Understanding stakeholder requirements on an NHS hospital project: application of semiotics-rooted theories.

Hospitals represent complex and difficult contexts for AEC (architecture, engineering and construction) professionals to engage with due to their functional complexity and diversity of stakeholder interests (i.e. patient, visitor, medical specialist). Hospital designers need to take note of changing NHS policy contexts (e.g. the possible empowerment of general practitioners to shape services), technological advances in medical equipment design and the potential health needs of future generations. It is imperative for hospital designers and architects to align their processes and methodologies (e.g. briefing and requirements capture) to the needs and desires of their clients so that a medical facility design is produced which is truly aligned to the requirements of the hospital stakeholders. Semiotics, the “study” or “discipline” of signs aims to investigate the nature of signs (their inception, representation and meaning), whilst semiotics-rooted theories are concerned with investigating how meaning and understanding is mobilized between persons and between organisations. This paper details a semiotics-rooted research approach for investigating the interactions between hospital designers and stakeholders on a forthcoming NHS hospital project in the UK. A semiotics grounded study will potentially provide a deeper understanding of how meaning and understanding is established between hospital project stakeholders and construction professionals.

Tactical ethics: how the discourses of fairtrade and black economic empowerment change and interact in wine networks from South Africa to the UK.

This paper explores the spaces and power relations of ethical foodscapes. Ethics can offer a commodity a valuable unique selling point in a competitive marketplace but managing the changeable and multiple motivations for stakeholder participation throughout the commodity chain in order to utilise this opportunity is a complex negotiation. Through exploring the spaces and relations within three South African– UK ethical wine networks, the discursive tactics used to sustain these are uncovered. The discourses of Fairtrade, Black Economic Empowerment and organics are highly adaptive, interacting with each other in such a way as to always be contextually appealing. This ‘tactical mutability’ is combined with ‘scales of knowing’, which, this paper argues, are essential for network durability. ‘Scales of knowing’ refers to the recognition by stakeholders of the potential for different articulations of a discourse within the network, which combines with ‘tactical mutability’ to allow for a scalar, contextual and ’knowing’ (im)mutability to ensure the discourse’s continued appeal. However, even when one discourse is the ‘lead’ it always folds within it linkages to other ethical discourses at work, suggesting that ethical practice is mutually supportive discursively. This means that at the producer end ethical interactions may offer more capacity to enact genuine transformation than the solo operations of a discourse.

Experiences with sustainability indicators and stakeholder participation: A case study relating to a 'Blue Plan' project in Malta

The practical application of systemic sustainability analysis (SSA; Bell and Morse, 1999) as applied in-a project instigated and managed by 'Blue Plan', one of the regional activity centres of the Mediterranean Action Plan, is set out and explained in this paper. The context in which SSA was applied and adapted to SPSA (systemic and prospective sustainability analysis). is described in the Mediterranean, primarily in Malta. The SSA process is summarized, its extension and linkage to the prospective approach is described and the comments of stakeholders in the context are added. Some preliminary outcomes are suggested. The pauticular focus of the paper is on the lessons learned from doing SSA/SPSA within a classic blueprint project framework. It is-not assumed that SSA/SPSA is 'finished' or 'definitive'. Rather, we suggest that it is a developing and changing approach that practitioners can adapt and change to meet the specific needs of the circumstances that confront them. Copyright (C) 2004 John Wiley & Sons, Ltd and ERP Environment.

How was patient empowerment portrayed in information leaflets describing the community pharmacy Medicines Use Review service in the UK?

Objective The Medicines Use Review (MUR) community pharmacy service was introduced in 2005 to enhance patient empowerment but the service has not been taken up as widely as expected. We investigated the depiction of the patient–pharmacist power relationship within MUR patient information leaflets. Methods We identified 11 MUR leaflets including the official Department of Health MUR booklet and through discourse analysis examined the way language and imagery had been used to symbolise and give meaning to the MUR service, especially the portrayal of the patient–pharmacist interactions and the implied power relations. Results A variety of terminology was used to describe the MUR, a service that aimed ultimately to produce more informed patients through the information imparted by knowledgeable, skilled pharmacists. Conclusion The educational role of the MUR overshadowed the intended patient empowerment that would take place with a true concordance-centred approach. Although patient empowerment was implied, this was within the boundaries of the biomedical model with the pharmacist as the expert provider of medicines information. Practice implications If patient empowerment is to be conveyed this needs to be communicated to patients through consistent use of language and imagery that portrays the inclusivity intended.

Modelling bi-directional research: a fresh approach to stakeholder theory

Purpose – While Freeman's stakeholder management approach has attracted much attention from both scholars and practitioners, little empirical work has considered the interconnectedness of organisational perspectives and stakeholder perspectives. The purpose of this paper is to respond to this gap by developing and empirically testing a bi-directional model of organisation/stakeholder relationships. Design/methodology/approach – A conceptual framework is developed that integrates how stakeholders are affected by organisations with how they affect organisations. Quantitative data relating to both sides of the relationship are obtained from 700 customers of a European service organisation and analysed using partial least squares structural equation modelling technique. Findings – The findings provide empirical support for the notion of mutual dependency between organisations and stakeholders as advocated by stakeholder theorists. The results suggest that the way stakeholders relate to organisations is dependent on how organisations relate to stakeholders. Originality/value – The study is original on two fronts: first, it provides a framework and process that can be used by researchers to model bi-directional research with other stakeholder groups and in different contexts. Second, the study presents an example application of bi-directional research by empirically linking organisational and stakeholder expectations in the case of customers of a UK service organisation.