Stakeholder challenges in purchasing medical devices for patient safety.

OBJECTIVE: This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. METHODS: Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. RESULTS: The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. CONCLUSIONS: The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.

Stakeholder engagement in early stage product-service system development for healthcare informatics

This paper presents the findings from four case studies on stakeholder engagement in new health information and communication technology (ICT) product-service system (PSS) development. The degree of connectivity between the new health ICT PSS and its intended operating environment has emerged to be an important contextual factor that may impact the decision of stakeholder engagement in the early stage development process. Along with the proposition of a four-level framework to guide stakeholder identification for new PSS development, three stakeholder engagement propositions that are based on the degree of connectivity are developed. Analysis has shown that there can be two types of connectivity: data and process. Moreover, each connectivity type can be characterized by how much the new PSS is connected with its environment: independent if there is no linkage, linked if it interfaces with, or incorporated if it is embedded into. Furthermore, depending upon whether and to what extent the PSS has data and process connectivity with its intended operating environment, the stakeholder engagement needs in early stage development vary. The propositions presented in this paper provide important directions for future work exploring PSS characterization and stakeholder engagement decision in early stage new PSS development in the healthcare industry. © 2013 PICMET.

Building more sustainable solutions in production-consumption systems: the case of food for people with reduced access

In new product development, the ability to integrate different dimensions of sustainability at a value chain level is still a complex, problematic goal. As product-service approaches are increasingly enabling the introduction of more sustainable paths, this paper describes the authors' experience thus far when building insights into conditions for the implementation of integrated solutions in a process of co-development and testing in real life conditions, which are driven by a social need focusing on food for people with reduced access. Throughout this process, which brought together producers, consumers and other stakeholders to design and test industrialised, sustainable solutions, empirical evidence demonstrates feasibility and usefulness of the approach and insight into the conditions for implementing interactive, comprehensive multi-stakeholder processes in real life situations. In addition, results show that the delivery of innovative solutions enabled to offer social added value, economic profits and environmental improvements under specific experimental conditions. © 2006 Elsevier Ltd. All rights reserved.

Community-led resettlement: From a flood affected slum to a new society in Pune, India

This paper describes the resettlement process of a community devastated by annual floods, to newly constructed housing in Pune, India. The relocation from Kamgar Putala slum to a housing society at Hadapsar was organized by a community-led NGO partnership in 2004. The housing development was coordinated by the local NGO Shelter Associates with significant community participation. The housing has been revisited in 2010 to evaluate the sustainability of the resettlement project’s delivery model via stakeholder perception. The process of organizing for resettlement after natural disaster is described along with the implementation and evaluation of the new housing nearly six years after initial occupation. The strong partnership approach overcame a series of political and financial hurdles at various stages of the relocation project. The story of resettling Kamgar Putala is detailed alongside an outline of the current political climate for an alternative slum-upgrading policy in India and Pune. The advantages of an empowered community supported by an influential local NGO demonstrate a commendable team effort which has tackled the threat of floods. The paper highlights the merits of a community-led partnership approach to housing development for achieving sustainable urban development as well as the alleviation of poverty in a developing context.

Simultaneous colour search renders other object properties less salient

A common approach to visualise multidimensional data sets is to map every data dimension to a separate visual feature. It is generally assumed that such visual features can be judged independently from each other. However, we have recently shown that interactions between features do exist [Hannus et al. 2004; van den Berg et al. 2005]. In those studies, we first determined individual colour and size contrast or colour and orientation contrast necessary to achieve a fixed level of discrimination performance in single feature search tasks. These contrasts were then used in a conjunction search task in which the target was defined by a combination of a colour and a size or a colour and an orientation. We found that in conjunction search, despite the matched feature discriminability, subjects significantly more often chose an item with the correct colour than one with correct size or orientation. This finding may have consequences for visualisation: the saliency of information coded by objects' size or orientation may change when there is a need to simultaneously search for colour that codes another aspect of the information. In the present experiment, we studied whether a colour bias can also be found in a more complex and continuous task, Subjects had to search for a target in a node-link diagram consisting of SO nodes, while their eye movements were being tracked, Each node was assigned a random colour and size (from a range of 10 possible values with fixed perceptual distances). We found that when we base the distances on the mean threshold contrasts that were determined in our previous experiments, the fixated nodes tend to resemble the target colour more than the target size (Figure 1a). This indicates that despite the perceptual matching, colour is judged with greater precision than size during conjunction search. We also found that when we double the size contrast (i.e. the distances between the 10 possible node sizes), this effect disappears (Figure 1b). Our findings confirm that the previously found decrease in salience of other features during colour conjunction search is also present in more complex (more 'visualisation- realistic') visual search tasks. The asymmetry in visual search behaviour can be compensated for by manipulating step sizes (perceptual distances) within feature dimensions. Our results therefore also imply that feature hierarchies are not completely fixed and may be adapted to the requirements of a particular visualisation. Copyright © 2005 by the Association for Computing Machinery, Inc.

Community-led resettlement: From a flood-affected slum to a new society in Pune, India

This paper describes the resettlement process of a community devastated by annual floods, to newly constructed housing in Pune, India. The relocation from Kamgar Putala slum to a housing society at Hadapsar was organized by a community-led NGO partnership in 2004. The housing development was coordinated by the local NGO Shelter Associates with significant community participation. The housing has been revisited in 2010 to evaluate the sustainability of the resettlement project's delivery model via stakeholder perception. The process of organizing for resettlement after natural disaster is described along with the implementation and evaluation of the new housing nearly six years after initial occupation. The strong partnership approach overcame a series of political and financial hurdles at various stages of the relocation project. The story of resettling Kamgar Putala is detailed alongside an outline of the current political climate for an alternative slum-upgrading policy in India and Pune. The advantages of an empowered community supported by an influential local NGO demonstrate a commendable team effort which has tackled the threat of floods. The paper highlights the merits of a community-led partnership approach to housing development for achieving sustainable urban development as well as the alleviation of poverty in a developing context. © 2011 Taylor & Francis.

The Effect of Motivation on Movement: A Study of Bradykinesia in Parkinson's Disease

Background: Bradykinesia is a cardinal feature of Parkinson's disease (PD). Despite its disabling impact, the precise cause of this symptom remains elusive. Recent thinking suggests that bradykinesia may be more than simply a manifestation of motor slowness, and may in part reflect a specific deficit in the operation of motivational vigour in the striatum. In this paper we test the hypothesis that movement time in PD can be modulated by the specific nature of the motivational salience of possible action-outcomes. Methodology/Principal Findings: We developed a novel movement time paradigm involving winnable rewards and avoidable painful electrical stimuli. The faster the subjects performed an action the more likely they were to win money (in appetitive blocks) or to avoid a painful shock (in aversive blocks). We compared PD patients when OFF dopaminergic medication with controls. Our key finding is that PD patients OFF dopaminergic medication move faster to avoid aversive outcomes (painful electric shocks) than to reap rewarding outcomes (winning money) and, unlike controls, do not speed up in the current trial having failed to win money in the previous one. We also demonstrate that sensitivity to distracting stimuli is valence specific. Conclusions/Significance: We suggest this pattern of results can be explained in terms of low dopamine levels in the Parkinsonian state leading to an insensitivity to appetitive outcomes, and thus an inability to modulate movement speed in the face of rewards. By comparison, sensitivity to aversive stimuli is relatively spared. Our findings point to a rarely described property of bradykinesia in PD, namely its selective regulation by everyday outcomes. © 2012 Shiner et al.

Choosing to make an effort: the role of striatum in signaling physical effort of a chosen action.

The possibility that we will have to invest effort influences our future choice behavior. Indeed deciding whether an action is actually worth taking is a key element in the expression of human apathy or inertia. There is a well developed literature on brain activity related to the anticipation of effort, but how effort affects actual choice is less well understood. Furthermore, prior work is largely restricted to mental as opposed to physical effort or has confounded temporal with effortful costs. Here we investigated choice behavior and brain activity, using functional magnetic resonance imaging, in a study where healthy participants are required to make decisions between effortful gripping, where the factors of force (high and low) and reward (high and low) were varied, and a choice of merely holding a grip device for minimal monetary reward. Behaviorally, we show that force level influences the likelihood of choosing an effortful grip. We observed greater activity in the putamen when participants opt to grip an option with low effort compared with when they opt to grip an option with high effort. The results suggest that, over and above a nonspecific role in movement anticipation and salience, the putamen plays a crucial role in computations for choice that involves effort costs.

Strategies to reduce the carbon footprint of consumer goods by influencing stakeholders

Consumer goods contribute to anthropogenic climate change across their product life cycles through carbon emissions arising from raw materials extraction, processing, logistics, retail and storage, through to consumer use and disposal. How can consumer goods manufacturers make stepwise reductions in their product life cycle carbon emissions by engaging with, and influencing their main stakeholders? A semi-structured interview approach was used: to identify strategies and actions, stakeholders in the consumer goods industry (suppliers, manufacturers, retailers and NGOs) were interviewed about carbon emissions reduction projects. Based on this, a summarising presentation was made, which was shared during a second round of interviews to validate and refine the results. The results demonstrate several opportunities that have not yet been exploited by companies. These include editing product choice in stores to remove products with higher carbon footprints, using marketing competences for environmental benefits, and bundling competences to create winewinewin business models. Governments and NGOs have important enabling roles to accelerate industry change. Although this work was initially developed to explore how companies can reduce life cycle carbon emissions of their products, these strategies and actions also give insights on how companies can influence and anticipate stakeholder actions in general. © 2012 Elsevier Ltd. All rights reserved.

A Comparative Picture of Corporate Social Responsibility Approaches by Leading Companies in the United Kingdom and Brazil

Purpose - This paper compares CSR strategy, stakeholder engagement and overseas approaches of six leading companies which have large potential environmental and social impacts, influential stakeholders and notable CSR actions. Design/methodology/approach - It is an exploratory survey based on interviews of senior executives from British and Brazilian companies operating in the steel, petroleum and retail sectors and makes comparisons between and within them. Findings - British companies interviewed are more rule-based, adopt an implicit CSR approach; react to stakeholder’s demands based on moral motives and focus on environmental issues. The Brazilian companies, reviewed in this study, adopt an explicit CSR approach, have relational motives to engage with stakeholders and are more concerned with building a responsible image and narrowing social gaps. Research limitations/implications - The survey is based on perceptions of senior executives interviewed which may or may not correspond to actual practices. The sample size restricts generalization of results and specific firms interviewed may not represent the prevailing CSR business strategy in their respective countries. Practical implications - British companies can learn from the Brazilian experience how to become more innovative in a broader approach to CSR. Brazil should reinforce its legal framework to provide a more systematic and rule-based approach to CSR close to the UK experience. Originality/value - The way CSR is conceived and implemented depends on the ethical, socioeconomic, legal and institutional environment of the country in which the firm operates