Published on March 7, 2014
CLASS PRESENTATION ON MAJORSTAKE HOLDERS IN HEALTH CARE DELIVERY SYSTEM PRESENTER: Mandeep Kaur M.Sc.1st Year Roll no. 1
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.
DEFINITION A stakeholder is a party that can affect or can be affected by the actions of the business as a whole.
DEFINITION Stakeholder is a person, group, or ganization or system who affects and can be affected by an organizational action.
DEFINITION Stakeholders are those entities in the organization’s environment that play a role in an organization’s health and performance or that are affected by an organizational action.
TYPES OF STAKEHOLDERS According to involvement People who will be affected by an enterprise & can influence it but who are not directly involved with doing the work. In private sector, people who are affected by any action taken by any organization or group. Example parents, children, custo mers, owners and suppliers’ people that are related or located
According to availability Primary Stakeholders: The primary stakeholders are those that are engaged in economic transactions with the business. Examples: stockholders, customer s & employers.
Contd….. Secondary Stakeholders: The secondary stakeholders are those who are although do not engage in direct economic exchange business but are affected by or can affect. Example general public, communities, a ctivist, business support groups & media.
According to position/work According to position or work the stakeholders can be divided into three and these are: • External stakeholders • Interface stakeholders • Internal stakeholders
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.
Those that provide inputs to organization: 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 are one of mutual dependence.
Those that compete with it: 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.
Those that have particular special interest: 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 competitors.
STAKEHOLDERS IN HEALTH CARE SYSTEM • GOVERNMENT • PUBLIC • PROVIDERS • HOSPITAL ADMINISTRATOR AND GOVERNING BOARDS • NON GOVERNMENTAL
GOVERNMENT 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.
At central level: Stakeholders at central level are Cabinet minister & Secretary for Health & Human services who runs the Department of health & Human services. The functions are: • Ensuring high levels of executive management performance. • Ensuring quality of patient care. • Ensuring financial health of the organization. • Assuming responsibility for itself (for its efficient and effective performance).
Contd.... •Formulating policy to guide decision making and action. •Making decisions, either by retaining authority with respect to its responsibilities or by delegating this authority to others. •Performing oversight by monitoring decisions and actions to make sure they are in compliance with policies.
At state level: At state level, state health directorate is responsible for administering health care services & regulating the health care delivery system. The functions are: Integrating health care services. During integration the state level administrators may have to overcome many of barriers in integration of health services such as insufficient understanding about changing environment and issues affecting health care organizations , ambiguity about roles, responsibilities, relationships, accountabilities, lack of readiness for change etc. Availability of medical facilities. Plan health programmes & drawing policies in providing health care. Provision of medicines.
At district level: The district level stakeholder in health care delivery system is deputy commissioner, MLAs of the area, civil surgeons, senior medical officers & district public health nurse.
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. 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. People are interested in receiving quality care at a reasonable cost.
THE PROVIDERS • Community health care professional • Hospital health care professional
HOSPITAL HEALTH CARE PROFESSIONAL: Physicians: 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.
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.
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 dissolved in 1950. The 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 anti tuberculosis 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 in villages is one of the important activities of the B.S.S. The Kastubra Memorial Fund: Created in the memory 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 gramsavikas. 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 voluntary 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.
BUSINESS & INDUSTRY: As health care costs increased in mid of 1990, the influence of business industry increased as well. Health insurance programmes are launched mainly through benefit programme. As the cost of health care increases, insurances costs increases as well, forcing business to assume greater financial burden to insure employee & their dependents as well. Cost for product increases accordingly.
TYPES OF STAKEHOLDER RELATIONSHIP • Mixed blessing stakeholder relationship • Supportive stakeholder relationship • Non supportive stakeholder relationship • Marginal stakeholder relationship
Mixed blessing stakeholder relationship: 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.
Supportive stakeholder relationship: 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.
Non supportive stakeholder relationship: 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.
Marginal stakeholder relationship: 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.
STEPS IN THE MANAGEMENT OF STAKEHOLDERS: diagnose each stakeholder identify type of stakeholder implement strategies and evaluate classify each stakeholder relationship formulate generic strategies
TYPE Identify type of stakeholder: Identify the major stakeholder and recognizes the function depicted to them.
Diagnose each stakeholder relationship: 1. Stakeholder potential for threat 2. Stakeholder potential for co-operation
Classify each stakeholder relationship Mixed blessing stakeholder relationship. Supportive stakeholder relationship. Non-supportive stakeholder relationship. Marginal stakeholder relationship.
Formulate strategies to reduce stakeholder’s potential to threat: 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 relationship: in the supportive 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 pro-actively 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 marginal relationships: 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 relationships. other three types of
Implementation of strategies and evaluation: 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.
BIBLIOGRAPHY • Randhawa K. Major stakeholders in health care delivery system. Available from URL: http://www.authorstream.com/Presentation/randhawakiran231773521-major-stakeholders-health-care-delivery-system/. • Eappen J. Major stakeholders in the Indian Health Care System. Available from URL: http://www.slideshare.net/jincy_eappen/major-stakeholders-inthe-healthcare-system. • Prabhakar M. Healthcare System Stakeholders. Available from URL: http://www. isites.harvard.edu/. • Rajeswari M. Health care delivery system. Available from URL: http://www.slideshare.net/muppidirajeswari/health-caredelivery-system-2.
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