CLASS PRESENTATION

ON MAJOR STAKEHOLDERS IN

HEALTH CARE DELIVERY SYSTEM

PRESENTER:

Christian Jenet Daniel

M.Sc.1st Year

Roll no. 1

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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.

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DEFINITION

A stakeholder is

a party that can

affect or can be

affected by the

actions of the

business as a

whole.

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DEFINITION

Stakeholder is a

person, group,

organization or

system who

affects and can be

affected by an

organizational

action.

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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.

DEFINITION

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TYPES OF STAKEHOLDERS

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TYPES OF STAKEHOLDERSAccording 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, customers,

owners and suppliers’

people that are related or

located nearby. 7

According to availability

Primary Stakeholders:

The primary

stakeholders are those

that are engaged in

economic

transactions with the

business. Examples:

stockholders,

customers &

employers.

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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, activist,

business support

groups & media. 9

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

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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.

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Those that provide inputs to organization:

The first category includessuppliers, patients andfinancial community. Therelationships between theorganization and theseexternal stakeholders are asymbiotic one, asorganization depends onthem for its survival. Inturn these stakeholdersdepend on the organizationto take their outputs. Therelationships between theorganization and thestakeholders are one ofmutual dependence.

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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.

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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.

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Interface Stakeholders:Some stakeholders functionon the interface between theorganization and itsenvironment. The majorcategories of interfacestakeholders include themedical staff, the hospitalboard of trustees. Theorganization must providesufficient inducements tocontinue to makeappropriate contribution.The organization may offerprofessional autonomy,institutional prestige orpolitical contacts, specialservices and benefits etc.

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Internal Stakeholders

Internal stakeholders almost entirely within theorganization and typically includemanagement, professional and nonprofessional staff. Management attempts toprovide internal stakeholders with sufficientinducements to gain continual contributionfrom them. The stakeholders determinewhether the inducements are sufficient for thecontribution that they are required to makepartly on the basis of alternative contributionoffer received from competitors.

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STAKEHOLDERS IN HEALTH CARE SYSTEM

• GOVERNMENT

• PUBLIC

• PROVIDERS

• HOSPITAL ADMINISTRATOR AND

GOVERNING BOARDS

• NON GOVERNMENTAL

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GOVERNMENT

Many federalgovernment health careefforts are headed by acabinet-level officer,the secretary for healthand human services,who runs thedepartment of healthand human services.The federal governmentmakes budget andother planning relatedto expenditure in healthcare. 18

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).

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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.

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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.

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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.

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THE PUBLIC

The public has a stake in health care fromseveral perspectives. As consumers of health careservices or as patients, the public is concernedwith quality, cost and access to care.

They expect an employer to offer a widevariety of option for health coverage that can becustomized to their specific needs. They also lookfor the employs to fund the majority of cost ofhealth insurance. People are interested inreceiving quality care at a reasonable cost.

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THE PROVIDERS

• Community health care professional

• Hospital health care professional

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HOSPITAL HEALTH CARE

PROFESSIONAL:

Physicians:Physicians provide direct medicalservices to clients in variety ofsettings, including offices, clinics,hospitals and freestanding centers. Inaddition, physician control 60% to70% of hospital costs through theirdecisions regarding the use ofresources. Physicians decide whichclient to admit, where to admit, thelength of stay, the ancillary services,whether to perform surgery, when toinitiate and to discontinue treatmentregimens, and which medications toprescribe.

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An individual whoprovides care to clients.The extent of participationvaries from simple patientcare tasks to the mostexpert professionaltechnique necessary inacute life threateningsituations. The ability ofnurse to functionindependently and makingself directed judgment willdepends on his or herprofessional development.Nurses provide a uniqueperspective on the healthcare system.

Nurses:

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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.

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NON GOVERNMENTAL

STAKEHOLDERSThe 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 aid28

• 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.

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• 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 gram-savikas. The trust has

nearly one crore of rupees and is actively engaged in various

welfare projects in the country.30

• 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.31

• Central Social Welfare Board: This is an autonomous organization

under the general administrative control of the Ministry of education. It

was set up by the Government of India in August 1953. The functions of

the Board are:

• Surveying the needs and requirements of voluntary welfare

organizations in the country.

• Promoting and setting up of social welfare organizations.

• Family and Child Welfare Services in rural areas for the welfare of

women and children. The activities of these projects comprise

teaching of craft, social education, literacy classes, maternity aid

for women, and distribution of milk, balwadis, and organization of

play centers for children.

• Family Planning Association of India: The Family Planning

Association of India was formed in 1949 (Head quarters in Mumbai). It

has done pioneering work in propagating family planning in India. These

Branches are running family planning clinics with grant –in-aid from the

Government. The Association has trained several hundred doctors,

health visitors, and social workers.

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1. World Health Organization:

WHO Is a specialized, non political

health agency of the United Nations,

has head quarters in Geneva

Switzerland. The constitution came in

to force on 7th April, 1946. This day is

celebrated as “World Health Day”. A

world health theme is chosen every

year to focus attention on specific

aspect of public health.

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Function of WHO:

• Prevention and control of specific diseases

• epidemiological surveillance of communicable

disease problems

• Immunization against common disease

• Development of comprehensive health services

• Family Health

• Environmental Health

• Health Statistics

• Bio-medical Research

• Health literature and Information

• Cooperation with other Organizations34

Other United Nations

Agencies

UNICEF (United Nations International

Children’s’ Emergency Fund):

It believes that future of of mankind

depends on the well being of our children. Its

slogan is –“the child of today for the world of

tomorrow” UNICEF is now called as United

Nation’s Children Fund”. It works with close

collaboration with WHO and other

specialized agencies for the welfare of

children and mothers. 35

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• United Nations Development Program (UNDP):

Established in 1966. The basic objective of the UNDP

is to help poorer nations develop their human and

natural resources more fully. The UNDP projects cover

virtually every economic and social sector i.e.

agriculture, industry, education and science, health

social welfare etc.

• United Nation’s Fund for Population Activities

(UNDPA): has been providing assistance to India

since 1974. In addition to funding national level

schemes, area projects for intensive development of

health and family welfare infrastructure and

improvement in the availability of services in the rural

areas have been under implementation in eleven

districts of Rajasthan.

Food and Agricultural Organization (FAO):

Formed on 1945, Head quarters in the Rome. It was the first

United Nation’s Organization specialized agency created to look

after several areas of world cooperation. The aims of FAOs are:

a. To help nations raise living standards.

b. To improve nutrition of the people of all countries.

c. To increase the efficiency of farming, forestry and fisheries.

d. To better the condition of the rural people and, through all

these means, to widen the opportunity of all people

productive work.

e. FAO’s prime concern is towards ensuring that the food is

consumed by the people who need it. Insufficient quantities

and in right proportions, to develop and maintain a better

state of nutrition throughout the world.

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International Labor Organization (ILO): Soon after world

war, it was recognized that problems of industry, like

disease, know no frontiers. In 1919 the International

Organization established in as an affiliate of the League of

Nations to improve the working conditions of the working

population all over the world.

World Bank: is a specialized agency of the United Nations.

Established with the purpose of helping less developed

countries to raise their living standards.

The Colombo Plan: At a meeting of common wealth

foreign minister at Colombo in January 1950, a program

was drawn up for cooperative economic development in

South and South East Asia.The All India Institutes of Medical

Science at New Delhi was established with the financial

assistance of New Zealand.

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The Swedish International Development

Agency (SIDA): This agency assisting in the

National Tuberculosis Control Program since

1979.

The Government of Denmark(DANID A):

Is providing assistance for the development of

services under National Blindness Control

Program since 1978.

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OTHER AGENCIES1. Rockefeller Foundation: This foundation is a philanthropic

organization chartered in 1913 and endowed by Mr. John D.

Rockefeller.Its purpose is to promote the well being of mankind

throughout the world.

2. Ford Foundation: Where as Rockefeller Foundation earlier

concentrated most of its assistance on the universities and post

graduate institutions. On professional education and on research,

the Ford Foundation has been active in the development of rural

health services and family planning.

3. Co-operative for Assistance and Relief Everywhere): was founded

in North America in the wake up of world war in the year 1945.

CARE is one of world’s largest non-profit, non-sectarian,

international relief and development organization. CARE provides

emergency aid and long term development assistance.

4. International Red Cross: It is a non-political, non official

international Humanitarian organization devoted to the services of

mankind in peace and war.40

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.41

TYPES OF STAKEHOLDER

RELATIONSHIP

• Mixed blessing stakeholder relationship

• Supportive stakeholder relationship

• Non supportive stakeholder relationship

• Marginal stakeholder relationship

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Mixed blessing stakeholder

relationship:

With the mixed blessing stakeholder relationship’s thehealth care executive faces a situation in which thestakeholder rank high on both type of potential: threatand co-operation. Physicians-hospital relationshipsprobably are the clear example of this type ofrelationship. Although physicians can and do providemany services that benefit hospitals, physicians alsocan threaten hospital because of their general controlover admissions, the utilization and provision ofdifferent services, and the quality of care.

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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.

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Non supportive stakeholder

relationship:

The most distressing stakeholderrelationship for an organization and itsmanager’s are non supportive ones. Theyare high on potential for threat but lowon potential for co-operation. Typicalnon supportive relationships forhospitals include competing hospitals,employee unions, the federalgovernment, other govt. regulatoryagencies the news media.

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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.

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STEPS IN THE MANAGEMENT OF

STAKEHOLDERS:

diagnose each stakeholder

classify each stakeholder relationship

formulate generic

strategies

implement strategies and

evaluate

identify type of stakeholder

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Introduction and meaning of stakeholders,

Definition,

Major stakeholders in health care system of

stakeholders,

The types of stakeholders,

Different stakeholders in health care delivery system,

Hospital administrators and governing bodies,

The non-governmental stakeholders,

International health agencies,

Steps in the management of stakeholders,

Business and industry,

Types of stakeholders’ relationship,

Other agencies

• ASSIGNMENT:

WRITE DOWN ROLE OF MAJORSTAKEHOLDER IN HEALTH

CARE DELIVERY

• SUBMITTED ON

10TH JAN.2017

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