MAJOR STAKEHOLDERS IN

HEALTH CARE SYSTEM

PRESENTED BY
Maninder kaur
Msc[N] 1ST year
 HEALTH CARE SYSTEM

 The health care system intended to provide

services and resources for better health. This
system includes hospitals, clinics, health centers,
nursing homes and special health programme in
school, industry and community. Health system
operates in the context of socioeconomic and
political framework of the country.
 INTRODUCTION

 Stakeholder encompass a wide sector of

society, they include consumer or patients,
community health care professionals,
hospital health care professionals,
pharmacists non governmental
organizations, supplier etc.
 STAKEHOLDER

 Stakeholder is a person, group,

organization or system who affects and can
be affected by an organizational action.
 TYPES OF
STAKEHOLDERS

EXTERNAL INTERFACE INTERNAL

STAKEHOLDERS STAKEHOLDER STAKEHOLDER
EXTERNAL STAKEHOLDER
 A health care organization must respond
to large number of external stakeholders.
They fall into three categories in their
relationships to the organization.
 Those that provide inputs to organization
 Those that compete with it
 Those that have particular special interest
 Conti….
 The first category includes suppliers, patients and
financial community. The relationships between the
organization and these external stakeholders are a
symbiotic one, as organization depends on them for
its survival. In turn these stakeholders depend on
the organization to take their outputs. The
relationships between the organization and the
stakeholders that provide necessary input are one of
mutual dependence. As such the both two parties
cannot, or do not want to, do without one another.
 Conti…..

 The competitor stakeholder seeks to attract

the focal organization dependents. The
competitor may be direct competitor for
patients (e.g. other hospital) or they may be
competing for skilled personnel. Competitor
does not need one another to survive, while
co-operation between hospitals and their
competitor has increased in recent years.
 Conti…..
 External stakeholders in third category are special
interest group. These are the government regulatory
agencies, private accrediting association, professional
associations, labor union, the media and political
action group. Because of special interest conflict most
often occur. Compromise and, in some cases, overt
collaboration generally resolves the conflicts.
 INTERFACE STAKEHOLDERS

 Some stakeholders function on the interface between

the organization and its environment. The major
categories of interface stakeholders include the
medical staff, the hospital board of trustees. The
organization must provide sufficient inducements to
continue to make appropriate contribution. The
organization may offer professional autonomy
institutional prestige or political contacts, special
services and benefits etc.
 INTERNAL STAKEHOLDERS
 Internal stakeholders almost entirely within the
organization and typically include management,
professional and non professional staff. Management
attempts to provide internal stakeholders with sufficient
inducements to gain continual contribution from them.
The stakeholders determine whether the inducements
are sufficient for the contribution that they are required
to make partly on the basis of alternative contribution
offer received from competitive
 STAKEHOLDERS IN HEALTH
CARE SYSTEM
 GOVERNMENT
 PUBLIC
 PROVIDERS
 HOSPITAL ADMINISTRATOR AND
GOVERNING BOARDS
 NON GOVERNMENTAL
 The government
 The role of government in the administration of health care can
not be overestimated. Many federal government health care
efforts are headed by a cabinet-level officer, the secretary for
health and human services, who runs the department of health
and human services. The federal
government makes budget and other
planning related to expenditure
in health care. As the major payer,
the federal government has been
active in regulating the health care industry.
 cont…..
 Therefore, hospital have great incentive to comply with
regulations promulgated by federal government,
because they can be fined or “decertified” as a provider
of care to Medicare clients if they do not.
Noncompliance can results in the loss of lot of money &
income for the hospital. Government regulation is
frequently opposed by the health care industry because
it often affects the health care practitioner’s autonomy.
 THE PUBLIC
 The public has a stake in health care from several
perspectives. As consumers of health care
services or as patients, the public is concerned
with quality, cost and access to care. Many people
believe that health care is a right and should be
universally available to all citizens, regardless of
the cost. Paradoxically, however, most do not
want to pay these costs. Patients want
compassion as well as skill with clear
communication.
 Conti…..

 They expect an employer to offer a wide variety of option for

health coverage that can be customized to their specific needs.
They also look for the employs to fund the majority of cost of
health insurance. Overall, public values regarding health care are
changing. People are interested in receiving quality care at a
reasonable cost. In addition, the public has a more positive view of
health promotion and illness prevention than in past.. Health care
resources remain focused on illness, however, with only 1% of
health care expenditures going to public health.
 The providers

 Community health care professional

 Hospital health care professional

 HOSPITAL HEALTH CARE
PROFESSIONAL
 Physicians: The role of physicians in the health care
system is important one. Physicians provide direct
medical services to clients in variety of settings,
including offices, clinics, hospitals and freestanding
centers. In addition, physician control 60% to 70% of
hospital costs through their decisions regarding the use
of resources. Physicians decide which client to admit,
where to admit, the length of stay, the ancillary
services, whether to perform surgery, when to initiate
and to discontinue treatment regimens, and which
medications to prescribe.
 Nurses:
 An individual who provides care to clients. The extent
of participation varies from simple patient care tasks to
the most expert professional technique necessary in
acute life threatening situations. The ability of nurse to
function independently and making self directed
judgment will depends on his or her professional
development. Nurses provide a unique perspective on
the health care system. The greatest impact and the
most frequently discussed aspect of nursing has been
the recurring shortage of nurses.
 Pharmacists:

The roles of the pharmacist are changing.

Some can now prescribe as well as
dispense medicine. They are more
interested in meeting the requirements of
pharmaceutical industry.
 Hospital administrators and
governing boards

 The chief executive, chief financial officer, chief

nursing officer, and governing boards of
hospitals strongly influence health care delivery
in their institutions. In addition most hospitals
are members of some association which
represents the industry’s efforts to influence
legislation, regulation, judicial decisions, and
health policy.
 Non governmental
stakeholders
 The voluntary agencies occupy an important place in
community health care system. These organizations
directly or indirectly act as stakeholder. These
organizations are administered by autonomous boards
which hold meetings, collect funds from private sources
and spend money for providing health services and
health education to individual, family and Community.
There are many NGO’S in India which serves to society.
Some of these organizations are given below:
 Indian Red Cross Society

 It was established in 1920 and has

over 400 branches all over India. It
has been executing programme for
the prevention of diseases and
promotion of health. Its activities are:
 Relief work
 Milk and medical supplies
 Armed forces
 Maternal and child welfare services
 Family planning
 Blood bank and first aid
 Hindu Kusht Nivaran
Sangh
 It was founded in 1950 with its headquarters in New
Delhi. Its precursor was the Indian council of British
Empire Leprosy Relief Association (B.E.L.R.A) which was
renamed as LEPRA in 1950. The programme of work of
the sangh include rendering of financial assistance to
various leprosy homes and clinics, health education,
training of medical worker and physiotherapists
conducting research and field investigation. The Sangh
has branches all over India and work in close cooperation
with the Government and other voluntary agencies.
 Indian council for child
welfare
 It was establish in 1952. It is affiliated with
international union for child welfare. The services of
I.C.C.W are devoted to secure for Indian children
those “opportunities and facilities, by law and other
means” which are necessary to enable them to develop
physically, mentally, morally, spiritually and socially in
a healthy and normal manner and in conditions of
freedom and dignity.
 Tuberculosis Association
of India
It was formed in 1939. It has branches in all
states of India. The activities of this
association comprise organizing T.B
campaign every year to raise funds, training
of doctors, health visitors and social workers
in antituberculosis work, promotion of health
education conferences.
 Bharat Sevak Samaj

The Bharat Sevak Samaj which is non-political

and nonofficial organization was formed in
1952.One of the prime objective of the Bharat
sevak is to help people to achieve health by
their own actions and efforts. The B.S.S. has
branches in all the states and nearly all the
districts. Improvement of sanitation is one of
the important activities of the B.S.S.
The Kastubra Memorial
Fund
Created in commemoration of Kastubra
Gandhi, after her death in 1994, the fund was
raised with the main objective of improving
the status of women, especially in the
villages, through gram-savikas. The trust has
nearly one crore of rupees and is actively
engaged in various welfare projects in the
country.
 All India Women’s
Conference
It is the only women’s welfare
organization in the country. Established in
1962, it has now branches all over the
country. Most of branches running M.C.H.
clinics, Medical centers, and adult
education centers, milk centers and family
planning clinics.
 The All India Blind Relief
Society

It was established in 1946 with a

view to coordinate different institutions
working for the blind. It organizes eye
relief camps and other measures for the
relief of the blind.
 Professional bodies

The Indian Medical Association, All India Dental

Association, The Trained Nurses Association Of India of all
men and women who are qualified in their respective
specialties and possess registerable qualifications. These
professional bodies conduct annual conferences, publish
journals, arrange exhibitions, foster research, set up standards
of professional education and organize relief camps during
periods of natural calamities.
 MANAGEMENT OF STAKEHOLDERS
RELATIONSHIP

 The stakeholder relationships can be

managed by following certain steps.
These are given below:
 Diagnose
each Classify each
stakeholder
stakeholder
relationship
Identify type
of

stakeholder
Formulate

generic
Evaluate the strategies
effectiveness
of strategies Implement

strategies for

each
stakeholder
 Diagnose of stakeholder relationship

 Stakeholder potential for threat.

 Stakeholder potential for co-operation.

 Stakeholder potential for threat

 A health care organization’s manager needs to

anticipate and evaluate systematically the actual
or potential threats in its relationship with
stakeholder. These threats may focus on
obtaining inducements from the organization that
may or may not be provided. The desired
inducement may include financial resource,
participation in decision making.
 Conti….
 Stakeholder power and its relevance for any
particular cause confronting the organizations
manager determine the stakeholder’s potential
for threat. Power is primary a function of the
dependence of the organization on
stakeholder. Generally, the more dependent
the organization, the more power full the
stakeholder.
 Stakeholder’s potential for
cooperation

 The stakeholder’s dependence on the

organization and its relevance for any
particular issue facing the organization
determine the stakeholder’s co-operative
potential. Generally the more dependent
the stakeholder on the organization, the
higher the potential for co-operation.
 Types of stakeholder
relationship

 Mixed blessing stakeholder relationship

 Supportive stakeholder relationship
 Non supportive stakeholder relationship
 Marginal stakeholder relationship
 Stakeholder’s Potential to threaten the
Organization
High

High

Stakeholder’s The mixed The supportive Low

Potential to blessing Relationship
Cooperative
With the
Relationship
organization

The non The marginal

supportive Relationship
Relationship
Low
 Type 1
 With the mixed blessing stakeholder relationship’s the
health care executive faces a situation in which the
stakeholder rank high on both type of potential: threat and
co-operation. Physicians-hospital relationships probably are
the clear example of this type of relationship. Although
physicians can and do provide many services that benefit
hospitals, physicians also can threaten hospital because of
their general control over admissions, the utilization and
provision of different services, and the quality of care.
 Type 2
 The ideal stakeholder relationship is one that
supports the organization’s goals and actions.
Managers wish all their relationships were of this
type, such a stakeholder is low on potential
threat but high on potential co-operation for e.g.
the relationships of well managed hospital with
its board of trustees, its manager, its staff
employees, local community and nursing homes.
 Type 3
 The most distressing stakeholder relationship for
an organization and its manager’s are non
supportive ones. They are high on potential for
threat but low on potential for co-operation.
Typical non supportive relationships for hospitals
include competing hospitals, employee unions,
the federal government, other govt. regulatory
agencies the news media.
 Type 4

 The marginal stakeholder relationships

are high on neither threatening nor co-
operative potential. This type of
relationships include professional
associations for employees, volunteer
groups in community etc, for a well run
hospital.
 Stakeholder’s potential to reduce stakeholder threat
High Low

High Collaborate Involve trustingly

cautiously in mixed in supportive
Stakeholder’s blessing relationship
Potential relationship
To
Enhance
Stakeholder Defend proactively Monitor efficiently
Cooperation
in non supportive in the marginal
relationship relationship
low
 Collaborate cautiously in the mixed
blessing relationship

 The best way to manage the mixed

blessing relationship, high on the
dimensions of both potential threat &
potential co-operation may be cautious
collaboration. The goal of strategy is to
turn mixed blessing relationship into
supportive relationships.
 Involve trustingly in the
supportive relationship
 As the supportive stakeholder poses a low
potential for threat, they are mostly ignored by
organization. However for maximizing the co-
operation from this type of stakeholder, the
health care executives can delegate authority to
manager, involve in decision making and other
plans. With this the manager will more likely to
committed to achieve organizational objective.
 Defend proactively in the non
supportive relationship
 Stakeholder relationship with high threatening
potential, but low co-operative potential is best
managed by a proactive defensive strategy.
Relationships with the federal govt. and indigent
patients are non supportive stakeholder relationship for
most health care organization. In stakeholder terms, a
defensive strategy involves proactively preventing the
stakeholder from imposing cost or other disincentives
on the organization.
 Monitor efficiently in the marginal
relationship:
 Monitoring helps to manage this
marginal relationship in which the
potential for both threat and co-
operation is low. The marginal
relationships are unstable; they can
move into any one of the other three
types of relationships.
 STRATEGY IMPLEMENTATION
AND OUTCOME

 The fifth step of management of

stakeholder relationship is implementation
of planned and articulated strategies. With
conscious, consistent relationship and
implementation of strategies, a quite fully
organized health care system can be
developed.