RESUMEN
An increasing number of firms are aiming to implement closed-loop supply chain (CLSC) management to contribute to a more circular economy. However, for many of these firms, it is difficult to translate this strategic aim into fruitful operational decisions. They need to address many deep uncertainties and dynamic complexities in their supply chain system, which make their transition towards CLSC management challenging. This article aims to develop a better understanding of how supply chain actors taking steps towards CLSC management could be supported to reach higher levels of maturity in dealing with deep uncertainty and dynamic complexity. This is investigated in a single, facilitated, embedded case study: a future-oriented decision-making process regarding the use of timber with four real-world actors in the construction industry. The process is structured and supported with analyses, following a methodology based on the capability maturity approach. In this empirical context, the selected approach is shown to have positive effects on clarifying the potential impact of transitions to CLSC management. Furthermore, it stimulates important learning processes during the transition, and as such supports actors to achieve higher levels of maturity and to take further steps towards CLSC management. In this context, a conceptual distinction is made between 'situational maturity' and 'mental maturity', which enriches double-loop learning theory in the context of transitions.
RESUMEN
OBJECTIVE: Communication technologies, such as personal online health communities, are increasingly considered as a tool to realise patient empowerment. However, little is known about the actual use of online health communities. Here, we investigated if and how patients' use of online communities supports patient empowerment. SETTING: A network of primary and secondary care providers around individual patients with Parkinson's disease. PARTICIPANTS: We conducted case studies to examine our research question. We interviewed 18 patients with Parkinson's disease and observed the use of online health communities of 14 of them for an average of 1â year. PRIMARY OUTCOME MEASURES: We analysed the interviews and the online conversations between patients and healthcare providers, using Foucault's framework for studying power processes. RESULTS: We observed that patient empowerment is inhibited by implicit norms that exist within these communities around the number and content of postings. First, patients refrained from asking too many questions of their healthcare providers, but felt obliged to offer them regular updates. Second, patients scrutinised the content of their postings, being afraid to come across as complainers. Third, patients were cautious in making knowledge claims about their disease. CONCLUSIONS: Changing implicit norms within online communities and the societal context they exist in seems necessary to achieve greater patient empowerment. Possibilities for changing these norms might lie in open dialogue between patient and healthcare providers about expectations, revising the curriculum of medical education and redesigning personal online health communities to support two-way knowledge exchange.