Guest column
Learn more about your stakeholders via analysis
By Patrice Spath, RHIT
Brown-Spath Associates
Forest Grove, OR
Each day, hospital case managers must balance the interests of the many stakeholders involved in patient care services. When care plans are developed, the wishes of the patient’s physician as well as the patient and family must be weighed against the requirements of health plans and the needs of out-of-hospital providers. For complex patients, such as those with spinal cord injuries, significant participation is required of numerous stakeholders when preparing, implementing, and monitoring care plans. The administrative aspects of case management also require that case managers engage the support of many different people and groups within the hospital. For example, to implement a new case management program in the emergency department, anyone who is affected by such an initiative needs to be consulted. Careful planning is necessary to determine who should be involved and how to involve them.
Whether case managing patients or working with others within the organization, case managers must have a good understanding of all the stakeholders in any decision or action. A stakeholder is anyone who is affected by or can influence that decision or action. Stakeholder analysis is a tool that case managers can use to identify and assess the importance of key people or groups. A better understanding of stakeholders allows case managers to anticipate the kind of influence (positive or negative) that others may have. Stakeholder analysis can help case managers develop strategies to get the most effective support for decisions or actions and reduce obstacles to successful implementation. The technique can be applied to patient care planning decisions and administrative actions. Case managers can conduct a stakeholder analysis individually or as part of a group activity.
Stakeholder analysis is used by case managers to organize their thinking about the various stakeholders in a patient care decision. It is also a powerful tool for deciding how to involve relevant people in various case management initiatives. Here is a step-by-step description of a method for conducting a stakeholder analysis. The process can be done by a single person or by a small group:
Draw a Stakeholder Analysis Matrix. (See matrix, below.) This diagram can be prepared on a flipchart or electronic whiteboard.
Stakeholder Analysis Matrix |
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| Stakeholder |
Stakeholder Interests |
Assessment of Attitude |
Assessment of Impact |
Actions |
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Identify and list all the stakeholders who will affect or be affected by the action. These may be individuals, or stakeholder groups, or some combination. If stakeholders can be treated as groups, list the group. For example, emergency department nurses would be considered a stakeholder group for a new case management initiative involving that department. The mother of a patient with a spinal cord injury would be named individually, as would the patient himself. Once you have a list of all potential stakeholders, review the list and identify the specific interests these stakeholders have in your decision or action. Consider issues such as:
- The benefits to the stakeholder.
- The changes that the action or decision might cause the stakeholder to make.
- The activities that might cause damage or conflict for the stakeholder.
Record these issues under the column, "Stake-holder Interests."
Next, review each stakeholder listed in column one. Ask the question, "How supportive will this person or group be of the decision or action?" Stakeholder attitudes can range from very supportive to opposed. To record your answer, use a five-category coding system such as:
- ++ strongly in favor
- + weakly in favor
- 0 indifferent
- - weakly opposed
- - - strongly opposed
Now ask the question, "How important are the stakeholder’s interests to the success of the decision or action?" Take into consideration the role key stakeholders must play for the action to be successful and the likelihood that the stakeholder will play this role. Also consider the likelihood and impact of the stakeholder’s negative response to the decision or action. Use an alphabetic or numeric coding system to record your answer in column three. For example, assign A for extremely important; B for fairly important; and C for not very important.
Remember these are your best guess estimates of the attitudes and influences of the stakeholders. If you are not confident in your judgment of stakeholder support or role, approach the person or group directly or ask someone else who can be assumed to know. You may wish to change your estimations as the project progresses.
The final step is to consider the kinds of things that you could do to get stakeholder support and reduce opposition. Consider how you might approach each of the stakeholders. What kind of information do they need? How important is it to involve the stakeholders in the planning process? Are there other groups or individuals that might influence the stakeholders to support your initiative? In general, stakeholders with high interest in an action or decision need to be involved in some way. The extent of involvement in an action or decision can range from:
- involved only as informants;
- consulted;
- directly involved in decision making;
- involved as co-action takers.
The people or groups that require the most attention are those who play an important role and are opposed. If these people resist involvement in the action or decision, then it’s time to find some way to neutralize their influence. Record your potential strategies for obtaining support or reducing obstacles in the last column in the matrix.
Systematic evaluation of all stakeholders in decisions or actions can help case managers anticipate and plan for all contingencies. When caring for patients, stakeholder analysis can be used to ensure that the needs and desires of everyone involved are thoroughly considered. When planning for a large undertaking such as an expansion of case management activities, stakeholder analysis can help all involved parties to get their needs met.
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