**1. Introduction**

In the modern operating environment of work, successful occupational health care requires collaboration, partnerships and alliances between various actors. The various actors with clear interests ('stakes') in the work and operations within a workplace are called stakeholders. The changing nature of workplaces is accelerating the needs for collaboration between various stakeholders.

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© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Some decades ago, the focus of occupational health care was either on a single illness or risk factor, or on changing a particular lifestyle habit or behaviour of individual employees. In countries like Finland, the development has clearly been towards a comprehensive approach in occupational health care, and thus the focus has been shifted towards active promotion of the work ability of individuals with an emphasis on structural developments [1]. In general, since the 1990s in many industrialized countries, occupational health care has been understood as more holistic and integrative by its nature [2].

Occupational health care can be understood today as the combined efforts of employers, employees and society to improve the health and well-being of people at work. This conceptual development has also meant that the number of actors in occupational health care has been increasing. Consequently, new types of collaboration between employees, employers and other actors in the field are required [1, 3]. The altering operational environment also requires new skills, such as networking skills, which are becoming essential for an effective occupational health care work [4].

Various stakeholders of occupational health care (e.g. employees, employers, shareholders and occupational healthcare providers) also have different key interests [5]. If their different interests are recognized and analysed, the operating environment of occupational health care can be improved. However, as the "Healthy workplaces: a model for action" by the WHO emphasizes, the various stakeholders in a workplace must work together in a collaborative manner [6].

The classic definition of a stakeholder according to Freeman is "an organization… [or] any group or individual who can affect or be affected by the achievement of the organization's objectives" [7]. While Freeman's groundbreaking book "Strategic Management: A Stakeholder Approach" in 1984 started the wider discussion and elaboration of stakeholders and their importance, an earlier concept of stakeholders had already emerged in the 1960s. In 1963, academics at the Stanford Research Institute stated that a firm also needs to be responsible – in addition to shareholders – to a number of stakeholders without whose support the organization would cease to exist [5]. Some scholars have even proposed that the roots of stakeholder thinking dates as far back as the 1930s [8].

The number of published titles in academic and professional literature about stakeholder management has grown rapidly since the 1980s. The main body of the stakeholder management literature still relates to the corporate environment, but the public sector [9] and the third sector [10] are becoming increasingly interested in the applications of stakeholder management as an element in their strategic management.

The concept of stakeholders and the potential for both convergent and competing issues in the corporate world have often been displayed through the consideration of corporate social responsibility and corporate ethics [10–12]. Some researchers argue that the fundamental concepts of stakeholder, stakeholder model, stakeholder management and stakeholder theory are explained by various authors in different ways and are supported or critiqued with diverse and often contradictory evidence and arguments [13].

The scientific literature concerning stakeholders in occupational health care is evolving, but still scarce, and there is an obvious lack of published research in this area [14]. The theme of stakeholders has been discussed in the context of national healthcare systems and healthcare organizations (see e.g. [15–18]). The importance of stakeholders and stakeholder positions for hospitals has also been discussed in the research literature (see e.g. [19, 20]). The importance of stakeholders in occupational health services has mainly been discussed in the context of the need for multiple stakeholder collaboration (see e.g. [21]), but a generic, structured approach to understand stakeholders and their positions in occupational health care is still covered only by few authors in the research literature.

Some decades ago, the focus of occupational health care was either on a single illness or risk factor, or on changing a particular lifestyle habit or behaviour of individual employees. In countries like Finland, the development has clearly been towards a comprehensive approach in occupational health care, and thus the focus has been shifted towards active promotion of the work ability of individuals with an emphasis on structural developments [1]. In general, since the 1990s in many industrialized countries, occupational health care has been under-

Occupational health care can be understood today as the combined efforts of employers, employees and society to improve the health and well-being of people at work. This conceptual development has also meant that the number of actors in occupational health care has been increasing. Consequently, new types of collaboration between employees, employers and other actors in the field are required [1, 3]. The altering operational environment also requires new skills, such as networking skills, which are becoming essential for an effective

Various stakeholders of occupational health care (e.g. employees, employers, shareholders and occupational healthcare providers) also have different key interests [5]. If their different interests are recognized and analysed, the operating environment of occupational health care can be improved. However, as the "Healthy workplaces: a model for action" by the WHO emphasizes, the various stakeholders in a workplace must work together in a collaborative manner [6].

The classic definition of a stakeholder according to Freeman is "an organization… [or] any group or individual who can affect or be affected by the achievement of the organization's objectives" [7]. While Freeman's groundbreaking book "Strategic Management: A Stakeholder Approach" in 1984 started the wider discussion and elaboration of stakeholders and their importance, an earlier concept of stakeholders had already emerged in the 1960s. In 1963, academics at the Stanford Research Institute stated that a firm also needs to be responsible – in addition to shareholders – to a number of stakeholders without whose support the organization would cease to exist [5]. Some scholars have even proposed that the roots of stakeholder

The number of published titles in academic and professional literature about stakeholder management has grown rapidly since the 1980s. The main body of the stakeholder management literature still relates to the corporate environment, but the public sector [9] and the third sector [10] are becoming increasingly interested in the applications of stakeholder man-

The concept of stakeholders and the potential for both convergent and competing issues in the corporate world have often been displayed through the consideration of corporate social responsibility and corporate ethics [10–12]. Some researchers argue that the fundamental concepts of stakeholder, stakeholder model, stakeholder management and stakeholder theory are explained by various authors in different ways and are supported or critiqued with diverse

The scientific literature concerning stakeholders in occupational health care is evolving, but still scarce, and there is an obvious lack of published research in this area [14]. The theme of

stood as more holistic and integrative by its nature [2].

occupational health care work [4].

26 Occupational Health

thinking dates as far back as the 1930s [8].

agement as an element in their strategic management.

and often contradictory evidence and arguments [13].

Understanding the stakeholders is essential also in the altering environment of value creation in occupational health care. In modern approach to occupational health care, the individuals (employees) of an organization are essential for the value creation. As the most important determinant of an individual's health is his or her own health behaviour, the different types of service can support an individual in co-creating better health [22]. Co-creation implies meaningful engagements of interaction, activities and exchange between collaborators [22]. The co-creation approach is valuable, as it emphasizes the critical role and the involvement of the users in the value creation, but also the various encounters with different actors.

The critical involvement of the users is described with the term 'value co-creation' and the value provision as a collaborative action between various actors and players is described with the term 'value co-production'. Joint actions of various entities can provide novel opportunities and avenues for various users. Value co-production as such is not a recent innovation; the recent innovation is to organize the value co-production systematically [23]. Effective occupational health care should utilize both modalities, as it needs both the strong involvement of various actors into value creation as well as well-organized collaboration between various actors to enable comprehensive service provision for the users of occupational health care [24].

The implications of co-production are also visible to occupational health care and its value creation. The value creation can take place in a more synchronous, less sequential manner by various actors. However, it also provides new opportunities to provide a comprehensive service provision for the users of occupational health care [23].

The altering operating environment of occupational health care, its novel challenges and new opportunities in value creation urge also the more in-depth knowledge and analysis of the various stakeholders.
