Manual High Stakes: The Critical Role of Stakeholders in Health Care

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Once a list of possible stakeholders has been created it is necessary to estimate their influence and importance. The tables below identify both the sources and indicators of influence that internal and external stakeholders may hold. Different stakeholders may have commonality of purpose at a very general level e.


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For example, these sources of importance can affect both internal and external stakeholders:. This technique can be used in relation to a particular strategic development such as the launch or withdrawal of a service. Stakeholders should first be plotted in relation to how they would line up — the level and nature for or against of their importance and the extent of their influence.

A second map can also be plotted showing how you would need stakeholders to line up if the development were going to have a good chance of success. By comparing the two maps and looking for the mismatches, priorities for managing stakeholders can be established, as well as priorities for maintaining stakeholders in their current positioning.

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The style of participation for stakeholders needs to be appropriate for gaining and maintaining their ownership. Quadrant two: Stakeholders placed here can be highly important but having low influence or direct power, however need to be kept informed through appropriate education and communication. Quadrant three: Stakeholders here have low influence and low importance and care should be taken to avoid the dangers of unfavourable lobbying and therefore should be closely monitored and kept on board.

Quadrant four: Stakeholders placed here can hold potentially high influence but low importance should be kept satisfied with appropriate approval and perhaps bought in as patrons or supporters. However, it is important to recognise, that the map is not static. Changing events can mean that stakeholders can move around the map with consequent changes to the list of the most influential stakeholders.

Stakeholder management is essentially stakeholder relationship management as it is the relationship and not the actual stakeholder groups that are managed. The Clarkson Centre for Business Ethics in Friedman and Miles developed the following list of principles that summarise the key features of stakeholder management:. Managers should acknowledge and actively monitor the concerns of all legitimate stakeholders, and should take their interests appropriately into account in decision-making and operations. Managers should listen to and openly communicate with stakeholders about their respective concerns and contributions, and about the risks that they assume because of their involvement with the corporation.

Managers should adopt processes and modes of behaviour that are sensitive to the concerns and capabilities of each stakeholder constituency. Managers should recognise the interdependence of efforts and rewards among stakeholders, and should attempt to achieve a fair distribution of the benefits and burdens of corporate activity among them, taking into account their respective risks and vulnerabilities.

Managers should work cooperatively with other entities, both public and private, to ensure that risks and harms arising from corporate activities are minimised and, where they cannot be avoided, appropriately compensated. Managers should avoid altogether activities that might jeopardise inalienable human rights e.

Managers should acknowledge the potential conflicts between a their own role as corporate stakeholders, and b their legal and moral responsibilities for the interests of stakeholders, and should address such conflicts through open communication, appropriate reporting and incentive systems and, where necessary, third party review. The lower levels, manipulation, therapy, informing relate to situations in which the organisation is merely informing stakeholders about decisions that have already taken place, although these levels represent bad practice if done in isolation.

At middle levels, explaining, placation, consultation, negotiation stakeholders have the opportunity to voice their concerns prior to a decision being made, but with no assurance that their concerns will impact on the end result. The highest levels, involvement, collaboration, partnership, delegated power, stakeholder control are characterised by active or responsive attempts at empowering stakeholders in corporate decision-making.

References :. Skip to main content. Create new account Request new password. You are here 5b - Understanding Organisations, their Functions and Structure. Identify and map internal and external stakeholders and partnerships The start of any stakeholder engagement process is stakeholder mapping. For example, a local health and well-being strategy may be developed by: Internal stakeholders who participate in the co-ordination, funding, resourcing and publication of the strategy from a local health and well-being partnership; External stakeholders who are engaged in contributing their views and experiences in addressing the issues that are important to them as patients, service users, carers and members of the local community.

Who is or will be affected, positively or negatively, by what you are doing or proposing to do? Who holds official positions relevant to what you are doing? Finally, democratic government has duties and responsibilities towards its citizens, but how they are defined in regard to the provision of healthcare is an evolving American story. Currently rising premiums and strict requirements are keeping many people from obtaining health insurance.

The insurance companies remain profit driven, but the nature of their service should not be profit focused. Adequate healthcare is becoming harder to obtain due to financial hardship.

What are Stakeholders? Stakeholder Definition | ASQ

The insurance companies need to find an appropriate balance between their responsibilities towards both shareholders and patients. Quarterly reports for stockholders encourage the companies to focus more on profits than affordability. This causes insurance companies to have tight regulations against preexisting conditions so that mostly healthy individuals are selected for their plans.

Such patients will not utilize costly procedures as often as individuals with chronic illnesses. However, this is unethical of insurance companies because it reduces healthcare to a profit centered industry, and prevents those in need from receiving care.


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Pharmaceutical companies also play a key role in the healthcare system because many patients rely on their products. The prices for drugs are rising, and there are no caps to prevent them from reaching extravagant prices. The argument that the pharmaceutical companies need to charge ever higher prices to cover research costs is simply not true.

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Whether or not you argue that pharmaceutical companies have a moral responsibility to ensure that people can afford their products, at the very least they have the duty to be honest and practice fair marketing. Marcia Angell, previously an editor of the New England Journal of Medicine , has written extensively about the unethical behaviors of pharmaceutical companies. Let me cite one example. Through personal experience the author who had an office practice since the early s, witnessed a sinister change in the way pharmaceutical companies market their products to physicians.

Previously they sent pharmacists with depth of knowledge about their products to objectively educate the physician about the benefits and risks of a particular brand medication.

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However, since the late s pharmaceutical firms send young attractive representatives with no formal training to market their drugs by establishing a social relationship with the physician and by offering incentives to prescribe their product. Many physicians whose prescribing practices are unduly influenced by pharmaceutical representatives share the blame. They tend to respond to conversation about certain drugs rather than reading the biomedical literature.

Physicians play a key role in ensuring that their patients receive adequate healthcare, but also in controlling the rising costs of healthcare. They have to find a balance between having a gatekeeper role for the insurance companies and being an advocate for the patient. Assigning a gatekeeper role to primary care physicians had the intention of lowering healthcare costs because fewer tests and referrals would be made.

However, this is not working and it may be best to re-evaluate the role a primary care physician has in regards to referring patients. A coordinator role may be more beneficial than gatekeeper status. Also, since primary care physicians have increased the number of patients seen in a day to compensate for their decrease in revenue, this causes an increase in defensive diagnostic testing.

David A. Shore, PhD

The doctors do not have adequate time to review the chart or spend time with the patient, so they order more tests to reduce their liability risks. These actions cause healthcare spending to increase as well. By placing the physician between these two roles, a conflict of interest is created.

Ethically, the doctor has a fiduciary duty to protect the interests of his patient, but in the current managed care environment, insurance companies give incentives to physicians to order fewer referrals and to cram more patients into each workday. It appears that money is at the center of our values. Physicians also have obligations to patients independent of insurance companies.

A physician has an obligation of beneficence to do whatever is necessary to benefit his patient. Thus, the obligation of beneficence must be balanced by the principle of patient autonomy. Each patient is unique and has the right to participate completely in decisions about his health. Patients also have an 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 living would lead to lower healthcare costs. Some companies, such as Wal-Mart and the WHO, have stopped hiring employees that smoke to reduce healthcare related costs.