The document discusses major stakeholders in the health care delivery system in India. It begins by defining stakeholders as individuals or groups that affect or are affected by organizational actions. It then outlines various types of stakeholders, including primary and secondary stakeholders, external, interface, and internal stakeholders. Major stakeholders in the Indian health care system are identified as: the government at central and state levels; the public; health care providers including community and hospital professionals; hospital administrators and governing boards; and non-governmental organizations. The relationships between these stakeholders and health care organizations are analyzed. Strategies for managing different types of stakeholder relationships are also presented.

1. CLASS PRESENTATION
ON
MAJORSTAKE HOLDERS IN
HEALTH CARE DELIVERY SYSTEM
PRESENTER:
Mandeep Kaur
M.Sc.1st Year
Roll no. 1

2. HEALTH CARE SYSTEM
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.

3. DEFINITION
A stakeholder is
a party that can
affect or can be
affected by the
actions of the
business as a
whole.

4. DEFINITION
Stakeholder is a
person, group, or
ganization
or
system
who
affects and can be
affected by an
organizational
action.

5. DEFINITION
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.

6. TYPES OF STAKEHOLDERS
According 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, custo
mers,
owners
and
suppliers’ people that
are related or located

7. According to availability
Primary Stakeholders:
The
primary
stakeholders are those
that are engaged in
economic
transactions with the
business. Examples:
stockholders, customer
s & employers.

8. 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, a
ctivist,
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

10. 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.

11. Those that provide inputs to organization:
The first category includes
suppliers,
patients
and
financial community. The
relationships between the
organization
and
these
external stakeholders are a
symbiotic
one,
as
organization depends on
them for its survival. In turn
these stakeholders depend on
the organization to take their
outputs. The relationships
between the organization and
the stakeholders are one of
mutual dependence.

12. 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.

13. 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.

14. 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.

15. Internal Stakeholders
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 stakeholders determine
whether the inducements are sufficient for the
contribution that they are required to make
partly on the basis of alternative contribution
offer received from competitors.

16. STAKEHOLDERS IN HEALTH CARE SYSTEM
• GOVERNMENT
• PUBLIC
• PROVIDERS
• HOSPITAL ADMINISTRATOR AND
GOVERNING BOARDS
• NON GOVERNMENTAL

17. GOVERNMENT
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.

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).

19. 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.

20. 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.

21. 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.

22. THE 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.
They expect an employer to offer a wide
variety of option for health coverage that can be
customized to their specific needs. They also look
for the employs to fund the majority of cost of
health insurance. People are interested in
receiving quality care at a reasonable cost.

23. THE PROVIDERS
• Community health care professional
• Hospital health care professional

24. HOSPITAL HEALTH CARE
PROFESSIONAL:
Physicians:
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.

25. 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.

26. 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.

27. 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 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 aid

28. • 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.

29. •
•
•
•
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 gramsavikas. The trust has nearly one crore of rupees and is actively engaged in
various welfare projects in the country.
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.

30. •
•
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. 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.

32. TYPES OF STAKEHOLDER
RELATIONSHIP
• Mixed blessing stakeholder relationship
• Supportive stakeholder relationship
• Non supportive stakeholder relationship
• Marginal stakeholder relationship

33. 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. Although physicians can and do provide
many services that benefit hospitals, physicians also
can threaten hospital because of their general control
over admissions, the utilization and provision of
different services, and the quality of care.

34. 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.

35. 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.

36. 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.

37. STEPS IN THE MANAGEMENT OF
STAKEHOLDERS:
diagnose each
stakeholder
identify type of
stakeholder
implement
strategies and
evaluate
classify each
stakeholder
relationship
formulate
generic
strategies

38. TYPE
Identify
type
of
stakeholder: Identify
the major stakeholder
and recognizes the
function depicted to
them.

39. Diagnose each stakeholder
relationship:
1. Stakeholder potential for threat
2. Stakeholder potential for co-operation

40. Classify each stakeholder relationship
Mixed blessing stakeholder relationship.
Supportive stakeholder relationship.
Non-supportive stakeholder relationship.
Marginal stakeholder relationship.

41. Formulate strategies to reduce stakeholder’s
potential to threat:
Collaborate cautiously in the mixed
blessing relationship: The best way to
manage
the
mixed
blessing
relationship, high on the dimensions of both
potential threat & potential co-operation
may be cautious collaboration. The goal of
strategy is to turn mixed blessing
relationship into supportive relationships.

42. Involve trustingly
relationship:
in
the
supportive
As the supportive stakeholder poses a low potential
for threat, they are mostly ignored by organization.
However for maximizing the co-operation from this
type of stakeholder, the health care executives can
delegate authority to manager, involve in decision
making and other plans. With this the manager will
more likely to committed to achieve organizational
objective.

43. Defend pro-actively in the non-supportive
relationship:
Stakeholder relationship with high threatening
potential, but low co-operative potential is best
managed by a proactive defensive strategy.
Relationships with the federal govt. and indigent
patients are non supportive stakeholder relationship
for most health care organization. In stakeholder
terms, a defensive strategy involves proactively
preventing the stakeholder from imposing cost or
other disincentives on the organization.

44. Monitor efficiently in marginal
relationships:
Monitoring helps to manage this marginal
relationship in which the potential for both
threat and co-operation is low. The marginal
relationships are unstable; they can move into
any
one
of the
relationships.
other three types of

45. Implementation of strategies and
evaluation:
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.

46. BIBLIOGRAPHY
• Randhawa K. Major stakeholders in health care delivery
system.
Available
from
URL:
http://www.authorstream.com/Presentation/randhawakiran231773521-major-stakeholders-health-care-delivery-system/.
• Eappen J. Major stakeholders in the Indian Health Care
System.
Available
from
URL:
http://www.slideshare.net/jincy_eappen/major-stakeholders-inthe-healthcare-system.
• Prabhakar M. Healthcare System Stakeholders. Available from
URL: http://www. isites.harvard.edu/.
• Rajeswari M. Health care delivery system. Available from
URL: http://www.slideshare.net/muppidirajeswari/health-caredelivery-system-2.