Effect of facilitation of local maternal-and-newborn stakeholder groups on neonatal mortality : cluster-randomized controlled trial

BACKGROUND: Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. METHODS AND FINDINGS: In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]). CONCLUSIONS: A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44599712. Please see later in the article for the Editors' Summary.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

Conflict or consensus : an investigation of stakeholder concerns during the participation process of major infrastructure and construction projects in Hong Kong

Public participate in the planning and design of major public infrastructure and construction (PIC) projects is crucial to their success, as the interests of different stakeholders can be systematically captured and built into the finalised scheme. However, public participation may not always yield a mutually acceptable solution, especially when the interests of stakeholders are diverse and conflicting. Confrontations and disputes can arise unless the concerns or needs of the community are carefully analysed and addressed. The aim of the paper is to propose a systematic method of analysing stakeholder concerns relating to PIC projects by examining the degree of consensus and/or conflict involved. The results of a questionnaire survey and a series of interviews with different entities are provided, which indicate the existence of a significant divergence of views among stakeholder groups and that conflicts arise when there is a mismatch between peoples’ perception concerning money and happiness on the one hand and development and damages on the other. Policy and decision-makers should strive to resolve at least the majority of conflicts that arise throughout the lifecycle of major PIC projects so as to maximise their chance of success.

Unpacking the connections between network and stakeholder management and their application to road infrastructure networks in Queensland

Since the late twentieth century, there has been a shift away from delivery of infrastructure, including road networks, exclusively by the state. Subsequently, a range of alternative delivery models including governance networks have emerged. However, little is known about how connections between these networks and their stakeholders are created, managed or sustained. Using an analytical framework based on a synthesis of theories of network and stakeholder management, three cases in road infrastructure in Queensland, Australia are examined. The paper finds that although network management can be used to facilitate stakeholder engagement, such activities in the three cases are mainly focused within the core network of those most directly involved with delivery of the infrastructure often to the exclusion of other stakeholder groups.

Stakeholder service delivery expectations of military facilities management

Purpose – The purpose of this paper is to examine the quality of service of a South East Asian country's military facilities management organisation. Design/methodology/approach – An interview survey and questionnaire survey were used to obtain a description and summary of stakeholders’ expectations and the extent to which they were being satisfied by the services provided. Findings – The method provides a useful means of identifying and prioritising varying expectations between stakeholder groups and of indicating any mismatch in expectations in the management of military facilities. Social implications – The development and use of a method to test and improve the effectiveness and efficiency of the management of military facilities helps in providing better value for money. Originality/value – In addition to re-affirming Parasuraman's overall dimensions of service expectation, the empirical summary of the stakeholders’ expectations obtained in this way is of practical value for the service provider in developing a strategy for expectation management. For the case studied, it is also apparent that although the current processes in service delivery are well understood by all involved stakeholders, there is a need for further improvement with regards to their expectation levels. It is also one of the very few reported studies on the management of military facilities.

A framework of promoting stakeholder mutual benefits for sustainable housing implementation

Strong regulatory pressure and rising public awareness on environmental issues will continue to influence the market demand for sustainable housing for years to come. Despite this potential, the voluntary uptake rate of sustainable practices is not as high as expected within the new built housing industry. This is in contrast to the influx of emerging building technologies, new materials and innovative designs as showcased in office buildings and exemplar homes worldwide. One of the possible reasons for this under-performance is that key stakeholders such as developers, builders and consumers do not fully understand and appreciate the related challenges, risks and opportunities of pursuing sustainability. Therefore, in their professional and business activities, they may not be able to see the tangible and mutual benefits that sustainable housing may bring. This research investigates the multiple challenges to achieving benefits (CABs) from sustainable housing development, and links these factors to the characteristics of key stakeholders in the housing supply chain. It begins with a comparative survey study among seven stakeholder groups in the Australian housing industry, in order to examine the importance and interrelationships of CABs. In-depth interviews then further explore the survey findings with a focus on stakeholder diversity, which leads to the identification of 12 critical mutual-benefit factors and their interrelationship. Based on such a platform, a mutual-benefit framework is developed with the aid of Interpretive Structure Modelling, to identify the patterns of stakeholder benefit materialisation, suggest the priority of critical factors and provide related stakeholder-specific action guidelines for sustainable housing implementation. The study concludes with a case study of two real-life housing projects to test the application of the mutual-benefit framework for improvement. This framework will lead to a shared value of sustainability among stakeholders and improved stakeholder collaboration, which in turn help to break the "circle of blame" for the current under-performance of sustainable housing implementation.

Stakeholder pressures and climate change disclosure : Australian evidence

This paper investigates the stakeholder pressures behind corporate accountability and disclosures in relation to climate change. By means of a questionnaire survey, the study focuses on ascertaining the views of a sample of stakeholder groups such as government bodies, institutional investors, environmental NGOs, media accounting professionals, and researchers to examine their perceptions of pressures upon Australian corporations to be accountable in relation to climate change. Prior social and environmental research found that NGOs (Deegan and Blomquist, 2006; Tilt, 1994) and the media (Brown and Deegan, 1996; Islam and Deegan, 2010) were powerful stakeholder groups influencing corporate social and environmental disclosure practices. Our paper finds that along with NGOs and the media, institutional investors and regulators (governments) are equally important and powerful actors for applying pressure for corporate accountability in relation to climate change. Based on the findings of the paper, we would argue that climate change is an issue with no single stakeholder group involved, rather it is a set of stakeholder groups including regulators, institutional investors, the media, and NGOs who demand corporations to be accountable.

Stakeholder pressures on corporate climate change-related accountability and disclosures: Australian evidence

This study investigates stakeholder pressures on corporate climate change-related accountability and disclosure practices in Australia. While existing scholarship investigates stakeholder pressures on companies to discharge their broader accountability through general social and environmental disclosures, there is a lack of research investigating whether and how stakeholder pressures emerge to influence accountability and disclosure practices related to climate change. We surveyed various stakeholder groups to understand their concerns about climate change-related corporate accountability and disclosure practices. We present three primary findings: first, while NGOs and the media have some influence, institutional investors and government bodies (regulators) are perceived to be the most powerful stakeholders in generating climate change-related concern and coercive pressure on corporations to be accountable. Second, corporate climate change-related disclosures, as documented through the Carbon Disclosure Project (CDP), are positively associated with such perceived coercive pressures. Lastly, we find a positive correlation between the level of media attention to climate change and Australian corporate responses to the CDP. Our results indicate that corporations will not disclose climate change information until pressured by non-financial stakeholders. This suggests a larger role for non-financial actors than previously theorized, with several policy implications.

Evaluating the level of stakeholder involvement during the project planning processes of building projects

The purpose of this study is to examine the current level of stakeholder involvement during the project's planning process. Stakeholders often provide the needed resources and have the ability to control the interaction and resource flows in the network. They also ultimately have strong impact on an organisation's survival, and therefore appropriate management and involvement of key stakeholders should be an important part of any project management plan. A series of literature reviews was conducted to identify and categorise significant phases involved in the planning. For data collection, a questionnaire survey was designed and distributed amongst nearly 200 companies who were involved in the residential building sector in Australia. Results of the analysis demonstrate the engagement levels of the four stakeholder groups involved in the planning process and establish a basis for further stakeholder involvement improvement.

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: Stakeholder perspectives, barriers, supports, and incentives

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from "a good idea" to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes. © 2014 Morris et al.

Investigating stakeholder concerns during public participation

Developing major infrastructure and construction (MIC) projects is complicated, since it involves multifaceted policy issues. As a result, appropriate participatory mechanisms have been increasingly employed to improve the legitimacy of the project decision process. Yet it cannot always guarantee a mutually acceptable solution since the expectations and requirements of multiple stakeholders involved can be diverse and even conflicting. Overcoming this necessitates a thorough identification and careful analysis of the expectations of various stakeholder groups in MIC projects. On the other hand, though most project stakeholder concerns are consistent across the globe, contextual differences may lead to diverse priority levels being attached to these factors. This research, therefore, aimed to examine the perceptual differences between paired stakeholder groups from mainland China mega-cities and Hong Kong in rating their concerns over MIC projects. The research findings are expected to benefit both the Central Government of China and the Government of Hong Kong SAR for coping better with the rapid expansion of MIC projects in the territory and the increasing expectations of social equality, and therefore achieving the much desired harmonious development of the community.

The importance of stakeholder engagement in invasive species management: A cross-jurisdictional perspective in Ireland

The management of invasive non-native species is a frequent cause of conflict in the field of biodiversity conservation because perceptions of their costs and benefits differ among stakeholder groups. A lack of cohesion between scientific researchers, the commercial sector and policy makers lies at the root of a widespread failure to develop and implement sustainable management practices for invasive species. The crisis of this situation is intensified by drivers stemming from international conventions and directives to address invasive species issues. There are further direct conflicts between legislative instruments promoting biodiversity conservation on the one hand while liberalizing trade at the national, European and global level on the other. The island of Ireland provides graphic illustration of the importance of cross-jurisdictional approaches to biological invasions. Using primarily Irish examples in this review, we emphasize the importance of approaching risk assessment, risk reduction and control or eradication policies from a cost-efficient, highly flexible perspective, incorporating linkages between environmental, economic and social objectives. The need for consolidated policies between Northern Ireland and the Republic of Ireland is particularly acute, though few model cross-border mechanisms for such consolidation are available. The importance of engaging affected stakeholders through positive interactions is discussed with regard to reducing the currently fragmented nature of invasive species management between the two jurisdictions.

Northern Visions? Applying Q methodology to understand stakeholder views on the environmental and resource dimensions of sustainability

Q methodology was used to enable the identification of discourses among stakeholders to the environmental and resource dimensions of sustainability policies and to gain an understanding of the usefulness of Q methodology in informing sustainability policy development. The application of Q methodology has been useful in identifying shared discourses between different stakeholder groups, and providing insights into how stakeholders frame or understand policy issues; and recommendations are made for ongoing research priorities. These insights, in turn, informed the choice of scenarios for an in parallel process of policy evaluation using Ecological and Carbon Footprinting.

Identifying functional stakeholder clusters to maximise communication for the ecosystem approach to fisheries management

Interaction with ecological models can improve stakeholder participation in fisheries management. Problems exist in efficiently communicating outputs to stakeholders and an objective method of structuring stakeholder differences is lacking. This paper aims to inform the design of a multi-user communication interface for fisheries management by identifying functional stakeholder groups. Intuitive categorisation of stakeholders, derived from survey responses, is contrasted with an Evidence-Based method derived from analysis of stakeholder literature. Intuitive categorisation relies on interpretation and professional judgement when categorising stakeholders among conventional stakeholder groups. Evidence-Based categorisation quantitatively characterises each stakeholder with a vector of four management objective interest-strength values (Yield, Employment, Profit and Ecosystem Preservation). Survey respondents agreed little in forming intuitive groups and the groups were poorly defined and heterogeneous in interests. In contrast the Evidence-Based clusters were well defined and largely homogeneous, so more useful for identifying functional relations with model outputs. The categorisations lead to two different clusterings of stakeholders and suggest unhelpful stereotyping of stakeholders may occur with the Intuitive categorisation method. Stakeholder clusters based on literature-evidence show a high degree of common interests among clusters and is encouraging for those seeking to maximise dialogue and consensus forming. © 2013 Elsevier Ltd.

The changing university business model: a stakeholder perspective

Universities are in a current state of transition, whereby they are expected to develop a wide range of relationships with stakeholders in order to enhance regional innovation systems. However, despite external environmental pressures commonly regarded as one of the main drivers of business model evolution, there is a lack of studies that explore business model innovation as a result of multiple stakeholder influences. Accordingly, the aim of this paper is to examine the changing university business model within a region of the United Kingdom, using a stakeholder perspective that will aid theoretical development and refinement in both the business model and stakeholder fields. This examination is aided by consideration of the university business model as an activity system. Repeat interviews, combined with stakeholder theory, have been used to show how the changing university business model–stakeholder relationship has progressed through different stakeholder stages with resultant changes in content, structure and governance. Furthermore, conflicting objectives between each of the stakeholder groups (i.e. academics, industry liaison staff, technology transfer office staff and government support agency representatives) have led to the university business model evolving not as a process of co-creation but rather in a series of transitions whereby multiple stakeholders are continually shaping the university business model through strategies that are dependent upon their salience. Finally, this paper contributes to the development and refinement of business model innovation research, in that the use of stakeholder constructs can illustrate the impact of multiple stakeholders' power and influence on business model innovation.