The snakes and ladders of user involvement:moving beyond Arnstein

For 35 years, Arnstein's ladder of citizen participation has been a touchstone for policy makers and practitioners promoting user involvement. This article critically assesses Arnstein's writing in relation to user involvement in health drawing on evidence from the United Kingdom, the Netherlands, Finland, Sweden and Canada. Arnstein's model, however, by solely emphasizing power, limits effective responses to the challenge of involving users in services and undermines the potential of the user involvement process. Such an emphasis on power assumes that it has a common basis for users, providers and policymakers and ignores the existence of different relevant forms of knowledge and expertise. It also fails to recognise that for some users, participation itself may be a goal. We propose a new model to replace the static image of a ladder and argue that for user involvement to improve health services it must acknowledge the value of the process and the diversity of knowledge and experience of both health professionals and lay people.

Developing user involvement in a UK cancer network:professionals’ and users’ perspectives

This paper explores the results of a consensus development exercise that explored diverse perspectives and sought to identify key principles for the development of user involvement in a cancer network. The exercise took place within one of 34 UK cancer networks and was a collaboration between the NHS, two universities and two voluntary sector organizations. The paper explores professionals’ and users’ perspectives on user involvement with reference to the current sociopolitical context of user participation. British policy documents have placed increasing emphasis on issues of patient and public participation in the evaluation and development of health services, and the issue of lay participation represents an important aspect of a critical public health agenda. The project presented here shows that developing user involvement may be a complex task, with lack of consensus on key issues representing a significant barrier. Further, the data suggest that professional responses can partly be understood in relation to specific occupational standpoints and strategies that potentially allow professionals to define and limit users’ involvement. The implications of these findings and the impact of the consensus development process itself are discussed.

Health inequalities and user involvement?

This chapter examines the theory and practice of user involvement and evaluates its impact on health inequalities in Great Britain. It describes different types of user involvement and highlights the problems in trying to define ‘hard to reach’ groups and the importance of user involvement for such groups. It concludes that user involvement is everyone's business that requires radical shifts in both theory and practice to succeed. It also suggests that creating and promoting greater exchange between those who provide and manage health services and communities and individuals who seek and receive services will create better tailoring of services to demand.

Managing conflict in user-oriented development environments: Effects on information systems success

Today, many organizations are turning to new approaches to building and maintaining information systems (I/S) to cope with a highly competitive business environment. Current anecdotal evidence indicates that the approaches being used improve the effectiveness of software development by encouraging active user participation throughout the development process. Unfortunately, very little is known about how the use of such approaches enhances the ability of team members to develop I/S that are responsive to changing business conditions.^ Drawing from predominant theories of organizational conflict, this study develops and tests a model of conflict among members of a development team. The model proposes that development approaches provide the relevant context conditioning the management and resolution of conflict in software development which, in turn, are crucial for the success of the development process.^ Empirical testing of the model was conducted using data collected through a combination of interviews with I/S executives and surveys of team members and business users at nine organizations. Results of path analysis provide support for the model's main prediction that integrative conflict management and distributive conflict management can contribute to I/S success by influencing differently the manifestation and resolution of conflict in software development. Further, analyses of variance indicate that object-oriented development, when compared to rapid and structured development, appears to produce the lowest levels of conflict management, conflict resolution, and I/S success.^ The proposed model and findings suggest academic implications for understanding the effects of different conflict management behaviors on software development outcomes, and practical implications for better managing the software development process, especially in user-oriented development environments. ^