IHP 600 Module 4 Stakeholder Analysis Paper Example

Who Has a Stake in Safer Assignments? A Stakeholder Analysis at Summit Valley Medical Center

[Student Name]

Southern New Hampshire University

IHP 600: Social and Organizational Issues in Healthcare

Module Four Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Who Has a Stake in Safer Assignments? A Stakeholder Analysis at Summit Valley Medical Center

Good ideas fail in hospitals when the people who can block them are ignored or the people who must carry them out are not consulted. Summit Valley Medical Center is considering two responses to its 24% registered nurse turnover: capping medical-surgical day assignments at five patients per nurse and launching a twelve-month residency for new graduates. This paper analyzes the stakeholders in that decision and recommends how to engage them.

The Decision and Its Costs

The assignment cap would require about 28 additional nurse positions, costing roughly $2.9 million a year before offsets. The residency would add a coordinator, protected education time and preceptor pay, at about $500,000 a year. Leaders expect savings from lower agency use and overtime, but those savings are uncertain and would arrive after the costs. That timing gap shapes how several stakeholders will react.

Why Stakeholder Analysis

Brugha and Varvasovszky (2000) reviewed the use of stakeholder analysis in health policy and management and described it as a way to understand the interests, positions and influence of actors connected with a decision so that managers can anticipate support and opposition. They noted that its value lies partly in the process, which forces planners to see an issue from other perspectives, and they warned that an analysis reflects one moment and the viewpoint of whoever conducts it.

Identifying the Stakeholders

Eleven groups were identified through the author's knowledge of the hospital, the organizational chart and conversations with four unit managers: medical-surgical registered nurses, new graduate nurses, nurse managers and charge nurses, the nursing and finance executives, the chief executive and board, hospitalist physicians, human resources, the nursing shared governance council, patients and families and the regional nursing school. Staffing agencies were also considered because they would lose business.

Sorting by Power and Interest

Bryson (2004) described several techniques for public and nonprofit organizations, including the power versus interest grid, which places stakeholders by how much they care about an issue and how much they can affect it. Those high on both are key players who must be closely involved; those with high interest but little power are subjects who need support and a voice; those with power but low interest are context setters who must be kept satisfied; and those low on both form a crowd that needs only general information. He stressed that grids are a starting point for deciding how to engage, not a final verdict.

Applying the Grid

The chief nursing officer, chief financial officer and medical-surgical nurses fall in the key player quadrant. New graduate nurses and patients care greatly about the outcome but have little formal power, placing them among the subjects. The board and chief executive hold power but, until recently, showed limited interest in nurse staffing details, making them context setters. Human resources and the nursing school sit closer to the middle, while agencies have high interest but little influence inside the hospital.

Table 1. Stakeholder Map for the Assignment Cap and Residency

Note. Selected stakeholders; the full map includes eleven groups.

Adding Legitimacy and Urgency

The grid treats power as the only source of influence. Mitchell et al. (1997) proposed that managers attend to stakeholders according to three attributes: whether a group can force an outcome, whether its claim is seen as proper and whether that claim presses for a quick response. Stakeholders with all three are definitive and demand immediate attention. That lens changes the picture for medical-surgical nurses. Individually they have little power, but their claim to safe working conditions is plainly legitimate, and it became urgent when a group began gathering signatures for a union election last month. Having gained power collectively, they now hold all three attributes.

The Finance Perspective

The chief financial officer's skepticism is reasonable and should be engaged, not overcome. The hospital's margin is about 1.5%, and $3.4 million in new cost is real, while savings from lower turnover are estimates. A joint model built with the finance team, using the hospital's own agency and overtime figures, and a phased start on the three highest-turnover units would lower risk and give the CFO ownership of the numbers.

Physicians and Frontline Leaders

Hospitalists worry that new staffing rules could slow admissions from the emergency department when beds are staffed but capped. Their support matters because they influence the chief medical officer and board members. Sharing data on how stable staffing shortens discharge delays, and inviting two hospitalists onto the design team, may turn mixed views into support. Charge nurses, who make assignments shift by shift, will determine whether a cap works in practice and need training and a clear escalation path.

Voices With Little Formal Power

New graduates and patients are easy to overlook because they cannot block a decision. Yet new graduates are the group leaving fastest, and patients experience the results. Two new graduates should sit on the residency design group, and the patient advisory council should review how staffing changes will be explained to families.

Limits of This Analysis

As Brugha and Varvasovszky caution, positions can shift quickly; the union campaign has already altered nurse and executive positions within weeks. The author is a nurse manager and may overestimate nurse support or underestimate finance concerns. Interviews with the CFO and board chair would strengthen the analysis, and the map should be revisited before each major decision point.

Conclusion

The staffing decision has three key players, the CNO, the CFO and medical-surgical nurses, and the nurses' growing urgency makes their engagement essential. Treating finance as a partner, involving hospitalists and charge nurses in design and giving voice to new graduates and patients offers the best chance that the proposal is adopted and sustained.

References

Brugha, R., & Varvasovszky, Z. (2000). Stakeholder analysis: A review. Health Policy and Planning, 15(3), 239-246. https://doi.org/10.1093/heapol/15.3.239

Bryson, J. M. (2004). What to do when stakeholders matter: Stakeholder identification and analysis techniques. Public Management Review, 6(1), 21-53. https://doi.org/10.1080/14719030410001675722

Mitchell, R. K., Agle, B. R., & Wood, D. J. (1997). Toward a theory of stakeholder identification and salience: Defining the principle of who and what really counts. Academy of Management Review, 22(4), 853-886. https://doi.org/10.2307/259247