One perspective on stakeholder involvement at Hanford

The Hanford nuclear site in Washington State had a major role in the production of nuclear weapons materials during the Manhattan Project in World War II and during the Cold War that followed. The production of weapons-grade radionuclides produced a large amount of radioactive byproducts that have been stored since the mid-1900s at the Hanford Site. These by-product radionuclides have leaked from containment facilities into the groundwater, contaminated buildings used for radionuclide processing, and also contaminated the nuclear reactors used to produce weapons-grade uranium and plutonium. This issue has been a major concern to Hanford stakeholders for several decades, and the U.S. Department of Energy, the U.S. Environmental Protection Agency, and the Washington State Department of Ecology established a Tri-Party Agreement in 1989, at which time Hanford ceased production of nuclear weapons materials and began a major effort to clean up and remediate the Hanford Site's contaminated groundwater, soil, and facilities. This paper describes the concerns of stakeholders in the production of nuclear weapons, the secrecy of Hanford operations, and the potential impacts to public health and the environment from the unintended releases of weapons-grade materials and by-products associated with their production at the Hanford Site. It also describes the involvement of public stakeholders in the development and oversight by the Hanford Advisory Board of the steps that have been taken in cleanup activities at the Hanford Site that began as a major effort about two decades ago. The importance of involvement of the general public and public interest organizations in developing and implementing the Hanford cleanup strategy are described in detail.     

Newborn blood spot screening in four countries: stakeholder involvement

While newborn blood spot screening has historically been viewed as a public health success, the potential harms and benefits are more finely balanced for new conditions being considered for program expansion. We highlight complex issues that must be addressed in policy decisions, which in turn requires a consideration of many stakeholder perspectives. Using national policy documents from the United Kingdom, the United States, Australia, and Canada, we describe the participation of stakeholder organizations in the newborn screening policy process, how such organizations have incorporated stakeholder views into their own policy writing, and their recommendations for inclusiveness. Stakeholder participation in newborn screening decision-making is widely acknowledged as important, and many methods have been endorsed - consultation as well as direct or indirect input into policy development. Differences across organizations and jurisdictions raise questions about the most effective approaches for facilitating inclusiveness, suggesting a need for formal evaluative research.     

Evaluating the effectiveness of community health partnerships: a stakeholder accountability approach

Community health partnerships (CHPs) are promoted as effective cooperative interorganizational relationships to improve community health status while conserving resources. However, relatively little is known about the effectiveness of these partnerships in achieving their goals. Using concepts from a network effectiveness framework (Provan and Milward, 2001) and a network accountability framework (Gamm, 1998), the authors propose that successful CHPs are those that are effective in multiple levels (community, network, organization/particpants) and/or accountability dimensions (political, commercial, clinical/patient, and community). The combined frameworks serve to identify a number of community health stakeholders and associated interests that vary according to accountability dimensions to which CHPs respond. Using survey data from over 400 participants in 25 Community Care Networks, the authors assess the usefulness of the conceptual framework in evaluating CHP effectiveness. The results suggest that CHP participants recognize three different levels of analysis in their evaluation of network effectiveness: community, network, and organization/participant. Furthermore, the results show that respondents distinguish between two different organization/participant benefits: enabling and client services. While respondents rated the intangible resources or enabling benefits (e.g., legitimacy and learning) of partnership participation most highly, client services resulting from CHP participation (e.g., client services and referrals) received the lowest ratings. Community benefit (e.g., improving community health status) and network effectiveness (e.g., ability to provide efficient, high quality health and human services) received ratings that fall between the enabling and client services. Given the relatively good scores (above 60%) received by CHPs on all four effectiveness dimensions considered here, it appears that the majority of respondents find at least some evidence of network effectiveness across all three levels of network effectiveness and all four dimensions of accountability.     

Empowerment evaluation as a social work strategy.

This article explores the application of empowerment strategies to program evaluation within a community health setting and presents a case study to examine the policy, direct practice, and research issues associated with the plan to evaluate a community-based HIV-prevention program. Empowerment evaluation strategies were used to develop an innovative street outreach intervention that can be measured and evaluated, to transfer evaluation knowledge from the researcher-expert to the program stakeholders, and to help overcome evaluation implementation obstacles. The article addresses the benefits and risks inherent in an empowerment approach to the evaluative research process.     

Nursing involvement in euthanasia: a 'nursing-as-healing-praxis' approach

Abstract  In an earlier article, it was found that the terms of preference utilitarianism are insufficiently sound for guiding nursing activity in general, including in relation to nursing involvement in euthanasia. In this article, I shall examine the terms of a more traditional philosophical approach in order to determine the moral legitimacy, or otherwise, of nursing engagement in measures intended to end the lives of patients. In attempting this task, nursing practice is considered in light of what I shall call a 'nursing-as-healing-praxis' approach which includes an account of the moral purpose of nursing and the virtues necessary for realizing that purpose. Ultimately, it is concluded that the terms of this approach rule out the involvement of nurses in euthanasia such that if euthanasia can be justified at all, those outside the nursing profession must provide for its administration.     

A stakeholder approach to community health management

Although community health management has become an important issue for health care organizations, there is little information on the roles that they and other community institutions ought to play in this area. This article develops a stakeholder approach to community health management, identifies the set of community health stakeholders, determines their salience to health care organizations, discusses the strategies they use to influence organizational involvement in community health management, and examines the responses of health care organizations. Implications for community institutions, health care managers, and researchers are discussed.     

Dementia‐friendly communities: challenges and strategies for achieving stakeholder involvement

Dementia‐friendly communities (DFCs) are a UK policy initiative that aims to enable people with dementia to feel supported and included within their local community. Current approaches to DFC creation rely on stakeholder involvement, often requiring volunteer assistance. There is though a lack of evidence that examines the reality of achieving this. This paper critically assesses the challenges and strategies for achieving stakeholder involvement in DFCs. The evidence base is drawn from an inter‐agency project funded by the National Health Service in the South of England where seven DFCs were developed by steering group partners and four part‐time project workers (PWs). Data from the independent evaluation undertaken in the first year (2013–2014) of the project were analysed: 14 semi‐structured interviews and a focus group examined PWs’ experiences; while progress and key milestones are determined from monthly progress forms, good news stories, locality steering group minutes and press releases. Analysis was undertaken using a directed content analysis method, whereby data content for each locality was matched to the analytical framework that was drawn from Alzheimer's Society guidance. Challenges to achieving stakeholder involvement were identified as: establishing networks and including people representative of the local community; involving people affected by dementia; and gaining commitment from organisations. Strategies for achieving stakeholder involvement were recognised as: a sustainable approach; spreading the word; and sharing of ideas. By highlighting these challenges and the approaches that have been used within communities to overcome them, these findings form the foundation for the creation of DFC initiatives that will become embedded within communities. Stakeholder involvement is unpredictable and changeable; therefore, reliance on this approach questions the long‐term sustainability of DFCs, and must be considered in future policies designed to enhance quality of life for people affected by dementia.     

四川省应对风险灾害社区抗逆力水平TOPSIS法分析

  目的  综合评价中国突发公共卫生事件社区抗逆力构建过程中的关键节点问题,为我国社区抗逆力的构建与完善提供参考依据。  方法  采用文献研究和小组讨论方法确定社区抗逆力构建中的问题清单,通过专家咨询法对问题的严重性和干预迫切性进行评价,并应用TOPSIS综合评价法对问题重要性进行排序。  结果  专家咨询的积极系数为95.0 %,权威系数为0.774,专家对突发公共卫生事件社区抗逆力构建问题清单中16项问题严重性和干预迫切性评分的协调系数分别为0.387和0.428（均P < 0.05）;TOPSIS综合评价结果显示,目前我国突发公共卫生事件社区抗逆力构建过程中居于前5位的关键节点问题依次为“尚未形成多主体的突发公共卫生事件社区抗逆力体系”（0.514）、“现有各主体间缺乏一定的沟通和协同机制”（0.487）、“地方政府与其他各利益相关者之间保持传统的自上而下管理模式,缺乏基于社区的灾害治理理念”（0.467）、“突发公共卫生事件灾害管理以政府和专业卫生组织为主,社区居民参与程度较差”（0.454）、“地方政府对社区及卫生组织的应急资源投入不足”（0.437）。  结论  目前中国在突发公共卫生事件社区抗逆力体系构建、社区主体间协调机制、社区管理模式、社区居民参与和应急资源投入方面仍存在较大问题,应重点加以关注。     

The Dutch Consumer Quality Index: an example of stakeholder involvement in indicator development

Background

Like in several other Western countries, in the Dutch health care system regulated competition has been introduced. In order to make this work, comparable information is required about the performance of health care providers in terms of effectiveness, safety and patient experiences. Without further coordination, external actors will all try to force health care providers to be transparent. For health care providers this might result in a situation in which they have to deliver data for several sets of indicators, defined by different actors. Therefore, in the Netherlands an effort is made to define national sets of performance indicators and related measuring instruments. In this article, the following questions are addressed, using patient experiences as an example:- When and how are stakeholders involved in the development of indicators and instruments that measure the patients' experiences with health care providers?- Does this involvement lead to indicators and instruments that match stakeholders' information needs?

Discussion

The Dutch experiences show that it is possible to implement national indicator sets and to reach consensus about what needs to be measured. Preliminary evaluations show that for health care providers and health insurers the benefits of standardization outweigh the possible loss of tailor-made information. However, it has also become clear that particular attention should be given to the participation of patient/consumer organisations.

Summary

Stakeholder involvement is complex and time-consuming. However, it is the only way to balance the information needs of all the parties that ask for and benefit from transparency, without frustrating the health care system.

     

Redefining parent involvement in Head Start: a two-generation approach

The present review of the literature aims to look at two-generation programs and their effects on children and parents as a potential strategy to improve parent involvement in Head Start while responding to the self-sufficiency needs of families. This paper reviews several two-generation program evaluations: Comprehensive Child Development Program, Even Start Family Literacy Program, Head Start Family Service Centers, New Chance and New Hope. Lessons learned from the evaluation of these programs are used to suggest options for enhancing Head Start program's ability to respond to the needs of low-income families and maintain a high level of parent involvement.     

Effective stakeholder participation in setting research priorities using a Global Evidence Mapping approach

ObjectiveWe present a multistep process for identifying priority research areas in rehabilitation and long-term care of traumatic brain-injured (TBI) patients. In particular, we aimed to (1) identify which stakeholders should be involved; (2) identify what methods are appropriate; (3) examine different criteria for the generation of research priority areas; and (4) test the feasibility of linkage and exchange among researchers, decision makers, and other potential users of the research.Study Design and SettingPotential research questions were identified and developed using an initial scoping meeting and preliminary literature search, followed by a facilitated mapping workshop and an online survey. Identified research questions were then prioritized against specific criteria (clinical importance, novelty, and controversy). Existing evidence was then mapped to the high-priority questions using usual processes for search, screening, and selection. A broad range of stakeholders were then brought together at a forum to identify priority research themes for future research investment. Using clinical and research leaders, smaller targeted planning workshops prioritized specific research projects for each of the identified themes.ResultsTwenty-six specific questions about TBI rehabilitation were generated, 14 of which were high priority. No one method identified all high-priority questions. Methods that relied solely on the views of clinicians and researchers identified fewer high-priority questions compared with methods that used broader stakeholder engagement. Evidence maps of these high-priority questions yielded a number of evidence gaps. Priority questions and evidence maps were then used to inform a research forum, which identified 12 priority themes for future research.ConclusionOur research demonstrates the value of a multistep and multimethod process involving many different types of stakeholders for prioritizing research to improve the rehabilitation outcomes of people who have suffered TBI. Enhancing stakeholder representation can be augmented using a combination of methods and a process of linkage and exchange. This process can inform decisions about prioritization of research areas.     

Investigating Hispanic adolescent involvement with alcohol: a focus group interview approach

Focus group interviews were conducted with Hispanic teenagers to explore their patterns of alcohol consumption, influences on drinking and possible intervention strategies. The findings revealed that drinking and alcohol-impaired driving are common. Conviviality and social facilitation are the predominant contexts for alcohol consumption in this population. The strong influence of peers was detected where drinking to 'fit in' and be part of the crowd was observed. Parents were also noted to have influence. Some parents actively promoted drinking among their sons as it is often seen as a sign of masculinity or 'machismo'. Suggestions for effective prevention strategies included a preference for messages which vividly portray the harmful consequences of alcohol consumption and the use of testimonials from people who have suffered some form of impairment due to alcohol abuse. Teens, especially those who speak Spanish and understand the Hispanic culture, were seen as the most credible spokespersons for prevention campaigns.     

Evaluating stakeholder management performance using a stakeholder report card: the next step in theory and practice

In the highly competitive health care environment, the survival of an organization may depend on how well powerful stakeholders are managed. Yet, the existing strategic stakeholder management process does not include evaluation of stakeholder management performance. To address this critical gap, this paper proposes a systematic method for evaluation using a stakeholder report card. An example of a physician report card based on this methodology is presented.     

Empowerment evaluation of worker safety and health education programs

BACKGROUND: The need to expand the use of evaluation to learn how education programs contribute to workers' occupational safety and health is well documented. Similarly recognized is the need to expand workers' involvement as primary stakeholders in program evaluation. METHODS: Articles for this review were identified through computer database and manual searches related to: intervention research and evaluation; occupational safety, health training, and education; and worker participation and empowerment. RESULTS: After identifying empowerment as a multilevel and multidimensional concept, this review used a theoretical framework of evaluation to show how various participatory and empowering approaches can affect evaluation studies and their use. CONCLUSIONS: The field of occupational safety and health has a unique historical opportunity to further expand workers' involvement in their own education through the use of participatory and empowering approaches to evaluation. Use of these approaches has the potential to strengthen capacities for organizational learning and improve both program theory and practice.     

How physical therapists perceive physicians: a stakeholder analysis

Physicians and physical therapy service units are facing a different health care climate than 5 to 10 years ago. Managed care, changes in Medicare reimbursement, and other financing issues are causing turbulence for the industry. This article reports on more than 1,300 physical therapy service unit managers of hospitals, long-term care facilities, outpatient clinics, and home health agencies who determined the most important stakeholderoftheir physical therapy service unit and the perceived degree of power the various stakeholders had over the physical therapy service area. This study indicates that historical roles and alliances in health care are undergoing major alterations.     

Business ethics and health care: a stakeholder perspective

This article examines the recent controversy in health care delivery about whether it should be conceptualized as a business. The current debate implicitly appeals to a common understanding of business and business practices that is no longer very useful. This common notion, which the authors call "cowboy capitalism," conceptualizes business as a competitive jungle resting on self-interest and an urge for competition in order to survive. The authors suggest that stakeholder capitalism offers a more useful framework for the dialogue about health care reform.