Major stakeholders in health care delivery system: Major stakeholders in health care delivery system Kiran Randhawa Introduction : Introduction The stakeholder concept was first used in 1963 internal memorandum at the Standard Research Institute . It defined stakeholders as those groups without whose support the organization would cease to exit. The theory was later developed by R.Edward.Freeman in the 1980s. Stakeholders are those individuals, groups, or organizations who have a contractual, ethical, financial, and/or political interest (stake) in the decisions and actions of a particular organization. Definition :: Definition : A stakeholder is a party that can affect or can be affected by the actions of the bussiness as a whole. Types of stakeholders: Types of stakeholders According to involvement: People who will be affected by an endeavor & 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,supliers people that are related or located near by. A participant in a community mobilization effect representing a particular segment of society. School board members, environmental organizations, elected officials, advisory cuncil members & religious leaders are examples of local stakeholders . According to availability: : According to availability : Primary stakeholders : The primary stokeholders are those that are engaged in economic transactions with the bussiness. Examples: stockholders, customers & employers. Secondary stakeholders : The secondary stakeholders are those who are although donot engage in direct economic exchange bussiness but are affected by or can affect its affects. Example general public, communities , activist , bussiness support groups & media. According to position/work: According to position/work Internal stakeholders : Interface stakeholders : External stakeholders . External stakeholders typically fall into three categories: those who provide inputs into the organization; those who are competitors with the organization; those who have a special interest in the functioning of the organization. PowerPoint Presentation: Competing integrated delivery system/network State & federal government Competing health plans Professional trades/organization Employers Patients Competing medical practies Other health are professionals. Competing hospitals Other health industry organization Local communties Health plans Physician as individual care giver Other health care provider Medical practices Hospitals GOVERNING BOARDS IDS/N Major stakeholders in health care system: Major stakeholders in health care system Governmental : The role of government in the administration of health care cannot be overestimated . Many federal government health care efforts are headed by a cabinet level officer. At central level: At central level The 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). • 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. At state level: At state level The state level state health directoriate is responsible for administring 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 dervices . these may be: Insufficient understanding about changing environment and issues affecting health care organizations Emphasis on institutions, autonomy, independence Lack of system perspective Ambiguity about roles, responsibilities, relationships, accountabilities Lack of Readiness for change. Avalibility of medical facilities. Plan health programmes & drawing policies in providing health care . Provision of medicines. At district level:: At district level: The district level stakeholder in health care delivery system is dupty commissioner, MLAs of the area, civil surgoens, senior medical officers & district public health nurse. Physicians: Physicians The role of physician in the health care system is important. The physician provides direct medical care to clients in variety of seTtings including offices, clinics,hospitals & free standing centers. Physicians decides which client to admit, where to admit, length of stay, quality of care , whether to perform surgery, when to initate & to discountinue treatment regimens & which medications to prescribe . Many physicians percieved a decline in their dominance & control of health care setting during 1980s & 1990s. The traditions that define medical practices such as autonomy, professional control, solo medical practice are being questioned & reformed. Hospital administrators & govering boards:: Hospital administrators & govering boards: The chief executive , chief financial officers, chief nursing officers & governing boards of hospital strongly influence the health care delivery . in addition, most hospitals are members American hospital association , which represents the industry,s efforts to influence legislation, judicial decisions, health policies. Nurses : Nurses Nurses outnumber physicians, dentists, pharmaceutical & every single group of health care providers. As of 2001, there are 199 million registered nurses employed in nursing . Among the 216 million RNs projected for 2005, about 2/3 will work in hospitals, a distribution that has remained constant since mid 1980s. Non governmental stakeholders : Non governmental stakeholders These include private doctors, nurses, bussiness & industry, pharmaceutical industries & the public. Private physicians : The physicians who work in their own private hospitals or clinics have a greater influence in health care delivery. Physicians decides which client to admit, where to admit, length of stay, quality of care , whether to perform surgery, when to initate & to discountinue treatment regimens & which medications to prescribe. Nurses: Nurses Nurses who works in private health care organization. They provide the quality care as they are more accountable for delivery the quality care to the patient & to met the needs of the client by focusing on the individualized patient care. The private nurses have a greater impact on health care delivery but in many private health organizations have recurited less skilled workers by replacing RN. However the collective expertise & leadership of nurses has not been yet utilized to shape the reform era. Nuring respond to rapid arket change has been largely reactionary. Bussiness & Industry: Bussiness & Industry May industries have a big stake in controlling the cost of provding health care. As health care costs increased in mid of 1990, the influence of bussiness industry increased as well. Health insurance programmes are launched mainly through benefit prgramme. As the cost of health care increases, insurances costs increases as well, forcing bussiness to assume greater financial burden to insure employee & their dependents as well. Cost for product increases accordingly. The bussiness industry leaders pretested the increased cost & began to take collective actions to drive cost down. Some strategies have included the following:: Some strategies have included the following: Increased deductibles. Larger & more frequent co-payments. Reduced benefits & services. Initiation of managed care programme. Mandantory second opinion. Precertification of admission. Increased contracting of care to health maintenance organizations & preffered provider organizations. The public: The public The public has a stake in health care from several perspectives . First as consumers of healh care services, the public is concerned with quailty, cost & access to care. Many people believe that health care is a right should be universally available to all citizens, regardless of the cost . People who are uninsured donot have the equal access to health care services that income & insurance provides. The uninsured represents 16% of non older adult population. Women & children are among those suffers the most. 25% of uninsured are children. PowerPoint Presentation: Overall ,public values regarding health care changing. People are interested in receiving quality are at the reasonable cost. In addition the public has a more positive view of health promotion & illness prevention than in the past health care resources remain focused on illness, however with only 1% of health care expenditure going to public health.