Abstract
Decisions on health-related risks affect many people personally. The public debate on hospital planning is therefore especially emotional and conflict-ridden. Due to the aging population and the high costs of constantly improving medical care, the question arises in many German rural areas as to which hospitals can be kept and developed further and which ones should be closed. The new approach of the present state government of Baden-Württemberg in Germany, in collaboration with the University of Stuttgart and the State Health Office Baden-Württemberg, is to apply citizen participation to prepare this type of decision. The design of this type of public participation process is based on the criteria of mediation (including open decision-making scope, opportunity for discussion in the protected context of the working group, as well as disclosure of all information and transparency of the results toward the public). This approach has proven useful for conducting dialogs in areas with potential conflict. Based on the experiences from this hospital participation process, further recommendations for an effective, efficient and fair participation processes could be derived. The case demonstrates that adequate and structured involvement processes are capable of delivering sustainably acceptable results even in difficult decision-making processes.
Similar content being viewed by others
References
Arnstein S (1969) A ladder of citizen participation. J Am Inst Plan 35:216–224. doi:10.1080/01944366908977225
Balme R (2009) Why public participation? Representative government beyond technocracy. In: Balme R (ed) Public participation: policy and practice in Europe. Law Press, Beijing
Beierle C, Cayford J (2002) Democracy in practice: public participation in environmental decisions. RFF Press, Washington
Böttcher S, Gans B, Hammacher P, Wachinger G, Wolsing N (2011) Thesen des Bundesverbandes Mediation, Fachgruppe Planen und Bauen, zur Ausgestaltung von Planungsverfahren durch Bürgermitwirkung. Spektrum der Mediation 42:9–11
Brody S, Godschalk D, Burby R (2003) Mandating citizen participation in plan making. Six strategic planning choices. APA J 69:3. doi:10.1080/01944360308978018
Fleischer J, Pettgrew R (2002) Quality and implementation of agreements: are products of environmental public policy conflict resolution and consensus-building efforts being implemented? Association for Conflict Resolution Environmental and Public Policy Section critical issues papers. Distributed at the Portland, Oregon meeting in May of 2004
Haug C (2012) Assembly publics and the problem of hegemony in consensus decision-making. http://www.opendemocracy.net/christoph-haug/assembly-publics-and-problem-of-hegemony-in-consensus-decision-making. Accessed 7 March 2014
Hien E (2014) Mehr Bürgerbeteiligung – weniger Demokratie? F.A.Z. Frankfurter Allgemeine Zeitung 24.01.2014:7
Irvin R, Stansbury J (2004) Citizen participation in decision making: is it worth the effort? Public Adm Rev 64(1):55–64. doi:10.1111/j.1540-6210.2004.00346.x
Landesgesundheitsamt Baden-Württemberg (2013) Zukunftsplan Gesundheit. Pilotgesundheitsdialog Landkreis Calw. http://www.gesundheitsamt-bw.de/SiteCollectionDocuments/20_Netzw_Sonstige/Gesundheitsdialog%20Calw.pdf. Accessed 7 March 2014
Ministerium für Arbeit und Sozialordnung, Familie, Frauen und Senioren Baden-Württemberg (2013) 2. Bürgerdialog am 21. September 2013. http://www.sm.baden-wuerttemberg.de/de/2_Buergerdialog_am_21_September_2013/301928.html?referer=293689&_min=_sm. Accessed 7 March 2014
National Research Council (2008) Public participation in environmental assessment and decision making. The National Academies Press, Washington, DC
Owen H (2008) Open space technology. a user’s guide. Berret-Koehler, San Francisco
Paton D (2008) Risk communication and natural hazard mitigation: how trust influences its effectiveness. Int J Glob Environ Issues 8(1/2):2–15. doi:10.1504/IJGENVI.2008.017256
Renn O (2008) Risk governance. Coping with uncertainty in a complex world. Earthscan, London
Renn O, Webler T, Wiedemann P (1995) A need for discourse on citizen participation. Objectives of the book. In: Renn O, Webler T, Wiedemann P (eds) Fairness and competence in citizen participation. Evaluating models for environmental discourse. Kluwer, Dordrecht, pp 1–16
Renn O, Wachinger G, Kinn U, Altendorf-Bayha U (2011) Lessons learned aus Stuttgart 21 – Bürgermitwirkung bei Planungs- und Bauprojekten. Spektrum der Mediation 42:4–8
Siegrist M, Cvetkovich G (2000) Perception of hazards: the role of social trust and knowledge. Risk Anal 20(5):713–719. doi:10.1111/0272-4332.205064
Stanghellini L, Collentine D (2008) Stakeholder discourse and water management—implementation of the participatory model CATCH in a Northern Italian alpine sub-catchment. Hydrol Earth Syst Sci 12:317–331
Terpstra T (2009) Flood preparedness: thoughts, feelings and intentions of the Dutch public. Thesis, University of Twente
Wachinger G, Renn O, Kinn U, Altendorf-Bayha U (2011) Gestaltung der Bürgermitwirkung in Kommunen. Die Gemeinde/Zeitschrift für Städte und Gemeinden/Organ des Gemeindetags Baden-Württemberg. BWGZ 21:851–854
Wachinger G, Begg C, Renn O, Kuhlicke C (2013) The risk perception paradox—implications for governance and communication of natural hazards. Risk Anal 33(6):1049–1065
Wachinger G, Hilpert J, Renn O (2014) Nationalpark Nordschwarzwald. In: DIALOGIK (ed) Innovativ und partizipativ: Einblicke in die Arbeit von DIALOGIK. Stuttgarter Beiträge zur Risiko- und Nachhaltigkeitsforschung
Acknowledgments
The authors wish to thank Landrat Helmut Riegger, Dr. Frank Wiehe, and Dr. Joachim Wetzig (Calw county administration) not only for the possibility to conduct such an innovative process in a real-life situation, but also for their extraordinary support in openly discussing, conceptualizing and organizing the entire participation process. The contributions by the author of the appraisal, Dr. Jörg Risse, GÖK consulting AG (figures 4–7) are gratefully acknowledged. We thank all mediators and facilitators for their cooperation, Dr. Joachim Wetzig for his photographs and Wadim Dick for preparing figures 8-12. This study was financed by the Ministry of Labor and Social Affairs, Families, Women and Senior Citizens of the state of Baden-Württemberg, Germany. The second citizen forum was financed by the Calw county.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wachinger, G., Renn, O., Wist, SK. et al. Using participation to create resilience: how to involve citizens in designing a hospital system?. Environ Syst Decis 34, 208–223 (2014). https://doi.org/10.1007/s10669-014-9502-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10669-014-9502-9