Multi-stakeholder engagement
In this chapter, multi-stakeholder engagement is described and the insights from the stakeholder workshops are presented. All the model regions also participated in an SDG Synergies workshop in Stockholm.
Multi-stakeholder consultations
Multi-stakeholder workshops were organised in the model regions – Agder, Päijät-Häme, Fjallabyggd and Tiohundra. The aim of these workshops was to understand the baseline of health care and care services including the opportunities and challenges in introducing digital healthcare solutions in the model regions and elaborate on the shared understanding of the sustainability impacts connected to these solutions. The Tandem framework was used to plan these workshops and structure the discussions. The Tandem framework is a tool for co-exploration and co-production (Daniels et al., 2019). The framework offers guidance for achieving the following goals:
- Improve the ways in which all participants work together to purposefully design transdisciplinary knowledge integration processes
- Co-explore the relevant needs, priorities and preferences for the co-production of integrated climate information (i.e. decision-relevant climate and non-climate data)
- Increase individual and institutional capacities, collaboration, communication and networks that can translate this data into climate-resilient decision-making and action
The insights from the multi-stakeholder workshops are varied, as shown in Table 1. However, there are some common aspects reported by most of the model regions.
In terms of opportunities for digitalised healthcare solutions, a reduction in travel distance and therefore also in greenhouse gas emissions was the issue that was raised the most. Access to information and the internet, the ability to manage new technological systems and concerns about privacy and data security were some of the most reported challenges for digitalised healthcare solutions. In terms of the needs and priorities of the model regions, the perspectives of different stakeholders, particularly users or clients, were emphasised by most of the model regions. Environmental, economic, social aspects were evident in what the participants from the model regions generally reported in terms of what sustainability means in their various projects and regions.
Table 4: Insights from multi-stakeholder workshops in the model regions
Model regions | Opportunities and challenges for distance health and care solutions | Project needs and priorities | What does sustainability look like in this landscape? | |
Opportunities | Challenges | |||
Agder region, Norway (in person, 17 January 2023) | - Reduced travel distance to hospitals and health centres. - Generous sharing culture. - Trust and high-quality standards. | - Difficulties investing in new technologies. - Information about the services is not adequately disseminated. - Staff in care centres/homes are required to have knowledge of a wide range of areas. - Concerns regarding privacy and data security. | - Perspectives of users/patients are needed. - Perspectives of politicians and other high-level government actors are needed. - Perspectives of technology designers are needed. | - Reduction in travel distance and greenhouse gas emissions. - Cost effectiveness of technologies. - Engagement of multiple stakeholders. |
Päijät-Häme wellbeing services county, Finland (online, 14 February 2023) | - Reduced workload (physical) connected with e-services. - Good communication between service providers and certain client groups. - Reduced travel distance to hospitals and health centres. - A digital leap is possible. - E-services are often more cost-effective than face-to-face services. - With e-services, clients can be more independent and serve themselves. | - Clients need guidance. - Increased requests for services from various clients lead to queuing and overcrowding. - The quality of the digital services provided varies. - Face to face meetings are needed to ascertain the overall well-being of clients. - Costs connected with equipment and connectivity may be a barrier for some clients. - The technical skills of some professionals and clients are a barrier. | - Different types of services are needed for different groups of clients. | - Occupational safety, health and general well-being of staff. - Attractiveness of workforce in home care services. |
Fjallabyggð Municipality, Iceland (online, 5 June 2023) | - New technology is being tried out to serve as a model for other municipalities. - Emphasis is on the integration of existing services rather than the creation of new services. | - There is a disconnect between the state and the municipality in the provision of healthcare and care services. | - Strengthen collaboration, sharing and learning between the healthcare and care sectors. | - Emphasis is on sustainable funding and consideration of the vulnerable segments of society e.g. the elderly. |
TioHundra Norrtälje, Sweden (in person, 17 May 2023) | - Reduced travel and the production of greenhouse gases. - Increased opportunity to serve more clients. - Reduced stress among service providers. - Opportunity to conduct several checks on patients at night. - Some patients, for example, those with dementia, feel safer with digital surveillance during the nighttime. | - Access to electricity and internet connectivity need to be reliable. - Shared responsibility in operating and managing the system – between patients or clients and service providers. - Surveillance cameras are currently only operational during the nighttime. | - Explore the possibilities of providing 24/7 monitoring of patients. - Gathering of good data during supervision is key to the continuous improvement of services. - Ensure that users in rural and urban settings have the same possibilities and experience of the system. | - Avoid unnecessary travel (reduce greenhouse gas emissions). - Create good working conditions. - Avoid accidents linked to driving. - Create good working conditions and retain staff. - Introduce and maintain cost- effective supervision of patients. |
SDG Synergies workshop
Following the multi-stakeholder workshop, the SDG Synergies workshop was held at the Stockholm Environment Institute (SEI) with representatives from all the model regions. The objective was to let the participants test the SDG Synergies approach, familiarise themselves with the type of insights it can generate and start to broaden their perspectives on the sustainability impacts of distance spanning healthcare solutions.
Photo 3. Instructions to the participants at the iHAC workshop at Stockholm Environment Institute.
The workshop followed the three standard steps of the SDG Synergies approach referred to in Box 1:
Step 1 - Contextualisation: The goals and targets (whether or not they are related to the 2030 Agenda) are selected and defined in order to set the boundary for the exercise in terms of its scope and identify the relevant stakeholders. This step was conducted ahead of the workshop.
For our exercise, the following distance spanning health solutions were included and presented to the participants:
- Use of medicine robot services: Medicine robot services can ensure that the user receives the correct medication at the right dose and at the right time. The user is notified via audio and light signals, as well as by information on the robot’s display, when it is time for them to take their medication. It can allow the user to become more independent with their medication, increase compliance with their medication and can also mean fewer staff journeys. The robot can also help to reduce problems regarding skills provision and streamline home care activities.
- Use of digital night monitoring: Digital night monitoring can replace potentially disruptive visits by night patrols to supervise elderly people. A surveillance camera and a mobile router are installed in the user’s home and allow for better matching to their unique needs compared to pre-scheduled visits. An assistant nurse at a central unit in the municipality performs online checks at specific times of night. The time required to conduct online checks is considerably less than physical visits.
- Use of smart video technology: Smart video technology is used as a tool to move care closer to the patient - from the hospital to the health centre and from the hospital/health centre to self-care. For example, it enables residents living in sparsely populated areas to meet a doctor remotely at their local health centre. A nurse examines the patient, takes samples, where applicable, and can contact the hospital’s on-call doctor who then talks with and examines the patient via a video link.
The following 7 SDGs were selected:
- SDG 3. Good health and well-being
- SDG 5. Gender equality
- SDG 6. Clean water and sanitation
- SDG 8. Decent work and economic growth
- SDG 10. Reduced inequalities
- SDG 12. Responsible consumption and production
- SDG 15. Life on land
19 experts participated in the workshop, representing all four regions and stakeholders as citizens, staff in health care and social services, researchers, digital service experts, change management consultants and managers.
Step 2 - Scoring interactions: The selected goals and solutions from step 1 had been transferred into a cross-impact matrix in the online SDG Synergies tool. The participants were divided into five groups in which they worked to assess a part of the matrix.
The tool guides participants through the matrix, asking them the guiding question for each interaction: “If progress is made towards Target X, how does this influence progress towards Target Y?” Participants referred to a scale ranging from +3: strongly promoting progress towards Target Y, via +2: moderately promoting, +1: weakly promoting, 0: no influence, -1: weakly restricting progress towards Target Y, -2: moderately restricting, to -3: strongly restricting (Weimer-Jehle 2006), and select a score based on their discussions. They were encouraged to add text to justify or further explain their selected score. An important feature of this step was that the participants focus on the direct influence between targets only, whereas the secondary effects are taken care of by the software of the SDG synergies tool. The SEI team was available throughout the group discussion to clarify questions and provide technical support.
Step 3 - Analysis: Following the scoring, the SEI team ran the network analysis to relate all interactions in the matrix and show the participants how progress towards the different goals could affect the whole system. Following the scoring, the participants had a joint discussion on the preliminary findings. Figure 10 shows the complete matrix with inputs from each group.
Figure 10: The cross-impact matrix collecting all scores. The colour codes are as follows (cf. Step 2 above in the process description): Red: -2, Pink: -1, White: 0, Light blue: +1, Blue: +2 and Green: +3. The row sums (11, 14, 8, etc.) show the first order influence of each goal on all other goals. The column sums (9, 7, 9, etc.) show how each goal is influenced by progress on all other goals (first order).
The participants discussed their respective strategies within their regions and with the other regions represented at the workshop. The task was to score how these strategies impacted the progress of the SDGs and to see where the interactions, synergies and trade-offs occur.
At first glance, the matrix shows more blue (positive) elements than red or yellow (negative) elements, suggesting that there were more synergies than trade-offs between the matrix elements. We can also see where critical trade-offs and strong synergies sit. Only seven trade-offs were identified but these merit discussion We also note that the matrix is relatively dense, i.e. there are few interactions that were assessed as non-existent (grey).
The numbers to the right of and below the matrix show the row sums and column sums, respectively. The row sums can be interpreted as an indication of a goal’s influence on all other goals. The column sums can be interpreted as an indication of how each goal is influenced by all other goals. For example, SDG 8 has the strongest positive influence overall, but also shows trade-offs with some goals.
Importantly, the row and column sums only include the direct effects between the goals, and to understand the impact of a goal we need to look more deeply into the network and include the secondary effects. For example, a goal that positively influences another goal which, in turn, has many and/or strong positive connections, can have significant systemic impact, whereas in contrast, the positive influence on a goal which, in turn, has a negative influence on many other goals, can be negative. A high number of strong positive connections to other goals with the same characteristics generate a high and positive multiplier effect, while a strong positive connection to a goal which, in turn, exerts a negative influence on other goals, generates a negative systemic impact. On the other hand, if the affected goal has few and/or weak positive connections, the positive effect quickly diminishes without having much systemic effect. Below we present the five highest ranking goals from three different perspectives.
Systemic impact. This ranking shows the five goals with the strongest positive systemic impact (secondary effects included). These goals can be seen as catalytic because promoting progress in them would have positive effects on the system as a whole.
- Decent work and economic growth (SDG 8)
- Dispensing robots
- Gender equality (SDG 5)
- Reduced inequalities (SDG 10)
- Video tech
Most supported goals. This ranking shows the goals that are most positively influenced by the progress made in other goals (secondary effects included). These goals may need less direct support to enable progress, as they benefit from the progress made in other goals.
- Good health and well-being (SDG 3)
- Decent work and economic growth (SDG 8)
- Reduced inequalities (SDG 10)
- Gender equality (SDG 5)
- Clean water and sanitation (SDG 6)
Least supported goals. This ranking shows the goals which are the least positively influenced by the overall progress. They may need extra support to enable progress, as they are not influenced by the progress made in other goals and can even be restricted as other goals progress.
- Responsible consumption and production (SDG 12)
- Life on land (SDG 15)
- Dispensing robots
- Night monitoring
- Video tech
Finally, the SDG Synergies tool can identify clusters of goals that are strongly interconnected. These clusters can be used to set up cross-sectoral (cross-goal) collaborations as they comprise goals that promote each other and therefore enable overall progress.