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Major stakeholders in health care system

The health care system is intended to provide services and resources for better health. This system includes
hospitals, clinics, health centers, nursing homes and special health programs in schools, industry and community.

Stakeholders encompass a wide sector of society. They include consumer or patients, community health care
professionals, hospital health care professionals, pharmacists, nongovernmental organization, suppliers etc.

Stakeholders

Stakeholder is a person, group, organization, or system who affects and can be affected by an organizational action.

Stakeholders re 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 stake holders

1. External stake holders


2. Interface stake holders
3. Internal stake holders

❖ External stake holder


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.

First category

It includes suppliers, patients, and financial community. The relationship between the organization and these
external stakeholders is a symbiotic one, as organization depends on them for its survival. In turn these stakeholders
depend on the organization to take their outputs. The relationship between the organization and stakeholders that
provide necessary input is one of the mutual dependence. As such the both parties cannot, or do not want to, do
without one another.

Second category

The competitor stakeholder seeks to attract the focal organization dependents. The competitor may be direct
competitor for skilled personnel. Competitor does not need one another to survive, while co-operation between
hospitals and their competitor has increased in recent years.

Third category

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.

Major Stakeholders in health care system:


1. Government

The role of government is the administration oh health care cannot be overestimated. Many federal government
health care efforts are headed by a cabinet-level officer, the secretary for 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.

Therefore, hospital has great incentive to comply with regulations promulgated by federal government, can be fined
or decertified a provider of care to Medicare clients if they do not. Government regulation is frequently opposed
by the health care industry because it often affects the health care practitioner’s autonomy.

2. 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 heath 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.

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 expenditure going to public
health.

3. Private sector
Health plans, insurance companies, pharma-ceutical ,and device manufacturers have a special responsibility in health
system reform. their products and services, directly affect the patient lives and healthy.

4. The providers
i. Community health care professional
ii. Hospital health care professional

i.) Community health care professionals: includes nurses, health workers, dais, doctors of the
community health centers, voluntary health workers etc.

ii.) Hospital health care professionals​:

♦ Physician

The role of physician in the health care system is an 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, weather 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 techniques 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 role of the pharmacist is changing. Some can now prescribe as well as dispense medicine. They are more
interested in meeting the requirements of pharmaceutical industry.

5. 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.
6. Patient
Patients also have a ethical responsibility towards their own health and towards controlling costs. While it would be
impossible to implement a program that forced people to live healthy lifestyles it is reasonable to assume
that healthier costs
7. 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.

❖ Various national voluntary organizations are as follows​:

1. Indian red cross society:

It was established in 1920 and has over 400 branches all over India. It has been executing programs for the
prevention and promotion of health. Its activities are:

● Relief work.
● Milk and medical supplies.
● Armed forces
● Maternal and child welfare services
● Family planning
● Bold bank and first aid

2. Hindu Kusth Nivaran Sangh:

It was founded in 1950 with its headquarters in New Delhi. It’s precursor was the Indian council of British Empire
Leprosy Relief Association (B.E.L.R.A.) which was renamed as LEPRA in 1950. The program 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 government and other voluntary agencies.

Activities:

♦ Production and distribution of health education and publicity material on leprosy.


♦ Observance of anti leprosy day on the 30​th​ January every year to create mass awareness about leprosy.
♦ Providing assistance to voluntary organizations and leprosy patients.
♦ Running of two mobile leprosy treatment units in two districts of Delhi (north-east and west) with funds
provided by government of India.
♦ Publication of quarterly Indian Journal Of Leprosy and a bi-monthly news bulletin Kusth Vinashak for
leprosy workers and the general public.

3. Indian council of child welfare

It was established 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 mean which are necessary
to enable them to develop physically, mentally, morally, spiritually and socially in a health and normal manner and
in conditions of freedom and dignity.

Activities:
♦ Advocating children’s rights.
♦ Crèches for children of working and ailing mothers.
♦ Training program for child care workers.
♦ Sponsorship for school
♦ education of under-privileged children
♦ Projects for street and working children.
♦ Rehabilitation of abandoned children.
♦ Programs with special focus on the girl child.

4. Tuberculosis association of India

It was found in 1939. It has branches in all states of India. The activities of the 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.

Activities:

♦ Publication of prestigious Indian journal of tuberculosis quarterly being uninterrupted published since
1953.
♦ Organization of annual conference
♦ TB seal campaign is organized every year.
♦ Providing quality diagnostic and treatment services through its New Delhi TB Centre.

5. Bharat Sevak Samaj

The Bharat Sevak Samaj which is non political and non official organization was formed in 1952. One of the prime
objective of 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.

Activities:

♦ Slum services
♦ Legal aid to the poor
♦ Night shelters for pavement.
♦ Institution for handicapped children
♦ Training of voluntary social workers yogic exercises for all

6. The Kasturba memorial fund

Created in commemoration of Kasturba 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- sevikas. The trust has nearly one crores
of rupees and is actively engaged in various welfare projects in the country.

Activities:

♦ Health services
♦ Leprosy eradication
♦ Women health worker training program
♦ Services in border areas
♦ Educational program
♦ Women helpline
♦ Peace study centers

7. 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 clinics.

Activities :

♦ Literacy and education


♦ Health, family welfare and population
♦ Socio economic program
♦ Computer training centers
♦ Rural sanitation, water and waste management
♦ Welfare institutional services
♦ Empowering rural women

8. The All India Blind 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.

Activities:

♦ Co-ordinates the work of different institutions working for the blind.


♦ It organizes eye relief camps and other measures for the relief of blind.

9. 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 register able qualifications.

Activities:

♦ conduct annual conferences


♦ publish journals
♦ arrange exhibitions
♦ foster research
♦ set up standards of professional education and organize relief camps during periods of natural calamities.
❖ Various international voluntary organizations are as follows​:
1. World health organization (WHO)
2. United Nations international child emergency fund (UNICEF)
3. United nations education, scientific and cultural organization (UNESCO)
4. Food and agriculture organization
5. International labour organization
6. United nations developmental programme

Management of stakeholders relationship

The stakeholders relationship can be managed by following certain steps. These are given below

Diagnose of stakeholder relationship

● Stakeholder potential for threat.


● Stakeholder potential for co operation.
1. 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 resources, participation in
decision making.

Stakeholder’s 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 dependence of the organization on
stakeholder. Generally, the more dependent the organization, the more powerful the stakeholder will be.

2. 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

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, physician 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 as stakeholder is low on potential threat but high on
potential co-operation for e.g. the relations of well managed hospital with its board of trustees, it’s manager, it’s
staff, employees, local community and nursing homes.

Type 3: The most distressing stakeholder relationship for an organization and it’s 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, offer 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

i. Collaborate cautiously in the mixed blessing relationship


The best way to manage the mixed blessing relationship, high on the dimensions of both potential threat and
potential co-operation may be cautious collaboration. The goal of strategy is to turn mixed blessing
relationship into supportive relationships.
ii. 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.
iii. 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.
iv. 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. The outside of the strategy implementation also has to be evaluated.

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