ability to access public services in the West Bank region of the occupied Palestinian territory.MethodsThis qualitative study was conducted between March 2021 and October 2021. The study was divided into two phases. The first phase consisted of interviews with people with different disabilities, while the second phase targeted policymakers and stakeholders in discussion of the results of the first phase. A total of 16 interviews with people with different types of disabilities (7 males, 9 females) were conducted via telephone. For the second phase, a total of 6 interviews were conducted with stakeholders most responsible for addressing the issue of disability and the needs of PWDs in the West Bank. Analytical memos were prepared for all interviews. Main themes and subthemes were identified by reading and re-reading memos and transcripts until themes and subthemes emerged.ResultsAll participants agreed that the COVID-19 pandemic had affected all aspects of life for all groups of people, including PWDs. The effects of the pandemic exacerbated the overall living conditions and access to basic services for PWDs. The results show that access to public transportation, public services, and to health services was all interrupted during the pandemic. This was compounded by deterioration of the financial situation for PWDs which further worsened their access. The stakeholders’ interviews confirmed and explained the findings as mainly due to lack of prioritization of PWD’s rights and needs.ConclusionThe study emphasized that most of the reported barriers to accessing essential services were intensified during the pandemic. Furthermore, the results show that PWDs and their needs are not considered a priority by the Palestinian Authority, exacerbated by the Israeli occupation. Our findings underline the importance of including PWDs in any future crisis planning.

Tackling Environmental Crimes and Biological Threats Across Borders of the Greater Mekong Subregion

Wildlife trafficking and other commodities associated with environmental crimes traded across the borders of the Greater Mekong Subregion (GMS) carry direct or indirect risks for biological threats. Outbreaks associated with these threats can have devasting implications for human populations as well as for farmed or native animal and plant populations. Although the links between environmental crimes and biological threats are obvious, we see two disconnected responses which limits the ability to tackle both the crime and the risks of biological threats. On one hand, there are efforts to improve law enforcement prioritisation and capability to disrupt transnational organised crime. On the other hand, we see increasing resources channelled through a One Health framework that aim to improve early warning surveillance of emerging infectious disease with a focus on diseases that can affect livestock or zoonotic diseases that can affect human health. The COVID-19 pandemic has provided a unique opportunity to explore alternative strategies, particularly the need to expand the operational definition of One Health to usher in more joined up partnerships between security sector personnel and human and animal health personnel working along borders of the GMS. This policy commentary draws on a literature review and informal stakeholder discussions conducted in preparation for on ongoing formal research project. This commentary provides policy and program considerations for improving both the enforcement of environmental crimes and early warning biological threat surveillance, preparedness and response in the Greater Mekong Subregion.

Research on eco-environmental flow based on the improved holistic method and its application in Wei River Basin

Abstract Water use of the ecosystem in the Wei River has been greatly reduced because of fierce competition between social–economic and eco-environmental water use, which leads to serious eco-environmental issues. Stakeholder theory was applied to the water resources utilization, and an improved holistic method for determining the eco-environmental flow was proposed. Considering the principles of inflow of tributaries, water intake from key sections, water balance and eco-environmental function regionalization, the new method integrated several methods to determine the water demand for the sub-items of eco-environmental flow. The three-level management targets of eco-environmental flow were proposed based on the opinions of stakeholders. Taking Shaanxi Section of the Wei River as an example, the eco-environmental flow at different levels was given for five key sections. The results show that: (1) the improved holistic method integrates multiple methods and models, making the calculation results of eco-environmental flow more scientific and reasonable; (2) the three-level management targets of eco-environmental flow can adapt to development and change in practical applications, and are operable and dynamic; (3) as a representative of the public benefits of ecosystems, government participates in the discussion of stakeholders and better coordinates competition among stakeholders. The improved method provides a new idea and reference for comprehensively and scientifically promoting reservoir ecological regulation.

Real-world data: Assessing electronic health records and medical claims data to support regulatory decision-making for drug and biological products.

Real-world data: Assessing electronic health records and medical claims data to support regulatory decision-making for drug and biological products.

Family conflict and aggression in the paediatric intensive care unit: Responding to challenges in practice

The paediatric intensive care unit (PICU) is a high-stress environment for parents, families and health care professionals (HCPs) alike. Family members experiencing stress or grief related to the admission of their sick child may at times exhibit challenging behaviours; these exist on a continuum from those that are anticipated in context, through to unacceptable aggression. Rare, extreme behaviours include threats, verbal or even physical abuse. Both extreme and recurrent ‘subthreshold’ behaviours can cause significant staff distress, impede optimal clinical care and compromise patient outcomes. The unique PICU environment and model of care may magnify stressors for both families and staff and the family-centred approach to care (FCC) central to paediatric practice, may also contribute to contextual challenges. Pervasive conflict in paediatric healthcare is harmful for patients, families, PICU staff and the institution more broadly. We propose that caring for children and caring for staff are inseparable goals and the latter has been inadvertently but detrimentally deprioritised as FCC has become a primary focus. A transparent and graded hierarchy of responses to variable levels of challenging behaviour is necessary to ensure that families are supported, while HCPs remain protected in the workplace. This requires establishing firm limits supported by all teams and levels of the institution. As such, we aim to identify and clarify the context and impact of challenging parent and family behaviour in the PICU and to offer potential, proactive mitigation strategies, based on reflections and stakeholder discussion following recent clinical challenges and experiences in our unit.

Assessing the Consequences of External Reference Pricing for Global Access to Medicines and Innovation: Economic Analysis and Policy Implications.

Background: External reference pricing (ERP) is used to set pharmaceutical prices to improve affordability, but its application may have negative consequences on patient access—thus, equity—across countries and on global innovation. With the United States contemplating ERP, negative effects could be magnified. Our aim: identify and quantify some major consequences of ERP. Research design, methods: Besides relying on databases and ERP modelling, we developed a heart failure case study. 4-step approach: 1) review ERP policies; 2) establish worldwide “price corridor”; 3) quantify patient access and health outcomes impact by ERP; 4) estimate ERP impact on innovation. Results: Our ERP referencing analysis highlights its perverse effects especially in lower-income countries. As counterstrategies to protect their revenues, manufacturers often implement tight list price corridors or launch avoidance/delays. Consequences include suboptimal patient access—hence, worse outcomes—illustrated by our case study: 500,000 + QALYs health loss. Additionally, the ensuing revenue reduction would likely cause innovation loss by one additional medicine that would have benefitted future patients. Conclusion: This research provides key insights on potential unintentional consequences of medicine price setting by ERP worldwide and under a new proposal for the United States. Our results can inform stakeholder discussions to improve patient access to innovative medicines globally.

An Analysis on How Artificial Light at Night May Impact the Sustainable Development Goals 2030 and Human Health

This study addresses the relationship between Sustainable Development Goals (SDGs) 2030 and artificial light at night (ALAN). In this research paper, different types of SDGs by the United Nations are discussed regarding the effects of ALAN on different goals. In addition, different policies associated with ALAN around the world are examined, and literature reviews are discussed. With this analysis and additional stakeholder discussions, several suggestions are introduced to create a better environment. Regarding different sustainable goals, we observe a trade-off between SDGs and ALAN. It is necessary to discuss different stakeholders, to minimize the negative impact of light pollution and make better policies for the world. One cannot attain SDGs 2030 without considering ALAN. We hope this paper will be helpful to create better policies for sustainable development.

Pediatric patients' views regarding smoke-free hospital grounds compared to those of adults: A survey study.

INTRODUCTIONChildren are important stakeholders in discussions about regulation of smoking and protection from secondhand smoke, but are rarely acknowledged as such. We explored the opinion of pediatric patients and other key stakeholders regarding the planned smoke-free zone around the Erasmus MC, a large university hospital in the Netherlands.METHODSIn 2019, we conducted a survey among pediatric patients and their parents, Erasmus MC employees, visitors, and adult patients, before implementation of the outdoor smoke-free zone, to assess their opinions on smoking and the planned smoke-free policy. Qualitative and quantitative data were collected and analyzed mostly using descriptive statistics and thematic analysis.RESULTSIn all, 91 parent-child dyads and 563 employees, visitors, patients and students filled in the questionnaires. Over 90% of children reported that they were regularly exposed to tobacco smoke, most often on the streets. Many underlined the exemplary role of healthcare providers, and 89% felt that nobody should be allowed to smoke near the hospital. Among parents, 89% were (very) positive towards the planned implementation of the smoke-free zone. In addition, 70% of adult patients, 81% of employees, 65% of visitors, 89% of students and 75% of ‘others’ were (very) positive about the new smoke-free policy. Smokers and former smokers generally were less positive about the policy.CONCLUSIONSChildren generally disapproved smoking around a hospital and felt that healthcare providers should be a good example concerning not smoking. The majority of adult patients, employees and visitors support a smoke-free zone surrounding the hospital, and virtually all pediatric patients and their parents do. Children should be acknowledged as important stakeholders in smoke-free policies and should be involved in planning and implementation.

Are stakeholders ready to transform phosphorus use in food systems? A transdisciplinary study in a livestock intensive system

Food systems worldwide are vulnerable to Phosphorus (P) supply disruptions and price fluctuations. Current P use is also highly inefficient, generating large surpluses and pollution. Global food security and aquatic ecosystems are in jeopardy if transformative action is not taken. This paper pivots from earlier (predominantly conceptual) work to develop and analyse a P transdisciplinary scenario process, assessing stakeholders potential for transformative thinking in P use in the food system. Northern Ireland, a highly livestock-intensive system, was used as case study for illustrating such process. The stakeholder engagement takes a normative stance in that it sets the explicit premise that the food system needs to be transformed and asks stakeholders to engage in a dialogue on how that transformation can be achieved. A Substance Flow Analysis of P flows and stocks was employed to construct visions for alternative futures and stimulate stakeholder discussions on system responses. These were analysed for their transformative potential using a triple-loop social learning framework. For the most part, stakeholder responses remained transitional or incremental, rather than being fundamentally transformative. The process did unveil some deeper levers that could be acted upon to move the system further along the spectrum of transformational change (e.g. changes in food markets, creation of new P markets, destocking, new types of land production and radical land use changes), providing clues of what an aspirational system could look like. Replicated and adapted elsewhere, this process can serve as diagnostics of current stakeholders thinking and potential, as well as for the identification of those deeper levers, opening up avenues to work upon for global scale transformation.

Ecosystem Service Assessments within the EU Water Framework Directive: Marine Mussel Cultivation as a Controversial Measure

To combat the persistent eutrophication in coastal waters, sustainable sea-based measures are recommended. Yet, they are the subject of controversial stakeholder discussion, which hampers the implementation and planning process. The aim of this study is to evaluate if a participatory mapping (PM) approach and ecosystem service assessments (ESA) can be suitable tools within Water Framework Directive (WFD) implementation to support the communication with different target groups to improve and accelerate the planning and realization of new sea-based mitigation measures. We conducted three stakeholder-based PMs to visualize the perception of sea-based mitigation measures in coastal waters and seven different ESAs to investigate the perceptions of different mussel cultivation scenarios as mitigation measures. The PMs showed that ecological measures were preferred. The ESA approach showed that, while experts rated mussel cultivation scenarios positively overall, non-expert stakeholders still seemed skeptical and preferred alternative measures like floating wetlands. The methodological results indicate that PM can be a cost-effective tool to visualize stakeholders’ perceptions, but it needs to be applied with an ESA to be beneficial for the WFD implementation process. A web-based ESA improves the discussion with stakeholders and can reveal potential misperceptions and concerns faster and lead to a more focused discussion.

Applying Discrete Event Simulation to Reduce Patient Wait Times and Crowding: The Case of a Specialist Outpatient Clinic with Dual Practice System.

Long wait times and crowding are major issues affecting outpatient service delivery, but it is unclear how these affect patients in dual practice settings. This study aims to evaluate the effects of changing consultation start time and patient arrival on wait times and crowding in an outpatient clinic with a dual practice system. A discrete event simulation (DES) model was developed based on real-world data from an Obstetrics and Gynaecology (O&G) clinic in a public hospital. Data on patient flow, resource availability, and time taken for registration and clinic processes for public and private patients were sourced from stakeholder discussion and time-motion study (TMS), while arrival times were sourced from the hospital’s information system database. Probability distributions were used to fit these input data in the model. Scenario analyses involved configurations on consultation start time/staggered patient arrival. The median registration and clinic turnaround times (TT) were significantly different between public and private patients (p < 0.01). Public patients have longer wait times than private patients in this study’s dual practice setting. Scenario analyses showed that early consultation start time that matches patient arrival time and staggered arrival could reduce the overall TT for public and private patients by 40% and 21%, respectively. Similarly, the number of patients waiting at the clinic per hour could be reduced by 10–21% during clinic peak hours. Matching consultation start time with staggered patient arrival can potentially reduce wait times and crowding, especially for public patients, without incurring additional resource needs and help narrow the wait time gap between public and private patients. Healthcare managers and policymakers can consider simulation approaches for the monitoring and improvement of healthcare operational efficiency to meet rising healthcare demand and costs.

Tuberculosis and Diabetes in India: Stakeholder Perspectives on Health System Challenges and Opportunities for Integrated Care

BackgroundIndia has a dual burden of tuberculosis (TB) and diabetes mellitus (DM). Integrated care for TB/DM is still in the early phase in the country and can be considerably enhanced by understanding and addressing the challenges identified from stakeholders’ perspectives. This study explored the challenges and opportunities at individual, health system and policy level for integrated care of TB/DM comorbidities in India.MethodsWe used an outlier case study approach and conducted stakeholder interviews and focus group discussions with relevant program personnel including field staff and program managers of TB and DM control programs as well as officials of partners in Indian states, Kerala and Bihar.ResultsThe integrated management requires strengthening the laboratory diagnosis and drug management components of the two individual programs for TB and DM. Focused training and sensitization of healthcare workers in public and private sector across all levels is essential. A district level management unit that coordinates the two vertical programs with a horizontal integration at the primary care level is the way forward. Substantial improvement in data infrastructure is essential to improve decision-making process.ConclusionBi-directional screening and management of TB/DM comorbidities in India requires substantial investment in human resources, infrastructure, drug availability, and data infrastructure.

Fisheries co-management in a digital age? An investigation of social media communications on the development of electronic monitoring for the Northeast U.S. groundfish fishery

Fisheries regulators have increasingly incorporated video monitoring systems, also known as electronic monitoring, into programs for fisheries data collection and documentation of bycatch. Electronic monitoring has recently emerged as one potential solution for fisheries monitoring and catch accounting in the Northeast United States, where fisheries regulators will soon require all commercial groundfish trips to be monitored either by electronic monitoring or human observers. Fisheries managers, scientists, and industry stakeholders have cooperated to some extent to solve some of the logistical and technical hurdles of electronic monitoring through recent pilot projects and coordination meetings. Whereas prior research has assessed the outcomes of stakeholder interactions in traditional venues (e.g., fisheries council meetings, workshops), we interrogated the dynamic connections between stakeholders in discussions about electronic monitoring policies and initiatives in the social media environment. Using social network and content analysis, we examined electronic monitoring-related discourse among Northeast U.S. fisheries stakeholders on Twitter over a period of 2 years. This research represents the initial phase of a multi-year study on co-management aspects of decision-making in Northeast U.S. federally managed fisheries. Our initial findings revealed that environmental NGOs and federal science agency organizations drive the discourse on electronic monitoring, but information-sharing between environmental NGOs, government, and industry as a form of cooperation appears to take shape with some fishing industry and community organizations joining the conversation. These preliminary results suggest that cross-stakeholder communications are prevalent, but expanding discursive networks will be necessary in realizing diverse participation in cooperative fisheries projects, particularly those aimed at implementing new approaches to fisheries science and management, as in the case of electronic monitoring for the Northeast groundfish fishery.

Simulation and Optimization of an Independent Sustainable Micro Hybrid Electricity System for Rural Consumers

A fundamental necessity for sustainable development is to ensure reliable and cost-effective access to modern energy services, primarily for the lower income and impoverished sectors of the population. Successful rural electrification is vital to bridging the rural-urban gap, given that the vast majority of the energy-deprived population resides in rural regions of developing countries. if the existing system of energy services intervened it can influence the development process by livelihood activities, micro or small enterprises, lifestyle energy services, value-added activities, survival irrigation, and so on. Different micro hybrid systems preferably with combination of renewable energy resources will be a good option for addressing given barriers. India has a large Availability of Higher solar radiations, a society that depends on agriculture has enough biomass resources, plentiful cattle dung, forest conifers and agriculture waste. In this paper, we examine the hybrid system’s techno economic feasibility and long-term viability. The system is made up of 60-kW solar photovoltaic panels (PV) and 40-kW biomass gasifier modules. Energy demand and resource availability are measured using data from comprehensive stakeholder discussions and field surveys, and they take into account daily and seasonal fluctuations in supply, end uses, and availability, as well as productive hours. The techno economic viability of electric renewable energy is evaluated using a hybrid optimization model (HOMER). Additionally, prospects for the growth of profitable uses and their extension into a long-term business model are investigated.

The challenge of competency assessment of the late-career practitioner.

Just as the general population of the United States is aging, so, too, is the population of active physicians. Training to become a physician and practice medicine is an arduous process. The competition to gain admission to medical school is fierce, the price tag of medical education is high, and waiting to learn about matching to a residency program is stressful. No wonder that physicians equate their profession with their identity. This sentiment, along with other factors, has resulted in many physicians continuing to practice well beyond the average retirement age. While each individual ages differently, there is evidence that the aging of physicians and length of time since medical school and residency is associated with deficiencies in history-taking, physical examination, record-keeping, and the ability to problem-solve. For late-career surgeons performing complex surgical procedures, there is a higher mortality rate for patients. Unlike other professions that have a mandatory retirement age, medicine does not. Health systems are grappling with how to fairly assess the competence of late-career practitioners. This article will explore that challenge from different perspectives, identify best practices, and describe how a risk manager can facilitate stakeholder discussion focused on implementing a competency-assessment process that is fair and effective.

NCCN Virtual Patient Advocacy Summit: Cancer Across the Lifespan.

Patients with cancer have widely divergent experiences throughout their care from screening through survivorship. Differences in care delivery and outcomes may be due to varying patient preferences, patient needs according to stage of life, access to care, and implicit or explicit bias in care according to patient age. NCCN convened a series of stakeholder meetings with patients, caregivers, and patient advocacy groups to discuss the complex challenges and robust opportunities in this space. These meetings informed the NCCN Virtual Patient Advocacy Summit: Cancer Across the Lifespan held on December 10, 2020, which featured a keynote presentation, multidisciplinary panels, and presentations from patient advocacy organizations. This article encapsulates and expounds upon the findings from the stakeholder meetings and discussions during the summit.

Opportunities and Barriers to Rural Telerobotic Surgical Health Care in 2021: Report and Research Agenda from a Stakeholder Workshop.

Background:There are well-recognized challenges to delivering specialty health care in rural settings. These challenges are particularly evident for specialized surgical health care due to the lack of trained operators in rural communities. Telerobotic surgery could have a significant impact on the rural–urban health care gap, but thus far, the promise of this method of health care delivery has gone unrealized. With the increasing adoption of telehealth over the past year, along with the maturation of telecommunication and robotic technologies over the past 2 decades, a reappraisal of the opportunities and barriers to widespread implementation of telerobotic surgery is warranted. Here we report the outcome of a rural telerobotic stakeholder workshop to explore modern-day issues critical to the advancement of telerobotic surgical health care.Materials and Methods:We assembled a multidisciplinary stakeholder panel to participate in a 2-day Rural Telerobotic Surgery Stakeholder Workshop. Participants had diverse expertise, including specialty surgeons, technology experts, and representatives of the broader telerobotic health care ecosystem, including economists, lawyers, regulatory consultants, public health advocates, rural hospital administrators, nurses, and payers. The research team reviewed transcripts from the workshop with themes identified and research questions generated based on stakeholder comments and feedback.Results:Stakeholder discussions fell into four general themes, including (1) operating room team interactions, (2) education and training, (3) network and security, and (4) economic issues. The research team then identified several research questions within each of these themes and provided specific research strategies to address these questions.Conclusions:There are still important unanswered questions regarding the implementation and adoption of rural telerobotic surgery. Based on stakeholder feedback, we have developed a research agenda along with suggested strategies to address outstanding research questions. The successful execution of these research opportunities will fill critical gaps in our understanding of how to advance the widespread adoption of rural telerobotic health care.