Advanced Nursing Practice

1. By-
Mr.Meghsham Gholap
1st M.Sc,CON,PIMS
Major Stakeholders In
Health Care System

2. Introduction
 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
programme in school, industry and community. Health
system operates in the context of socioeconomic and
political framework of the country.

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

4. Types of Stakeholders
1. External Stakeholders
2. Interface Stakeholders
3. Internal Stakeholders

5. External stake holders
A health care organization must respond to large number of
external stakeholders. They fall into three categories in
their relationships to the organization.
1. Those that provide inputs to organization.
2. Those that compete with it.
3. Those that have particular special interest.
The first category includes suppliers, patients and Financial
community.

6.  The relationship between the organization and these
external stakeholders is a symbiotic (interdependent
relationship) one, as organization depends on them for its
survival.
 stakeholders depend on the organization to take their
outputs.
 The relationship between the organization and the
stakeholders that provide necessary input is one of mutual
dependence. As such the both parties cannot, or do not
want to, do without one another.

7.  The competitor stakeholder may be direct competitor for
patient (e.g. other hospital) or they may be competing for
skilled personnel. competitor dose not need one another
to survive.
 Special interest group are the government regulatory
agencies, private accrediting associations, professional
associations, labor union, the media and political group.
Because of special interest conflicts most often occurs.

8. 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.

9. 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 stakeholder determine whether the inducement are
sufficient for the contribution that they required on the
basis of alternative contribution offer received from
competitive.

10. Stakeholders in Health Care
System

11. 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.

12. 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.
 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.

13. Providers
1. Community Health Care Professional
2. Hospital Health Care Professional

14. Community health care
professionals
 Includes nurses, health workers, dais, doctors of the
community health centers, voluntary health workers etc.

15. Hospital Health Care Professional
 Physicians
The role of physicians 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, whether to perform surgery,
when to initiate and to discontinue treatment regimens,
and which medications to prescribe.

16.  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.

17.  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.

18. 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.

19. 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 these are as fallows

20. Indian Red Cross Society
 It was established in 1920 and has over 400 branches all
over India. It has been executing programmes 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.

21. 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.

22. 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 mean 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.

23. 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.

24. Bharat Sevak Samaj
 The Bharat Sevak Samaj which is non-political and
nonofficial organization was formed in 1952.0ne 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.

25. The Kastubra Memorial Fund
 Created in commemoration of Kastubra Gandhi, after her
death in 1944, 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.

26. All India Women’s Conference
 It is the only women's welfare organization in the country.
Established in 1926, 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.

27. 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.

28. 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. 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.

29. Management Of Stakeholders
Relationship

30. Diagnose Of Stakeholder
Relationship
1. Stakeholder potential for threat.
2. Stakeholder potential for co-operation.

31. Stakeholder’s 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.

32. 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.

33. Types of Stakeholder Relationship
1. Mixed blessing stakeholder relationship.
2. Supportive stakeholder relationship.
3. Non supportive stakeholder relationship.
4. Marginal stakeholder relationship

34. 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.

35. 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.

36. 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.

37. 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.

38. Stakeholder’s Potential To Reduce
Stakeholder Threat
 Collaborate cautiously in the mixed blessing relationship
 Involve trustingly in the supportive relationship
 Defend proactively in the non supportive relationship
 Monitor efficiently in the marginal relationship

39. 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.

40. Summary
We had seen the topic Major Stakeholders in Health care
delivery system under following subtopic-
 Definition.
 Types.
 Stake holders in health care delivery system.
 Management of stakeholders relationship.
 Stakeholders potential to reduce stakeholders threat

41. Bibliography
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