**4. Analysing key positions of stakeholders**

#### **4.1. Researching stakeholders**

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 practitio-

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

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 impor-

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

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

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

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 solu-

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

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 occupa-

buyers, users and payers might be separate entities with disparate interests [51].

ners and occupational health physicians is often lacking or sub-optimal [41].

engagement to the provision and development of occupational health care [47].

tant accelerator for occupational health care (see e.g. [48]).

programs distract attention from workplace health hazards [14].

to mental health challenges for employees (see e.g. [14]).

tion-oriented co-operation for all parties involved [50].

eventual pension expenses [49].

tional health care (see e.g. [52]).

**3.4. External stakeholders**

32 Occupational Health

After the thorough identification on key stakeholders, it is essential to understand their key positions, arguments and interests in occupational health care work.

It is necessary to recall that the function of time is also an important issue to consider in stakeholder analysis, as stakeholder interests may converge over time. Stakeholder positions are not, however, static. Rather it is clear that stakeholder positions change and evolve over time [10].

A variety of methods can be used to map the opinions and positions of various stakeholders. Recommendable methods include face-to-face interviews using checklists, semi-structured interviews and structured questionnaires, which all can be used to collect data from primary sources [26]. Secondary methods could include analysis of published and unpublished documents, policy statements and various regulations [26]. An effective method can also be the utilization of focus groups, which might also be venues for development of novel ideas and tackling complex issues (see e.g. [54]). During the planning phase of stakeholder analysis, the strengths and weaknesses as well as the resource requirements of various methods should be clarified [54].

During a Finnish case study of stakeholder positions in workplace health promotion, 45–60 min long semi-structured, thematic interviews undertaken by two researchers was the main method used. The interviews were chosen as a key information collection method, as they also enabled the capturing of detailed knowledge, potential clarifications and the amplification of earlier questions [14].

## **4.2. Mapping and assessing stakeholder positions**

The wide literature of stakeholder analysis provides many different examples of matrices, charts, position maps, network maps and other figures to present the data analysed and collected [26]. For the purposes of this article, two tools are used to illustrate the stakeholder positions. These are the division to primary and secondary stakeholders, and the power/influence matrix. These tools should be seen as complementary to each other.

According to the well-known definition of Clarkson, the "primary stakeholder group is one without whose continuing participation the corporation cannot survive as going concern" [31]. Furthermore, the "secondary stakeholder groups are defined as those who influence or affect, or are influenced or affected by, the corporation, but they are not engaged in transactions with the corporation and are not essential for its survival" [31].

In the context of occupational health care, the classification into primary and secondary stakeholders shows the fundamental understanding of an organization of the key target groups of its occupational health care work, and which stakeholders it needs to take into consideration in fulfilling the objectives of its occupational health care work. Thus the primary stakeholders are the elementary groups to work with and the secondary stakeholders are necessary and required supporting groups.

A simplified visualization is to present the primary and secondary stakeholders of occupational health care in a two-column table which also includes short commentaries of their importance (see **Table 1**).


**Table 1.** Classification to primary and secondary stakeholders.

However, the classification to primary and secondary stakeholders does not yet indicate the relative power, influence or interest of the stakeholders – this can be achieved by undertaking an evaluation of the power and interest of the various stakeholders. This is usually visualized with a power/interest matrix showing the assessment of the organization of the contemporary importance of the various stakeholders regarding occupational health care.

#### **4.3. Power and interest of stakeholders**

The implementation and development of effective occupational health care within an organization requires support from several key stakeholders. Thus it is also important to assess their relative power and influence. This is undertaken by reporting the stakeholder positions or power and influence, which can also be visualized as a power/interest matrix.

In the power/interest matrix there are two important sets of questions to be assessed. According to the classification proposed by Johnson and Scholes, the question "If we were to pursue this strategy with disregard to the views of this particular stakeholder, could/would they stop it?" assesses the power of the stakeholder. The interests of the stakeholder is assessed with the questions "How high is this approach on their priorities?" and "Are they likely to actively support or oppose this approach, or will their interest be short-lived?" [32].

affect, or are influenced or affected by, the corporation, but they are not engaged in transac-

In the context of occupational health care, the classification into primary and secondary stakeholders shows the fundamental understanding of an organization of the key target groups of its occupational health care work, and which stakeholders it needs to take into consideration in fulfilling the objectives of its occupational health care work. Thus the primary stakeholders are the elementary groups to work with and the secondary stakeholders are necessary and

A simplified visualization is to present the primary and secondary stakeholders of occupational health care in a two-column table which also includes short commentaries of their

However, the classification to primary and secondary stakeholders does not yet indicate the relative power, influence or interest of the stakeholders – this can be achieved by undertaking an evaluation of the power and interest of the various stakeholders. This is usually visualized with a power/interest matrix showing the assessment of the organization of the contemporary

The implementation and development of effective occupational health care within an organization requires support from several key stakeholders. Thus it is also important to assess their relative power and influence. This is undertaken by reporting the stakeholder positions

In the power/interest matrix there are two important sets of questions to be assessed. According to the classification proposed by Johnson and Scholes, the question "If we were to pursue this strategy with disregard to the views of this particular stakeholder, could/would they stop it?" assesses the power of the stakeholder. The interests of the stakeholder is assessed with

importance of the various stakeholders regarding occupational health care.

or power and influence, which can also be visualized as a power/interest matrix.

**4.3. Power and interest of stakeholders**

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

**Primary stakeholders Secondary stakeholders**

Stakeholder A Stakeholder G - rationale 1 - rationale 11 - rationale 2 - rationale 12 Stakeholder B Stakeholder H - rationale 3 - rationale 13 - rationale 4 - rationale 14 Stakeholder C Stakeholder I - rationale 5 - rationale 15


**Table 1.** Classification to primary and secondary stakeholders.

required supporting groups.

34 Occupational Health

importance (see **Table 1**).

The power dimension indicates the level of influence a stakeholder has in either supporting or resisting a strategic initiative. Stakeholders may exercise their power in many ways, for example through a legal position, possession of knowledge and key resources or even informal networking with other decision makers. The interest dimension depends on how high a priority this strategy is. Interests can be open or hidden, which makes their assessment challenging. Interests may be based on a stakeholder's anticipated economic gain, brand value or power position. The level of interest can be estimated by assessing whether a stakeholder has a long-term commitment to the strategy [32].

In a recent Finnish case study on stakeholder views on workplace health promotion, the researchers asked the 17 interviewees to describe their position among the stakeholders and also to assess the other stakeholders and their relative power and interest (see **Table 2**). The interviewees were asked to present arguments about the power and of the interest of the other


**Table 2.** Example of a Finnish study of stakeholder positions of workplace health promotion – a modified excerpt (applied from [14]).

stakeholders and these were summarized. Based on the interviews, the researchers assessed each stakeholder identified in the stakeholder typology according to their power and interest using a three-grade score (high, medium and low) [14]. This score was also used in building a power/interest matrix.

The results of the power/interest matrix can also be summarized as a two-dimensional powerinterest matrix (see **Table 3**). Stakeholders in the upper right corner (high/medium power and interest) are the key players in driving the change towards effective occupational health care (see also e.g. [14]).

## **5. Developing stakeholder strategies**

The comprehensive stakeholder analysis is an important tool in identifying, planning and implementing strategies for managing stakeholder relationships and identifying current and future opportunities and threats (see e.g. [26]).

The results of the work of stakeholder analysis presented in the power/interest matrix are valid for establishing guidelines with regards for the work with various stakeholders (see **Table 4**). Naturally it should be understood that such a classification can only give rough guidance, as in every case the stakeholders vary from another in their activity, involvement and energy. However, such a simplified classification can ensure that all the stakeholders are regarded and that no identified stakeholder groups are left unnoticed.

**Table 4.** Power **/** interest matrix and strategies according to stakeholders.

stakeholders and these were summarized. Based on the interviews, the researchers assessed each stakeholder identified in the stakeholder typology according to their power and interest using a three-grade score (high, medium and low) [14]. This score was also used in building

The results of the power/interest matrix can also be summarized as a two-dimensional powerinterest matrix (see **Table 3**). Stakeholders in the upper right corner (high/medium power and interest) are the key players in driving the change towards effective occupational health care

The comprehensive stakeholder analysis is an important tool in identifying, planning and implementing strategies for managing stakeholder relationships and identifying current and

The results of the work of stakeholder analysis presented in the power/interest matrix are valid for establishing guidelines with regards for the work with various stakeholders

a power/interest matrix.

**5. Developing stakeholder strategies**

Table 3. Power / interest matrix.

future opportunities and threats (see e.g. [26]).

(see also e.g. [14]).

36 Occupational Health

It is obvious that not much effort should be directed on stakeholders with little power and a low level of interest. It is good to note their presence, but no particular actions are needed for them.

The needs of stakeholders with low power, but high or medium interest should be addressed mainly through continuous, selected information distribution. Gaining the support of these stakeholders through lobbying can be a good tactic, because they can be valuable allies in influencing the attitudes of other, more powerful stakeholders (see e.g. [55]).

Stakeholders with high or medium power, but low interest, are often difficult to plan with and to develop consistent strategies. These stakeholders might, in general, be quite passive, but might unexpectedly exercise their power in reaction to a particular event or policy. Under-estimation of this group can have disastrous consequences for the adoption of the new approach. These stakeholders should be kept satisfied through continuous communication, and possibly also through selected involvement to focal activities.

Stakeholders in the middle of the power/interest matrix with relatively high power and interest should be encouraged for a solid and continuous support of the work and activities undertaken. These stakeholders can be valuable resources and also provide required support to plan and initiate new ideas.

The most important stakeholders, who are crucial to the success of any strategic development in occupational health care, are the ones with high power and with high interest. These might also be stakeholders, whose opinions and views need to be discussed and elaborated, as their views can also differ and vary.

One recommended method in occupational health care development is to utilize steering groups, which should include key stakeholders, and thus also include key agents for the work to be planned and undertaken. A comprehensive study of organization-level occupational health interventions concluded that the use of steering groups for projects was unanimously recommended by different developers [34].

Another recommended method is having for occupational health care clearly an owner within an organization, who also keeps up the communication with selected stakeholders. It is counterproductive to involve the stakeholders at the start of an activity and after that leave them out of the communication loop. Many studies confirm that active communication with different parties is an essential success factor for occupational health care activities (see e.g. [34]).

Furthermore, it should be noted that the level and intensity for participation to the work and development of occupational health care within one stakeholder group may vary significantly. For instance, all the individuals within an organization might not share the same ambitions and do not assess the value of workplace health promotion in a similar manner. Thus when developing strategies for stakeholder participation, it is also important to understand that the range of participation can be wide from passive participation to self-directed activities and work.
