**3. Identification of key stakeholders**

#### **3.1. Classification of various stakeholders**

intentions, inter-relations and interests. Furthermore, such analysis is beneficial in the assessment of the influence and resources stakeholders bring to bear on the decision-making or the

Stakeholder analysis is the essential tool to be used in stakeholder management. Stakeholder management is an approach to strategic management of an organization, which emphasizes the crucial role of different stakeholders in the success of the operations of an organization [7, 27]. Stakeholder analysis and stakeholder management are of particular importance to public and non-profit organizations, which have more diverse groups of stakeholders than private

Although stakeholder analysis is an important building block in stakeholder management, stakeholder analysis itself can make a significant contribution as a research method and as a means of organizational change [28]. Thus stakeholder analysis presents its own, independent and intrinsic value even if an organization is not implementing a thorough stakeholder

'Stakeholder analysis' is not a clearly defined analysis technique; rather it includes an array of various techniques. Bryson has identified and presented 15 stakeholder identification and analysis techniques [9]. In this article, the stakeholder analysis is described to include the fol-

Auvinen et al. used a similar approach in mapping and analysing the positions of Finnish

The first stage is to identify the key stakeholders. In the stakeholder literature, the definition of the 'wide sense of stakeholders' and the 'narrow sense of stakeholders' is an essential element (see e.g. [29, 30]). The 'narrow sense of stakeholders' limits the scope of stakeholders to groups or individuals who can affect the achievement of an organization's objectives or who are affected by the achievement of an organization's objectives; the 'wide sense of stakeholders' widens the scope of stakeholders to identifiable groups or individuals on which the organizations is dependent for its continued survival [29]. In this article, the wide sense of a stakeholder was applied, and thus the stakeholders were defined as all those who have a legitimate interest (either direct or indirect) in occupational health care and its

The following stage is to classify the stakeholders as either primary or secondary stakeholders [9, 31]. According to Clarkson's widely used definition, the primary stakeholder groups are ones without whose continuing participation the corporation cannot survive as a going concern. Furthermore, the secondary stakeholder groups are those who influence or affect, or are influenced or affected by, the organization, but they are not engaged in transactions with

implementation process [26].

28 Occupational Health

for-profit organizations [9].

management approach.

lowing key stages:

activities.


stakeholders in workplace health promotion [14].

the corporation and are not essential for its survival [31].


Comparative studies have shown that one success factor of occupational health interventions in organizations is the establishment and working of steering groups involving key stakeholders [34].

The effective stakeholder work requires also the recognition of the different roles of different stakeholders. Stakeholders differ according to their resources. In organizational contexts, where stakeholders are active, knowledgeable and inter-dependent, success is dependent on active, practical stakeholder relationship management [35, 36].

The diversity of the stakeholders has led to various classification structures. In this article, the starting point is the model developed by Fottler et al. for the stakeholders of hospitals. Their classification included three layers: internal stakeholders, interface stakeholders and external stakeholders [19].

It is generally understood, that in healthcare organizations the primary stakeholders are the patients [37]. Innovative pharmaceutical companies, such as Novo Nordisk in their diabetes drug development, have also placed the user in the middle of their stakeholder chart [10] (see **Figure 1**).

Another key internal stakeholder group is the management of an organization. The management includes senior management, line management and human resources management (HRM). All these groups and their collaboration are essential for successful occupational health care [34, 38, 39].

**Figure 1.** Key stakeholders of occupational healthcare (modified with permission from [14]).

The interface stakeholders are the occupational health-service providers, who provide their services to organizations and also take part in the development of occupational health care [40]. In addition, the public healthcare providers can also be seen as interface stakeholders (see e.g. [41]).

The external stakeholders consist of all the other important stakeholders, such as government and governmental agencies, trade unions, employers' unions, pension funds, municipalities, technology providers and service providers. Furthermore, other external stakeholders also, such as customers and suppliers of an organization as well as shareholders and competitors can be regarded as external stakeholders of occupational health care.

#### **3.2. Internal stakeholders**

The key rationale of occupational health care is to provide a safe working environment for the individuals and also to promote their health and well-being (see e.g. [6, 12, 34]). In this article the key stakeholder is an individual (employee) working in an organization, and thus they are in the centre of the stakeholder chart.

Various studies on occupational health care show that strong participation of the employees and utilization of participatory principles in the occupational health care interventions are critical success factors (see e.g. [34]). The wide variation in the health conditions of the individuals poses challenges to occupational health care activities in the workplace. For instance, disparities in living habits (including nutritional habits, exercising habits etc.) are wide within working age population in many countries and also within workplaces. It is also notable that these disparities are also partially linked to the socio-economic status of the individual, and thus are also out of the reach of the mandate of occupational health care.

Within the work environment, the occupational health care actions can also be supported by peer groups – in particular, in workplace health promotion (see e.g. [42]) – which can also be considered as important internal stakeholders.

The managers of an organization play an important role in occupational health care. Their decisions of policy guidelines, resource allocations as well as daily management define the destiny of occupational health care activities. Thus various managers must be regarded as major internal stakeholders (see e.g. [39]). For instance, a Canadian study showed that general managers and human resource managers differed in their attitudes and ambitions regarding workplace health promotion [43]. It is important to regard several managers, who have different roles in an organization, of different management levels as important internal stakeholders of occupational health care.

Senior management support for occupational health care has been seen in many studies as a critical success factor (see e.g. [34]). Recent comparative study showed, that there is considerable evidence of the negative impact of senior management support to occupational health care interventions, but less evidence about the positive impact of the management support component of intervention processes [34].

The middle managers are the actual key drivers of occupational health care work and thus their role is imperative within an organization (see e.g. [34, 38, 44]). The middle managers are the drivers of change also in this area, but they can also block important processes within a workplace [34].

Human Resources Management (HRM) is supporting both senior management and middle managers, and their support for the occupational health care activities for managers in formulating goals and implementing action plans are considerable [38, 45].

## **3.3. Intermediate stakeholders**

The interface stakeholders are the occupational health-service providers, who provide their services to organizations and also take part in the development of occupational health care [40]. In addition, the public healthcare providers can also be seen as interface stakeholders

The external stakeholders consist of all the other important stakeholders, such as government and governmental agencies, trade unions, employers' unions, pension funds, municipalities, technology providers and service providers. Furthermore, other external stakeholders also, such as customers and suppliers of an organization as well as shareholders and competitors

The key rationale of occupational health care is to provide a safe working environment for the individuals and also to promote their health and well-being (see e.g. [6, 12, 34]). In this article the key stakeholder is an individual (employee) working in an organization, and thus they are

Various studies on occupational health care show that strong participation of the employees and utilization of participatory principles in the occupational health care interventions are critical success factors (see e.g. [34]). The wide variation in the health conditions of the individuals poses challenges to occupational health care activities in the workplace. For instance, disparities in living habits (including nutritional habits, exercising habits etc.) are wide within

can be regarded as external stakeholders of occupational health care.

**Figure 1.** Key stakeholders of occupational healthcare (modified with permission from [14]).

(see e.g. [41]).

30 Occupational Health

**3.2. Internal stakeholders**

in the centre of the stakeholder chart.

The essential intermediate stakeholders for occupational health care can be defined to be occupational health services (OHS) providers and generic public healthcare providers.

The contemporary requirements for OHS providers are multifaceted ranging from health promotion of individuals to the development of the working environment (see e.g. [40]). It is also obvious that many employers do not have sufficient knowledge of occupational health care [40], and thus the OHS service providers can be strategically also an important partner in developing the working environment of an organization. The benefits of such a strategic partnership also require a lengthy and open process of collaboration between an employer and an OHS provider.

It is also critical to regard public health care service providers as important stakeholders of occupational health care, as there exist important differences in scope and options for various interventions between public health and workplace health contexts [46]. Although a country might have a well-working public health system, the organizations are willing to develop and widen their occupational health care activities (see e.g. [43]). Understanding the potential and services of public health care can also focus on the occupational health services more effectively. Unfortunately, according to some studies, the cooperation between general practitioners and occupational health physicians is often lacking or sub-optimal [41].

#### **3.4. External stakeholders**

The legislative framework of the occupational health care has been developing during the last decades in most industrialized countries. The legal requirements create the necessary framework for occupational health care, and they are elementary in encouraging the employer engagement to the provision and development of occupational health care [47].

The development of the legislative framework, laws and regulations can also be initiated by international global organizations (such as the WHO or ILO, see e.g. [6]). For member states of the European Union, the policy and regulation development within the EU can be an important accelerator for occupational health care (see e.g. [48]).

Trade unions are important stakeholders, as they represent the interests of employees in an organization (see e.g. [12]). Furthermore, the interests of trade unions with regard to occupational health care can have a different emphasis from those of employers. Trade unions have an important role in improving workplace conditions. In a recent Finnish study on stakeholder positions of occupational health care, trade unions seem to fear that health promotion programs distract attention from workplace health hazards [14].

The organizations and conglomerates of employers have clearly understood the challenges in occupational health care, and they also understand the value of joint development actions to tackle common problems, such as increasing absenteeism and rising trend of problems linked to mental health challenges for employees (see e.g. [14]).

Pension funds are also important stakeholders in occupational health care. They do have an incentive to prevent disability and early retirement, since they have to pay a large part of the eventual pension expenses [49].

Social insurance agencies and other public authorities can benefit from well-organized and systematic cooperation between organizations, OHS providers and social insurance offices. A Swedish study showed the clear financial and operational benefits of systematic and solution-oriented co-operation for all parties involved [50].

Developers of new technological solutions for occupational health care can be interesting stakeholders, as they can provide novel solutions e.g. for workplace health promotion (see e.g. [22]). However, the challenges in such new technologies and services can often be, that the buyers, users and payers might be separate entities with disparate interests [51].

The role of researchers and developers of occupational health care can also be important for organizations. In some countries, like Finland, there are specialized research institutes for occupational health care [14]. The close collaboration between research institutions, universities and companies can be essential in developing novel solutions and methods for occupational health care (see e.g. [52]).

A wide range of various external stakeholders are pushing organizations to improve their work and respond in more responsible ways to contemporary challenges (see e.g. [53]). Thus important occupational health care stakeholders are also the suppliers, customers and competitors of an organization. Well-organized occupational health care can be an important element of the image of an organization, as it competes of its customers as well as of highlyskilled professional workforce [12, 23].
