INTRODUCTION Stakeholder management is used synonymously with stakeholder theory (Freeman, 1984, Jones, 1995, Donaldson and Preston, 1995, Mitchell, Agle and Wood, 1997, Ogden and Watson, 1999, Heugens and Van Oosterhout, 2002, Freeman, Harrison, Wicks, Parmar and De Colle, 2010), which is said to have originated (Dunham, Freeman and Liedtka, 2006), or at least gained momentum with “strategic management: a stakeholder approach” (Freeman, 1984). The contributions into stakeholder theory have aimed to develop or support labels for stakeholder identification (Sheehan and Ritchie, 2005), saliency (Agle, Mitchell and Sonnenfeld, 2000, Dansky and Gamm, 2004, Fernández and Antolín, 2004), wants and needs (Ogden and Watson, 1999), influences (Hendry, 2005, Smith and Fischbacher, 2005, Rowley, 1997, Minoja, 2012), measurement (Atkinson, Waterhouse and Wells, 1997, Neely, Adams and Kennerley, 2002), positioning (Rowley, 1997) and dynamics (Windsor, 2010). These studies have significantly contributed to the body of knowledge’s development and acceptance. However, there remains a dearth of literature that investigates managerial approaches toward stakeholder theory. That is, are there limitations as to when and how managers adopt these contributions? Stakeholder theory is premised on the management of relationships, in their various forms, with stakeholders (Lopez-de-pedro and Rimbau-Gilabert, 2012). Given this, it would seem reasonable to empirically examine i) the relationships that managers pursue and foster, ii) the mechanisms used to assist in their management, and iii) the relationships that managers (deliberately) do not form or fail at forming. To assist in this analysis, stakeholder relationships have been identified as being i) monadic (i.e. unilateral relationship between the focal firm and stakeholder), ii) dyadic (i.e. bilateral relationship between the focal firm and stakeholder) or iii) triadic (i.e. network or multidimensional relationship between the focal firm and stakeholders) in their nature. This project empirically researches stakeholder management approaches, across multiple stakeholder groups, in the Australian health industry. Two global medical device organisations and their stakeholders in regulators, government, hospitals, physicians, insurers and industry associations have contributed to and participated in this research project. The Australian health industry provides a data rich environment to research stakeholder theory due to its i) normative core, and ii) complex, litigious and regulated stakeholder environment.

RESEARCH OBJECTIVES The objectives of this empirical research project are: 1. To provide an interpretation of how and the extent to which managers have adopted the multiple and varied contributions to stakeholder theory; 2. To examine the managerial mechanisms used in stakeholder management; 3. To identify any limitations of how managers have adopted stakeholder (theory) management. RESEARCH SCOPE The scope of this research project is: 1. Semi-structured interviews with executive and senior management operating in Australia; 2. Semi-structured interviews with twenty-eight (28) executive and senior managers from within two global medical device manufacturers and from their stakeholder groups including hospitals, physicians, regulators, government, insurers and industry associations; 3. Each interview requiring up to one hour in duration. Whilst follow-up interviews were available, they were not required. RESEARCH METHODOLOGY Field-based case study (McKinnon, 1988, Ferreira and Merchant, 1992) and semi-structured (Rubin and Rubin, 1995) research methods, as an interpretive approach (Burton and Steane, 2004) informed this project to gain a depth of understanding across multiple research sites and management layers. Two global medical device manufacturers, who manage operations in Australia, and their managers were identified as suitable research sites / participants based on their perceived contribution to management decisions, direction of the firm and management of stakeholders (Flick, 2002, Creswell, 1998, Goulding, 2005). Stemming from the two focal firms for the research, an approach was also made directly to members of their stakeholder environment. This included representatives from Physicians, Hospitals, Government / Regulatory Bodies, Health Insurers and Industry Associations. Each semi-structured interview lasted up to one hour in duration. All interviews were recorded using a digital recording device, with the interviewee’s written consent, and transcripts produced that were then analysed using open, axial and selective coding via the constant comparison method (Goulding, 2005) and qualitative data analysis (QDA) (Parker and Roffey, 1997) Nvivo software. This analysis allowed for the transcripts to be studied as themes emerged. Each interviewee held an Executive (e.g. Non-Executive Board Director, Chief Executive Officer, Managing Director, Executive General Manager, Director) or Senior Management (e.g. General Manager, Head of, Senior Manager) position that numbered twenty-eight (28) interviewees, producing seventeen (17) hours of recording.

FINDINGS The term stakeholder management acted as a heuristic that ignited vibrant discourse of how critical it was for the successful achievement of managerial and organisational objectives. However, thirty (30) percent of managers stated that the term itself was poorly understood or used as a collective for referring to a range of individuals and organisations but adds little value. As one interviewee said “Maybe stakeholder is a little bit like strategy, it means something different to every single person…and unless you’re a student of strategy or a student of stakeholder management it’s gobbledegook and it’s meaningless.” (Interviewee 23) Monadic Managers will adopt a “monadic” approach toward stakeholder management for the purpose of managing and resolving actual or potential crises, issues, disputes and conflict. This approach provides for the development and issuance of communications, messaging and information to the stakeholder(s) raising, investigating or following an issue, dispute or conflict. The aim of these communications and messages is to i) defend against truths and untruths, ii) protect against loss of brand or reputational value, or iii) control the agenda. Whilst, by its very nature, the communications and messaging of this approach is monadic, stakeholder responses influence the continuance or variation to this approach. The monadic stakeholder relationship approach is typical in times of attack by competitors, industry associations, unions, media, government and regulators. As such, the adoption of this approach is typically limited to those managers who “manage” these stakeholders.

Figure 1: Monadic approach to stakeholder management Dyadic For the dyadic approach, stakeholder management is synonymous with supplier management, performance management, change management, relationship management, account management or project management. Each of these management disciplines aims at building rapport and relationships with a particular entity to manage the development and distribution of products and services, including the resources required to develop and distribute the same. Managers will adopt a “dyadic” approach toward stakeholder management for the purpose of managing their day-to-day business of bringing products and services to fruition. To achieve this, they will “engage” and “consult” through a series of meetings with resource providers where project / relationship / account / change / supplier / performance management methodologies and techniques will guide the relationship.

The relationship is limited to the pursuit, establishment and maintenance of the identified products and services. As such, this approach is limited to i) the stakeholders it identifies, ii) the duration of the relationship, and iii) the exchange of value between the focal firm and the stakeholder. Managers establish these relationships to foster project approvals / resources, supply chain processes and protocols, establishing supplier relationships and promotion to customer markets.

Figure 2: Dyadic approach to stakeholder management Triadic The triadic approach to stakeholder management is perhaps the most closely aligned with Freeman’s work but is the least quoted by managers. It is also suggested to be the least structured and formal within the organisation. Managers will seek a “triadic” approach toward stakeholder management for the purposes of achieving growth, diversification or market development strategies but in the absence of a rigorous and structured framework, they will adopt ad-hoc and inconsistent processes with less than desired success. Managers within the medical device focal firms highlighted an interesting dilemma. That is, they are unable to adopt a monadic (i.e. communications / marketing) approach toward achieving strategic objectives (i.e. market growth, diversification, change or entry) due to restrictive legislation, and ii) their dyadic relationships are largely restricted to colleagues, suppliers and regulators. Constituting one of the most significant limitations of stakeholder management, managers remained unsure as to how to use stakeholder theory to pursue strategic objectives. Having said this, there were isolated instances where managers recounted how they leveraged networks and stakeholder groups to achieve strategic objectives.

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