Strategic Community Research Articles

Empathy, indiscipline and employability: A research essay on the bilingual Masters programme ‘Cultural Intelligence and Innovation’ at Université de Paris

This study considers the 2-year bilingual Masters programme, ‘Cultural Intelligence and Innovation’ at Université de Paris, for which classes are taught in English and in French. Alumni are working as strategic planners, brand managers, community managers, advertisers, futures and trend specialists, web content writers and project leads in a wide variety of organizations throughout the world. This humanities-driven programme has empathy and sensibility at its heart, firstly through the exercise of the imagination and multilingualism and the attendant ability to identify with others, and, secondly, by being attuned to society’s faint frequencies allowing cultural foresight. The programme encourages work outside the confines of discipline as well as critique and counter-thinking. Thinking culture and industry together (academic teachers join forces with those from industry to create hybrid content for courses) is important in preparing the students for work. The programme also fosters the ability to detect shifts in sensibility as a first step in innovation. Finally, the authors consider how the programme might be generalized and similar initiatives established in other higher education institutions.

Abstract 395: Building A Regional Multi-stakeholder Consortium To Implement Innovation In Healthcare: Lessons From The Quality & Value Innovation Consortium (QVIC)

Research Objective: A challenge to improving the quality and value of healthcare has been the need for multiple stakeholders to collaborate in a coordinated effort. To address this, a novel program has been developed to create a regional commitment to deliver high quality care that is more patient-centered and efficient. Study Design: The Kansas City Quality & Value Innovation Consortium (QVIC) has created a network of hospitals and other stakeholder to collaborate and innovate on healthcare delivery. This initiative began by first identifying healthcare systems’ priorities through individual meetings with leadership from regional hospitals, including CEOs, CNOs, COOs, CQOs, and CMOs. Concurrently, meetings were held with payers, hospital associations, providers, health departments, researchers, patients, and community-based organizations (CBOs). These interviews identified 32 key quality improvement topics. Focus groups and surveys reduced this to 11 topics that were then selected for community forums where stakeholders provided brief presentations on the biggest challenges and strategies for improving healthcare value within the specified topic. A multi-stakeholder advisory board was created to oversee the program. Through this mixed methods approach, valuable feedback from the strategic advisory board, community forums, and surveys were aggregated and resulted in the selection of two topics. Population Studied: Study participants included leadership from 14 regional hospitals, 4 payer organizations, 2 state hospital associations, 4 public health departments, and 9 community based organizations, as well as 50+ regional researchers. In total, over 75 meetings and interviews with more than 200 individuals and groups were held. The twenty community forums have been attended by over 1,700 attendees. Principal Findings: Evaluations of the community forums have shown broad interest and satisfaction. The QVIC efforts have been recognized as a community asset for helping build collaboration and partnerships across stakeholder groups and competitors. Ultimately, these two regional initiatives (opioid management and transitions in heart failure care to reduce readmissions by impacting social determinants of health) were selected for novel implementation, measurement, and dissemination strategies. A suite of interventions is being offered and adopted by providers, within each of the two regional initiatives. Metrics for quantifying improvements in healthcare value are being developed and data collection is beginning. Implementation strategies are identified and being customized for pragmatic integration into each healthcare system. Conclusions: While the entire country is grappling with the challenge of improving the quality of care, while lowering its costs, Kansas City has modeled a unique culture and strategy for achieving this goal.

Indian Strategic Culture: The Debates in Perspective

One of the pioneering works on India’s strategic culture is by George K. Tanham (1992) titled India’s Strategic Thought: An interpretive essay, in which he argues that virtually there is no evidence to prove that Indian elites have consistently thought about a national strategy. According to him this lack of a coherent strategic thought can be explained by analyzing four principal factors that have conditioned the thought process of the Indian strategic community viz., geography, history, culture and the British raj(pp.1-19). These factors have contributed mostly to the absence of strategic thinking (pp.50-67). From among the Indian strategic community, a few have partly, and another section wholeheartedly agreed with the arguments of Tanham. Rejecting Tanham’s argument Siv Shankar Menon, former Foreign Secretary and National Security Advisor, has made a powerful intervention in the debate by stating that India possesses a strategic culture and the same gets applied in bilateral and multilateral diplomacy (Menon, 2013). The present paper reviews the positions of both Tanham and Shiv Shankar Menon. The paper sums up that India does have a strategic culture rooted in its civilization and its modern manifestation is the concept of strategic autonomy which got distilled from the ancient text Arthasastra of Kautilya.

India’s Approach to China’s Belt and Road Initiative—Opportunities and Concerns

Abstract China’s Belt and Road Initiative (BRI) as a geoeconomic vision and geopolitical strategy is closely watched and scrutinised by Indian economists, diplomats, and strategists. Perspectives on India’s approach to the BRI can broadly be classified into three—the optimist, the sceptic and the cautionary. Whereas, economists generally appear optimistic, there is a sense of uneasiness within India’s strategic community that the BRI represents much more than China’s ambition to emerge as an economic leader in the region. This article argues that India’s approach to the BRI has largely been pragmatic, cautious and complex. Accordingly, India has taken an atomistic approach to the various components of the BRI depending on its security and economic needs, which explains why on the one hand India has become increasingly receptive of the Bangladesh-China-India-Myanmar Economic Corridor (BCIM EC) and on the other continues to publicly oppose the China-Pakistan Economic Corridor (CPEC).

Summaries

Summaries

Dangerous Confidence? Chinese Views on Nuclear Escalation

Chinese views of nuclear escalation are key to assessing the potential for nuclear escalation in a crisis or armed conflict between the United States and China, but they have not been examined systematically. A review of original Chinese-language sources and interviews with members of China's strategic community suggest that China is skeptical that nuclear escalation could be controlled once nuclear weapons are used and, thus, leaders would be restrained from pursuing even limited use. These views are reflected in China's nuclear operational doctrine (which outlines plans for retaliatory strikes only and lacks any clear plans for limited nuclear use) and its force structure (which lacks tactical nuclear weapons). The long-standing decoupling of Chinese nuclear and conventional strategy, organizational biases within China's strategic community, and the availability of space, cyber, and conventional missile weapons as alternative sources of strategic leverage best explain Chinese views toward nuclear escalation. China's confidence that a U.S.-China conflict would not escalate to the use of nuclear weapons may hamper its ability to identify nuclear escalation risks in such a scenario. Meanwhile, U.S. scholars and policymakers emphasize the risk of inadvertent escalation in a conflict with China, but they are more confident than their Chinese counterparts that the use of nuclear weapons could remain limited. When combined, these contrasting views could create pressure for a U.S.-China conflict to escalate rapidly into an unlimited nuclear war.

India’s Nuclear Doctrine and Debate of No First Use Policy

India has committed for a ‘No First Use Policy’ (NFU) regarding its nuclear warfare strategy. This has continued since the time India became a nuclear state. India's nuclear doctrine has always played an important role in determining the stability in Asia. Recently the issue has been escalated as India’s Defence Minister gave a statement to media which shows that Indian government could explore other options also regarding its Nuclear Policy. Statement has come at the time when there is abrogation of Article 370 from Jammu and Kashmir has happened letting the tensions to rise between India and Pakistan. This rise in exertion from the side of China and Pakistan has sparked the debate on India's nuclear capability. It raises questions like; does India need to update its doctrine? There is an emerging debate among the strategic community also that India needs to give the NFU policy and even need to make many other changes in the whole doctrine. The NFU policy has often been held as proof of India’s status as a responsible nuclear power. Various factors are to be analyzed before reaching to any conclusion.

Russian Orthodox Church and Nuclear Command and Control: A Hypothesis

The Russian Orthodox Church plays an immense role in current Russian national security policy. The intertwining of the church and the strategic community is nowhere more visible than in the nuclear-weapons complex, where the priesthood has penetrated all levels of command, been involved in operational activities, and positioned itself as a provider of meanings for, and guardian of, the state’s nuclear potential. The first work to highlight the phenomenon of the Russian church-nuclear nexus, this article focuses on the ecclesiastical impact on Russian nuclear command and control. The findings suggest that it is not inconceivable that the Russian military clergy—like the Soviet political officers and contrary to chaplains worldwide—might become future participants in decision making on matters of national security, and that de facto there might be two parallel chains of command authority emerging in Russia, with potential tensions between them. The article outlines the causes of this overlooked singularity and its implications for the theory and practice of international security.

Deaf Ears and the U.S.-EU-Russia Sanctions Tangle: Contending Strategic Discourses and Mutual Emboldenment

The contemporary strategic landscape between Russia and the West is marred by interlocking economic sanctions, despite little tangible evidence that they are effective. Both Russia and the West seem complacent about the “high incidence-low effectiveness” of their sanctions-related behaviour, and there are no obvious off-ramps to the continuation or escalation of current sanctions policies. What factors caused this U.S.-EU-Russian sanctions tangle, and what can be done to address it? This article addresses these questions by comparing the sanctions-related discourse of the Russian and western strategic communities as expressed in over 1,000 academic research articles published since 2010. Statistical analysis of publication output, citation patterns and the textual content of these articles reveals contending Russian and western “world views” according to which each strategic community embraces fundamentally different understandings of the meaning, objectives, processes and legitimacy of sanctions-related behaviour. This suggests that breaking the sanctions tangle will require that the Russian and western strategic communities deepen their understanding of, and engage with, each other’s world views, and in so doing re-examine the beliefs, objectives and expectations that form the basis of each side’s current use of sanctions.

A review of sediment diversion in the Mississippi River Deltaic Plain

One of the proposed methods for restoring the disappearing Mississippi Delta is sediment diversion which uses channels and structures to divert water and sediment from the Mississippi and Atchafalaya Rivers into adjacent basins. This study presents a comprehensive review of geological and physical aspects of sediment dynamics in the Mississippi River Deltaic Plain (MRDP), with special reference to diversion studies over the past two decades. We synthesize these studies, present the current understanding of sediment diversions in the context of sediment dynamics, identify multiple key knowledge gaps, and make recommendations for future studies.To maximize net land building in the MRDP, management strategies should be focused on (a) enhancing river sediment delivery (both mud and sand), (b) increasing sediment retention in receiving basins and (c) minimizing erosion in bays and estuaries. Compared with extensive studies of land building, there have been relatively fewer studies of erosional processes. A heterogeneous coastal geological framework, cohesive sediment erodibility and subsidence together play complicated yet critical roles in future sediment dynamics in bays and estuaries of the MRDP. Sediment retention rates are highly sensitive to spatial and temporal scales, types of sediments and delivery season. Sediment diversions to seaward receiving basins provide more surge protection but tend to have lower sediment retention due to active coastal processes. Structures and devices that improve sediment retention, trap sediments, dissipate waves, and build living shorelines should be explored and cost-to-benefit analysis is needed. Long-term planning should consider more landward diversions, strategic community relocation, and nonlinear response of the complex sedimentary system of the MRDP.

On the asymmetric advantages of cyberwarfare. Western literature and the Chinese journal Guofang Keji

ABSTRACTAn issue that has been widely debated in the West is whether cyberwarfare gives militarily weaker actors asymmetric advantages. Is cyberwarfare a weapon of the weak? Or does it rather multiply the advantages enjoyed by militarily superior actors? These questions have major implications for China, which – as a rising power – must face stronger and weaker opponents at the same time. Based on an analysis of the Chinese journal Guofang Keji, this article investigates how China’s strategic community theorises advantage and disadvantage in the cyber domain and how this differs from Western perspectives on cyberwarfare.

Build Program Awareness Through Strategic Community Partnerships

Build Program Awareness Through Strategic Community Partnerships

Local-scale climate change stressors and policy response: the case of Homer, Alaska

Northern communities are experiencing greater climate variability, with extreme climate impacts occurring more frequently and with more intensity; with the need for adaptation to reduce the risk becoming more immediate. Specific stressors and decision dynamics surrounding the nature of local government policy and planning for climate adaptation are underrepresented in the scholarship. This paper seeks to contribute to the literature by exploring the case of Homer, Alaska. Through narratives of key informants connected to the community’s climate change agenda, this research explores primary climate stressors and the nature of adaptation policy integration. Findings suggests that while Homer is experiencing a variety of climate change impacts, adaptation remains a low priority for city officials. This study sheds light on some of the challenges of integrating climate adaptation policy with strategic community planning, and in turn provides decision-makers with insight into considerations for mainstreaming resilience thinking at a local government scale.

Coastal climate adaptation planning and evolutionary governance: Insights from Homer, Alaska

Climate variability is not a new challenge for coastal communities. However, because climate variability is manifesting with more extreme climate impacts, occurring with greater frequency and with more intensity, the necessity for adaptation to minimize risk is becoming more pronounced. Though this is true of coastal communities around the globe, it is an acutely important concern for coastal communities in high northern latitudes, where the impacts of climate change are occurring at a disproportionate rate. With Homer, Alaska, as a case study, and through the lens of evolutionary governance, this research investigates coastal stressors (eg. storm surges, bluff instability) and subsequent decision dynamics around local government policy and planning for climate adaptation. In particular, the paper explores the relationship between actors and institutions, the connection between power and knowledge, as well as the challenges of path and goal dependencies. Narratives from key informants associated with Homer's climate change agenda highlight that while some stakeholders are keen to mainstream adaptation thinking into long-term strategic planning, adaptation policy remains a low priority (with a focus instead on mitigation). Uptake is further hindered by a belief among key decision-makers that the threat of climate change is a concern for the future. This in turn has resulted in diminished internal capacity (eg. institutions, knowledge) to effectively prepare for climate variability in general. Drawing insights through evolutionary governance theory, this study may provide coastal community decision-makers with an appreciation of the value (and nuanced challenges) of embedding climate adaptation thinking into strategic community planning.

Co-creation within hybrid networks: what can be learnt from the difficulties encountered? The example of the fight against blood- and sexually-transmitted infections

This article analyses co-creation processes within hybrid networks. Specifically, it looks at a particular co-creation mechanism, in this case, a strategic community set up to test new ways of dealing with blood- and sexually-transmitted infections in Quebec. A strategic community is a temporary structure of inter-organizational collaboration, made up of professionals, first-level managers, general practitioners, representatives of community organizations, etc. tasked with generating, implementing and evaluating new ideas about the organization of services. The results of this study highlight the difficulties encountered as well as the issues related to these co-creation processes. Notes for practitioners The implementation of co-creation processes, involving public, private and community actors, has to contend with numerous challenges: (1) the enrolment of the stakeholders concerned by the complex issues; (2) the creation of places for discussion and experimentation involving actors who play an important role in the implementation of change; (3) the mobilization of tools and facilitators to develop a common vision; (4) the action stage to validate new ways of doing things.

Metropolization Process for enhancing local and regional planning : an experience of cirebon metropolitan, West Java

Metropolitan develops in line with resource utilization, investment, and transactions of regional activities. Metropolization of an area gives emerge urban economy that changes the situation, form, and pattern of urban space interactions. On the other hand, metropolism concerns the strategy of changing variation of urban space, so that metropolitan invasion not only form of urban space but also the process of interaction among stakeholders in developing metropolitan area. Based on participatory research, this article explores metropolitan invasion process for enhancing local and regional planning, both indigenous and intrusive cataclysmic. The study find that the primeval, rural, and urban as elemental environment must be considered in developing metropolitan, not merely form the structure and pattern of urban space. The metropolization process also requires the strategic of rural urban linkage, context setting and local assessment, strategic community investment, and interculturalist approach. The other findings of the study show that metropolization in Cirebon Metropolitan, West Java emphasizing on promotion of competitiveness strategy, value chain urban activities, and networking of urban areas. Cirebon Metropolitan must promote the realization of growth centers and connect the interregional activities of metropolitan area for providing sustainable economic growth.

Planting Seeds to Grow Healthy Children: Strategic Community Partnerships.

More than one third of U.S adults are considered obese, and childhood obesity has more than doubled in the past 30 years. Food security can influence obesity, in particular, within inner cities where access to healthy food is often limited. The use of a mobile food truck program (with refrigeration) was implemented in two large inner cities in Connecticut as part of an initiative aimed at helping low-income families with young children gain access to healthy food and nutrition education. Collaborating with community child care centers was used. The experiences of the families who participated in the program were assessed via focus groups. Main ideas derived from the focus groups were participant satisfaction with money saving suggestions, ideas for how to make healthier choices, and excitement about opportunities to receive foods that they would not normally buy. This innovative mobile food truck program demonstrated the value of strategic community partnerships to influence health.

The New Renewable Energy Consumption Policy of Rare Earth Metals to Build Indonesia's National Energy Security

This study aims to discuss the policy of using renewable energy in the form of rare metal eart as an effort to build national energy security. The research method used a legal research looking from various perspectives in social science. Law is seen as a space for the process of scientific study in order to seek truth. The use of relevant legal research wants to understand the law more thoroughly. In performing implementation analysis, using the method of Regulatory Impact Assessment (RIA) with focus on energy regulation. The results of the study show that: First, the policy of the Indonesian republic government regarding the use of new energy and renewable energy aims to prepare the carrying capacity of national energy security. This policy has not fully gone well. The policy is not supported by consistency in issuing derivative policies. Second, the use of new energy and renewable energy, especially rare earth metals as part of efforts to encourage national energy security in Indonesia is still very far from expectations. The use of rare eart metal is only around 0.7% of the use of new energy. Efforts to explore and exploit rare earth metals have not been carried out in a timely manner. Whereas the potential of rare earth metals is a strategic community and has the potential to encourage national energy security in Indonesia. Indonesia is projected to produce rare earth metals reaching 20% of the world's supply.

Implementation of the Active TB Case Finding in Nigeria; Processes, Lessons Learnt and Recommendations

Introduction: Tuberculosis remains a major public health issue in Nigeria with the country ranking seventh among the 30 high TB burden countries. Nigeria is among the three countries that account for half of the 4.3 million “missing” TB cases globally. One untreated TB case is able to infect about 10 - 20 people annually. Hence, it is pertinent that TB is controlled effectively through the use of active case finding strategies to find the missing TB cases. Objective: This article highlights the best practices and key lessons learnt during the implementation of the active house to house TB case finding strategy in Nigeria. Lessons Learnt and Recommendations: Strategic community engagement, massive awareness creation using mass media and local means of communication, mapping of locations where registered TB cases live, to inform home visits for contact tracing and strengthening of laboratory systems, are viable mechanisms to improve TB case finding. Conclusion: Active TB case finding interventions should be implemented in the context of a strengthened diagnostics system, strategic community engagement and media involvement.

Population health management in a small health system: Impact of controlled substance stewardship in a patient-centered medical home.

The success of a patient-centered medical home in providing population health management (PHM) services through controlled substance stewardship is described. In 2013, Penobscot Community Health Care (PCHC), in Bangor, Maine, was fully engulfed in the prescription opioid crisis. At PCHC, patients' opioid doses were startlingly high. Within the organization, measures to ensure that prescriptions were being used as prescribed, and not diverted, were underutilized. PCHC responded to these challenges by developing a comprehensive approach to controlled substance stewardship, defined as a coordinated effort to promote the appropriate use of controlled substances, improve patient outcomes, reduce misuse and abuse, and decrease patient morbidity and mortality attributed to these high-risk medications. Since the establishment of the program, over 1,300 patient reviews have been conducted. During this time, the number of PCHC patients receiving chronic opioids has decreased by 67.2% and continues to drop, with a corresponding 65.6% decrease in the number of patients receiving benzodiazepines. Premature deaths were reviewed to identify associations with opioids prescribed at the time of death, which revealed a decline of 50% between 2013 and 2015. Since program inception, the reviews conducted based on internal quality-improvement reports have been expanded to include patients on combinations of opioids and benzodiazepines, high-dose opioids, and carisoprodol. Systematic approaches addressing areas of critical need in high-risk populations are integral to PHM efforts in small health systems. The pharmacy team can serve a unique role in identifying, developing, and implementing key PHM services. Coupled with strategic community partnerships, successful PHM integration can assist in the financial survival of small health systems.