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Background: Over recent years, the exposure of people and assets to disasters has been faster than reducing vulnerability in all countries. As a result, new risks have been formed and losses due to disaster are progressively increasing. Suffering from significant losses in the aftermath of disasters every year, Iran is no exception. Governmental and non-governmental stakeholders are jointly responsible for managing the risks of disasters. Hence, appropriate, collaborative and timely interactions of involved organizations will play an important role in their operation, especially during disasters. Methods: In this study, we used the Social Network Analysis (SNA) to analyze the network of stakeholders in disaster risk management in Iran. Our review of literature, laws, and regulations of disaster risk management plus brainstorming identified a list of 85 stakeholders. We used the Delphi method among purposefully selected experts to score the relationship between the stakeholders. We then used the modularity optimization method to identify groups with greater interaction. Organizations with key-roles in the network and the ones in need of stronger relationships were identified through centrality measurements. Results: The density of this network was 0.75, which represented that not all the stakeholders were connected. Among all organizations identified, the National Disaster Management Organization and Civil Defense Organization showed higher influences considering their responsibilities. Conclusion: To provide a visual and tangible picture of the status and interrelationships among the stakeholders, this method identified groups with better interaction using community/cluster detection and modularity optimization methods. Understanding the current structure of the network and strengths and weaknesses of the interactions among stakeholders may help improve disaster risk management in Iran. Results of this research determine the role and importance of different organizations, their weakness, and strong points. Also, results help them to plan to strengthen their roles and solve their problems.

Background: Stakeholders are responsible for managing the risks of disasters. Hence, appropriate, collaborative, timely interactions of involved organizations, and having a collective view of these interactions, have an important influence on the operation of the whole system. This study was aimed at social network analysis (SNA) for the implementation of the Sendai framework for disaster risk reduction in Iran. Methods: SNA was used in this study. A review of literature on disaster risk management (DRM) plus snowball sampling technique identified a list of 85 stakeholders. Delphi method among purposefully selected experts was used to score the relationship between the stakeholders. Louvain method, along with the modularity optimization method, was applied to identify groups of stakeholders with greater interactions. Centrality measurements were used to define organizations with key-roles in the network. Results: The density of this network was 0.75, which showed that not all the stakeholders were connected. The National Disaster Management Organization and Civil Defense Organization showed higher influences considering their responsibilities. A total of 3 clusters of stakeholders with specific duties that mostly interact with each other and have some interaction with other groups were recognized. Conclusion: Understanding the pre-disaster interaction of the network and the strengths and weaknesses of the interactions among stakeholders could help improve DRM.

Introduction/purpose of presentationFar-reaching policy commitments to information technology-centered transformations of healthcare systems have now been made in many countries. There is as yet little empirical evidence to justify such decisions, hence the need for rigorous independent evaluation of current implementation efforts. Such evaluations however pose a number of important challenges. This presentation has been designed as a part of a Panel based on our experience of evaluating the National Health Service’s (NHS) implementation of electronic health records (EHR) systems in hospitals throughout England. We discuss the methodological challenges encountered in planning and undertaking an evaluation of a program of this scale and reflect on why and how we adapted our evaluation approach—both conceptually and methodologically—in response to these challenges.Study design/population studiedCritical reflections on a multi-disciplinary and multi-facet independent evaluation of a national program to implement electronic health record systems into 12 ‘early wave’ NHS hospitals in England.FindingsOur initial plan was to employ a mixed methods longitudinal ‘before-during-after’ study design. We however found this unsustainable in the light of fluxes in policy, contractual issues and over-optimistic schedules for EHR deployments. More importantly, this research design failed adequately to address the core of multi-faceted evolving EHRs as understood by key stakeholders and as worked out in their distinct work settings. Thus conventional outcomes-centric evaluations may not easily scale-up when evaluating transformational programs and may indeed prove misleading. New assumptions concerning the implementation process of EHR need to be developed that recognize the constantly changing milieu of policy, product, projects and professions that are inherent to such national implementations. The approaches we subsequently developed substitute the positivist view that EHR initiatives are self-evident and self-contained interventions, which are amenable to traditional quantitative evaluations, to one that focuses on how they are understood by various stakeholders and made to work in specific contexts. These assumptions recast the role of evaluation towards an approach that explores and interprets processes of socio-technical change that surround EHR implementation and adoption as seen by multiple stakeholders.Conclusions and policy implicationsThere is likely to be an increase in politically-driven national programs of reform of healthcare based on information and communication technologies. Programs on such a scale are inherently complex with extended temporalities and extensive and dynamic sets of stakeholders. They are, in short, different and pose new evaluation challenges that previously formulated evaluation methods for health information systems cannot easily address. This calls for methodological innovation amongst research teams and their supporting bodies. We argue that evaluation of such system-wide transformation pro...