Read the articles posted in the "Readings" folder on Blackboard about Wicked Problems. How do Wicked Problems relate to the triple bottom line and is it realistic for consumers to expect a triple bottom line (profit/environmental wellbeing/social responsibility) from the companies they do business with? Why or why not?It's a discussion so it should be around 15-20 lines
RESEARCH Open Access Tackling wicked problems in infection prevention and control: a guideline for co-creation with stakeholders Anne F. G. van Woezik1*, Louise M. A. Braakman-Jansen1, Olga Kulyk1, Liseth Siemons1 and Julia E. W. C. van Gemert-Pijnen1,2 Abstract Background: Infection prevention and control can be seen as a wicked public health problem as there is no consensus regarding problem definition and solution, multiple stakeholders with different needs and values are involved, and there is no clear end-point of the problem-solving process. Co-creation with stakeholders has been proposed as a suitable strategy to tackle wicked problems, yet little information and no clear step-by-step guide exist on how to do this. The objectives of this study were to develop a guideline to assist developers in tackling wicked problems using co-creation with stakeholders, and to apply this guideline to practice with an example case in the field of infection prevention and control. Methods: A mixed-method approach consisting of the integration of both quantitative and qualitative research was used. Relevant stakeholders from the veterinary, human health, and public health sectors were identified using a literature scan, expert recommendations, and snowball sampling. The stakeholder salience approach was used to select key stakeholders based on 3 attributes: power, legitimacy, and urgency. Key values of stakeholders (N = 20) were derived by qualitative semi-structured interviews and quantitatively weighted and prioritized using an online survey. Results: Our method showed that stakeholder identification and analysis are prerequisites for understanding the complex stakeholder network that characterizes wicked problems. A total of 73 stakeholders were identified of which 36 were selected as potential key stakeholders, and only one was seen as a definite stakeholder. In addition, deriving key stakeholder values is a necessity to gain insights into different problem definitions, solutions and needs stakeholders have regarding the wicked problem. Based on the methods used, we developed a step-by-step guideline for co-creation with stakeholders when tackling wicked problems. Conclusions: The mixed-methods guideline presented here provides a systematic, transparent method to identify, analyze, and co-create with stakeholders, and to recognize and prioritize their values, problem definitions, and solutions in the context of wicked problems. This guideline consists of a general framework and although it was applied in an eHealth context, may be relevant outside of eHealth as well. Keywords: eHealth, Guideline, One health, Stakeholder, Wicked problem, Zoonosis * Correspondence: a.f.g.vanwoezik@utwente.nl 1Center for eHealth and Wellbeing Research; Department of Psychology, Health and Technology. Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands Full list of author information is available at the end of the article © 2016 van Woezik et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. van Woezik et al. Antimicrobial Resistance and Infection Control (2016) 5:20 DOI 10.1186/s13756-016-0119-2 http://crossmark.crossref.org/dialog/?doi=10.1186/s13756-016-0119-2&domain=pdf mailto:a.f.g.vanwoezik@utwente.nl http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/publicdomain/zero/1.0/ Background In today’s society of human dominance, international travel, urban crowding, and other human behaviors asso- ciated with distorting ecological balance in the world, infection prevention and control can be seen as a societal challenge, a multifaceted problem, and an outright ‘wicked problem’ [1]. Wicked problems were first described by Rittel and Webber as a category of public policy problems that, in contrast to ‘tame problems’, are difficult to be clearly defined, are influenced by complex social and polit- ical factors, and are never solved [2]. The authors outline ten distinguishing characteristics of wicked problems, of which three are particularly applicable to infection prevention and control [2–4]: 1 No consensus regarding the problem definition. No exhaustive problem formulation can be given, as an understanding of the problem is based on the under- standing of the solutions to the problem. Because there are often many different solutions to a wicked problem, there are also many different problem definitions that can be formulated. 2 Involvement of multiple, often independent stake- holders. Wicked problems are characterized by many different stakeholders with a stake in the problem, often with different or even conflicting views on what the problems and solutions are. As a result, there is a high risk for conflict. It is impossible to please everyone and trade-offs are necessary to somehow address the needs of those involved. 3 No clear cut “stopping rule”. As there is no clear problem definition and no clear solution, there are also no criteria to evaluate whether a solution has been found. This in turn makes it unclear when efforts to tackle wicked problems can be ceased. What is a job well done to one group of stakeholders can be an unacceptable progression according to others. It is likely that efforts will be terminated because of external issues such as a lack of time or money. Wicked problems, in our view, are continuous, dynamic problems that require multi-dimensional, flexible solu- tions. Wicked problem solutions involve compromises between competing values, call for a multidisciplinary approach, and depend on collaboration between those parties involved [5]. Considering the fact that stakeholders have different views on the problem and its solution [2, 4], stakeholders will have different important insights to contribute. According to stakeholder theory, an organization is at the center of a network of stakeholders, with stakeholder being defined as ‘any group or individual who can affect or is affected by the achievement of the organization’s objectives’ (p. 46) [6]. Translated to the context of wicked problems, this implies that scientists working towards tackling these kind of problems have to take the relevant stakeholders in the existing stakeholder network into account, as unsupportive, uninvolved, and even hostile stakeholders can hinder sustainable implementa- tion of the research project [7, 8]. In the context of eHealth development, the importance of involving stake- holders in research projects is becoming more and more evident [7–12]. In our research, several eHealth inter- ventions have been conducted in the field of infection prevention and antibiotic stewardship, with findings suggesting promising effects of stakeholder involvement in the development of these projects, but further appli- cation of their methods and validation of their findings is needed [11, 12]. In a co-creation approach, researchers view stakeholders as active contributors of value and collaborate with them not only in the implementation phase but also in the design phase [11], thereby gene- rating positive effects such as increased stakeholder commitment to and ownership of the project [10, 13]. Although the benefits of co-creating with stakeholders are clear, working with stakeholders comes with several challenges that need to be overcome, such as working with different values and priorities and investing a con- siderable amount of time in building relationships [14]. Although the need to involve stakeholders when tack- ling wicked problems is clear, the required approach and methodology to do so are not. Even though many different techniques exist to identify stakeholders and to assign im- portance to them [8, 15], there is little information and no clear step-by-step guide available on how to co-create with stakeholders successfully. Especially in the field of wicked problems, very few studies have been conducted with stakeholders. Signal and colleagues did use a stakeholder- driven approach, but do not elaborate in detail on how they did this and how others could do the same [16]. Van Limburg et al. [12] were to our knowledge the first who proposed a guideline on how to involve and co-create with stakeholders. However, a limitation to this framework is that it is only demonstrated in one example case. Further validation of its generic use as a complete framework for other projects, particularly in the context of wicked prob- lems, is warranted. Example case: zoonoses prevention and control The majority (60.3 %) of all emerging and re-emerging infectious diseases are zoonotic in nature [17]. A zoonotic infection is an infection that can be transmitted by animals to humans [18]. Zoonoses control and prevention are wicked problems as they fit the three characteristics of wicked problems (no consensus regarding a problem definition, involvement of multiple stakeholders, and no stopping rule) [2, 4]. In addition, they (A) have econom- ical, sociological and political implications [19, 20], (B) consist of a complex stakeholder network comprising of many stakeholders from different sectors across different van Woezik et al. Antimicrobial Resistance and Infection Control (2016) 5:20 Page 2 of 12 hierarchical levels (from local veterinarians to governmental decision makers) with strongly held different or even opposing views, and (C) harbor an implementation context which is a dynamic field in which new initia- tives start rapidly alongside each other which generates competition. The World Health Organization recognized that interdisciplinary collaboration between different sec- tors involved (including veterinary, human and public health) is essential [19], which is in line with the global “One Health approach” that emphasizes interdisciplinary collaboration and communication in order to prevent and control zoonoses [21]. However, in reality a lack of collab- oration between these three sectors, uncertainties about their respective tasks and responsibilities for risk commu- nication, and poor knowledge of the general public about zoonoses negatively affect current risk communication strategies in the Netherlands [22]. In order to help tackle the wicked problem of zoonoses prevention and control in the Netherlands, we are in- volved in the development of an online platform in line with the One Health approach, called the “eZoon” platform. The aims of the platform are to support collaboration and risk communication on non-alimentary zoonoses between the veterinary, human health, and public health sectors in the Netherlands. eZoon will be an online information-, education- and communication plat- form aimed at the general public and professionals work- ing in these three sectors. Although the exact content and design of the platform are yet to be co-created with stake- holders and end-users, the platform will include a smart Question and Answer system aimed at informing the general public about zoonoses and a serious game to educate professionals on communication and collabor- ation. By involving stakeholders and attending to their needs, we tackle the three characteristics associated with wicked problems by 1) finding out what different stake- holders see as problems with and solutions to the preven- tion and control of zoonoses, 2) attending to stakeholder needs in order to increase cooperativeness, and 3) finding out what stakeholders see as solutions in order to identify when efforts can be ceased. The aim of this paper is twofold. With it often being difficult to develop suitable strategies, solutions or inno- vations in the complex context of wicked problems like infection prevention and control and no guidance currently exist, our first objective