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. 2023 Oct 16;9(4):e001722. doi: 10.1136/bmjsem-2023-001722

Table 3.

Hierarchical representation of stakeholder groups and their responsibilities, which are the following: (1) interwoven responsibilities (self-identified responsibilities that appear to align with what is expected by others); (2) self-identified responsibilities (stand-alone) (additional self-identified responsibilities that are not reported as an expectation from others and thus not included as part of interwoven responsibilities) and (3) expected responsibilities (stand-alone) (additional responsibilities that others expect of a specific stakeholder but not identified by stakeholders themselves and thus not included as part of interwoven responsibilities) within the NZR community setting

Hierarchical level Responsibilities
Governing body NZR
Interwoven:
  1. Education

  2. Player welfare and safety

  3. Enforcing protocols

  4. Buy-in, attitudes and behaviours

Self-identified (stand-alone):
Develop and implement policy
Expected (stand-alone):
  1. Communication between stakeholders

  2. Resource provision and support

(2) Provincial unions, clubs and schools Provincial Union Representatives Schools Clubs
Interwoven:
Injury reporting and administration
Self-identified (stand-alone):
  1. Education

  2. Develop and implement policy

  3. Follow-up

  4. Communication between stakeholders

  5. Clearance

  6. Resource provision and support

  7. Enforcing protocols

  8. Buy-in, attitudes and behaviours

  9. Player welfare and safety

  10. Role multiplicity and task shifting


Expected (stand-alone):
No additional expected responsibilities
Interwoven:
  1. Communication between stakeholders

  2. Develop and implement policy


Self-identified (stand-alone):
Role multiplicity and task shifting
Expected (stand-alone):
  1. Concussion knowledge

  2. Player welfare and safety

  3. Authority and leadership

  4. Manage recovery process

  5. Injury reporting and administration

  6. First-aid knowledge

  7. Resource provision and support

  8. Buy-in, attitudes and behaviours

  9. Follow-up

  10. Log concussion

  11. Recognise

Interwoven:
  1. Enforcing protocols

  2. Resource provision and support

  3. Player welfare and safety

  4. Communication between stakeholders


Self-identified (stand-alone):
No additional self-identified responsibilities
Expected (stand-alone):
  1. Authority and leadership

  2. Manage recovery process

  3. Injury reporting and administration

  4. Buy-in, attitudes and behaviours

  5. Education

(3) Direct supervisors Coaches Parents Physiotherapists General practitioners*
Interwoven:
  1. Education

  2. Buy-in, attitudes and behaviours

  3. Authority and leadership

  4. Leadership and logistical management/coordination as part of acute incident

  5. Injury reporting and administration

  6. Communication between stakeholders

  7. Player welfare and safety

  8. Role multiplicity and task shifting

  9. Recognise

  10. Remove


Self-identified (stand-alone):
  1. Follow recovery protocol

  2. Manage recovery process

  3. Follow-up

  4. Enforcing protocols

  5. On-field support

  6. Seek diagnosis and treatment


Expected (stand-alone):
  1. Concussion knowledge

  2. Acute medical management

  3. Baseline testing

  4. First-aid knowledge

  5. Stop game

Interwoven:
  1. Concussion knowledge

  2. Player welfare and safety

  3. On-field support

  4. Recognise

  5. Buy-in, attitudes and behaviour


Self-identified (stand-alone):
  1. Education

  2. Communication between stakeholders

  3. Seek diagnosis and treatment

  4. Remove

  5. Resource provision and support

  6. Baseline testing


Expected (stand-alone):
  1. Enforcing protocols

  2. Injury reporting and administration

Expected:
  1. Manage the recovery process

  2. Leadership and logistical management/coordination as part of acute incident

  3. Recognise

  4. Acute medical management

  5. Clearance

  6. Follow recovery protocol

  7. Follow-up

  8. Concussion knowledge

  9. Player welfare and safety

  10. Authority and leadership

  11. Log concussion

  12. Enforcing protocols

  13. Buy-in, attitudes and behaviours

  14. Education

Expected:
  1. Diagnose

  2. Clearance

  3. Concussion knowledge

  4. Portal usage

  5. Manage the recovery process

  6. Follow-up

  7. Quality of care

  8. Authority and leadership

(4) Stakeholders involved in acute concussion incident and recovery phase Team leads Wider team Players Referees* Medics/undergraduate physiotherapy
Interwoven:
  1. Recognise

  2. Remove

  3. Manage the recovery process

  4. Follow-up

  5. Communication between stakeholders

  6. Buy-in, attitudes and behaviours


Self-identified (stand-alone):
  1. On-field support

  2. Acute medical management

  3. Seek diagnosis and treatment

  4. Role discomfort

  5. Leadership and logistical management/coordination as part of acute incident

  6. Role multiplicity and task shifting

  7. Education

  8. Baseline testing


Expected (stand-alone):
  1. First-aid knowledge

  2. Use of blue card

  3. Concussion knowledge

  4. Report injuries

  5. Authority and leadership

Interwoven:
  1. Player welfare and safety

  2. Buy-in, attitudes and behaviours

  3. Injury reporting and administration

  4. Communication between stakeholders


Self-identified (stand-alone):
Spot and recognise
Expected (stand-alone):
No additional expected responsibilities
Interwoven:
  1. Buy-in, attitudes and behaviours

  2. Player welfare and safety

  3. Remove

  4. Disclose


Self-identified (stand-alone):
  1. Injury reporting and administration

  2. Seek diagnosis and treatment

  3. Follow the recovery protocol

  4. Concussion knowledge

  5. Stop game


Expected (stand-alone):
No additional expected responsibilities
Expected:
  1. Recognise

  2. Leadership and logistical management/coordination as part of acute incident

  3. Stop game

  4. Remove

  5. Concussion knowledge

  6. First-aid knowledge

  7. Player welfare and safety

  8. Use blue card

  9. Acute medical management

  10. Authority and leadership

  11. Injury reporting and administration

  12. Buy-in, attitudes and behaviours

Expected
  1. Recognise

  2. Log concussion

  3. Concussion knowledge

  4. Leadership and logistical management/coordination as part of acute incident

  5. Acute medical management

*Stakeholder not interviewed.

NZR, New Zealand Rugby.