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Stakeholder Management in Health Sector

Article in SSRN Electronic Journal · December 2019

DOI: 10.2139/ssrn.3511454

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Ramakrishnan Ramachandran
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(i) Title of submission: STAKEHOLDER MANAGEMENT IN HEALTH SECTOR

(ii) Name of the author: Dr. R Ramakrishnan,

Chief Consultant, Vivin Consultants Chennai

(iii) Mailing address: J 108 S&P Living Spaces, Kamarajar Street

Aynambakkam Chennai 600095 INDIA
(iv) E-mail address: ramakrish54@gmail.com or consultvivin@gmail.com

(v) Phone number Mobile : +919952669656

Dr Ramakrishnan Ramachandran, a baby boomer, did his PhD in Stakeholder Management and
has been associated in founding 3 B schools in rural Tier 2/3 cities in India.
After working in the Government of India in the Cabinet Secretariat and Indian High Commission
Seychelles for 22 years, he worked in the manufacturing and IT sector for the next 8 years and has also
done consultancy works in the field of Quality for small and medium industries in India. He joined
academics on a full time basis in 2005 to pursue his passion –teaching’.
Author of books ranging from Total Quality management to Environmental Science to Ethics,
Ramakrishnan Ramachandran has presented over 30 papers on various management topics. He is
continuing his research work on various topics ranging from Mentoring to Marketing as he tries to give
shape to the future managers of India. He can be contacted at Cell No. +919952669656 and
ramakrish54@gmail.com
Dr Ramakrishnan is currently engaged in training corporate clients on TQM, 5S, TPM,
Stakeholder engagement, CSR, CRM, Improving Sales and other consultancy works. He also conducts
workshops for students of MBA/Engineering and other college students on Soft Skills- Improving Self
confidence, Goal Setting, Time Management, How to be employable etc and giving guest lectures on the
current topics in Management like Business Analytics, Social Forecasting, Crowd Sourcing, IPR etc.

***************
 Stakeholder Management in Health Sector
ABSTRACT
Business can survive and grow only when the Society is stable and thriving. Trust is
critical, and stakeholders must feel that they can trust the organization and the environment in
which they function. Employing stakeholder management in an organization is important as it
creates a mutually beneficial relationship between an organization and its stakeholders.
Stakeholder theory is based on important principles such as cooperation, relationship
building, fairness, integrity, reciprocity, long-term thinking, and win-win solutions. Organizations
can only be effective and reach their goals if there is shared meaning between them and their
stakeholders
In order to meet demands to decrease costs and errors and increase efficiency and
quality, Health care organizations need to become flexible, adaptable and knowledgeable. Any
individual or institution affected by the operation of the healthcare industry directly or indirectly is
considered a stakeholder.
Hospitals are an exceptional case when it comes to dealing with stakeholders as they
have to deal with more complex situations and many stakeholders. The environment they
operate in is extremely complex, as they operate not in an entirely free market and have to deal
with many regulations from the government as well. Patients are the end consumers of a
hospital’s services and their experience matters.
A well-managed health organization should deal effectively with the social, political and
legal dynamics of its environment as well as the more traditional product and market-focused
variables found in the economic and technological environment.
It could be concluded that the main task of the governance model is to build and
maintain conditions, where the actual health care service production can perform well according
to the strategy of the organization. These conditions require that different stakeholder
expectations are considered and managed to ensure a balanced strategy and stakeholder
commitment to any strategic changes. At the same time a risk of leading through compromises
need to be acknowledged

*****************
 Stakeholder Management in Health Sector
FULL PAPER
Business can survive and grow only when the Society is stable and thriving. A new
business paradigm has emerged in recent years that have brought the importance of
stakeholder management. Organizations need to gain trust of all the stake holders and stay
legitimate. Trust is critical, and stakeholders must feel that they can trust the organization and
the environment in which they function.
With Business corporations affecting larger population and get affected by them, the
concept of stake holder management has come in as part of their corporate social responsibility.
Health and Education are the main areas that affect any nation; the relevance of stakeholder
management in these areas thus becomes critical. Health and health equity affect the public
policies of all sectors.
Employing stakeholder management in an organization is important as it creates a
mutually beneficial relationship between an organization and its stakeholders. Steyn and Puth,
(2000)1 explains stakeholder management as the process where the interest of individuals and
groups who can have an effect on or are possibly affected by the organization in its dealings
and decisions, is systematically taken into account. Vinten, (2000)2 describes a stakeholder as
any individual or group who can affect or is affected by the achievement of the organization’s
objectives.
Freeman and Liedtka (1997)3 explains stakeholder management as the process where
the interest of individuals and groups who can have an affect on the organization or in turn be
affected by the organization, its dealings and decisions, is systematically taken into account.
Harrison & St John (1998)4 defines it as “communicating, negotiating, contracting and managing
relationships with stakeholders and motivating them to behave in ways that are beneficial to the
organization and its other stakeholders”. They advocate Stakeholder analysis that involves
“identifying and prioritizing key stakeholders, assessing their needs, collecting ideas from them,
and integrating this knowledge into strategic management processes”.
Cooper (2003)5 adds that the concept of stakeholder management is to consistently
create dialogue and communicate with the organization's stakeholders.

1 Steyn, B., & Puth, G. (2000). Corporate communication strategy. Heinemann.

2 Vinten, G. (2000). The stakeholder manager. Management Decision, 38(6), 377-383.
3 Freeman, E., & Liedtka, J. (1997). Stakeholder capitalism and the value chain. European Management Journal, 15(3), 286-296.
4 Harrison, J. S., & John, C. H. S. (1994). Strategic management of organizations and stakeholders: Theory and cases. West Group.
5 Cooper, S. M. (2003). Stakeholder communication and the Internet in UK electricity companies. Managerial Auditing Journal, 18(3), 232-243.
 Clarkson (1995)6 classified Stakeholders as primary (those that have formal, official, or
contractual relationships with the organization) or secondary (all others). Mitchell, Agle, and
Wood (1997)7 classified Stakeholders based on their stake in the organization (ownership,
economic or social stake) or their influence (formal, economic or political power) and urgency
(time sensitive of their requirements).
Freeman (2001) 8defines a stakeholder as “any group or individual who is affected by or
can affect the achievement of an organization’s objectives” According to Johnson, Scholes, &
Whittington (2008)9, “Stakeholders are those individuals or groups who depend on an
organization to fulfill their own goals and on whom, in turn, the organization depends”. Freeman
originally built stakeholder management as a new strategic management framework to support
corporate governance in an environment of increased accountability to wider stakeholder
interests.
Stakeholders can be thought of as core (a specific subset of strategic stakeholders that
are essential for the survival of the organization); strategic (those groups that are vital to the
organization and the particular set of threats and opportunities it faces at a particular point in
time); and environmental (all others in the organization’s environment) (Clarkson 1994)10.
Campbell (1997)11 asserts that organizations should gain the loyalty of all their stakeholders -
not only the shareholders for their survival.
Steyn and Puth (2000)12 further explain Campbell's view in saying that organizations
who take a wide range of their stakeholders into account, are more likely to act responsibly.
These organizations can thus successfully create financial and social wealth. Wheeler and
Sillanpaa (1998)13 supports this notion by saying that organizations who take their stakeholders
into consideration during decision making, will gradually start doing better than those who don't.
Stakeholder theory is based on important principles such as cooperation, relationship
building, fairness, integrity, reciprocity, long-term thinking, and win-win solutions. Organizations

6 Clarkson, M. E. (1995). A stakeholder framework for analyzing and evaluating corporate social performance. Academy of management review, 20(1),
92-117.
7 Mitchell, Ronald K., Bradley R. Agle and Donald J. Wood (1997), ‘Toward a Theory of Stakeholder Identification & Salience: Defining the Principle of
Who & What Really Counts’, Academy of Management Review, 22 (4), 853–86.
8 Freeman, R. E. & McVea, J. (2001). A Stakeholder Approach to Strategic Management. Darden Graduate School of Business Administration,
University of Virginia, Working Paper No. 01-02.
9 Johnson, G., Scholes, K., & Whittington, R. (2008). Exploring corporate strategy: text & cases. Pearson education.
10 Clarkson, M. (1994, May). A risk based model of stakeholder theory. In Proceedings of the second Toronto conference on stakeholder theory (pp.
18-19).
11 Campbell, A. (1997). Stakeholders: the case in favour. Long Range Planning, 30(3), 446-449.
12 0p.cit.1
13Wheeler, D., & Sillanpa, M. (1998). Including the stakeholders: the business case. Long Range Planning, 31(2), 201-210.
can only be effective and reach their goals if there is shared meaning between them and their
stakeholders". Interactivity with stakeholders implies communication. Communication has a
natural Outcome, namely relationships (Steyn & Puth, (2000)14. These relationships with
stakeholders can be described as situational and behavioral. Situational, because the
relationship changes and situations change and behavioral because the relationship depends
on how the various parties within the relationship behave toward each other (Grunig &Hon,
1999)15
Broom, Casey and Ritchey (1997)16 defines relationships as patterns of dealings,
transaction and exchange as well as links between an organization and its stakeholders.
Relationships should therefore be regarded as potentially changing mental behavioral creations
of stakeholders. They further outline the certain linkages or characteristics that describe
relationships as:
 Necessity - refers to the quality of a relationship which is borne from legal or
regulatory requirements.
 Asymmetry - scarcity of resources prompts these types of relationships where
one party has the potential to exercise power or control over another.
 Reciprocity - where benefits are produced from the linkage in other words it
fosters cooperation, collaboration and coordination.
 Efficiency - a relationship is established in order to improve internal input-output
ratios. Relationships are entered in to in order to reduce costs of exchanges that
would otherwise occur in the market place.
 Stability - uncertainty prompts organizations to establish and manage linkages in
order to achieve reliable stable patterns of exchanges.
 Legitimacy - relationships are forged as it lends justification to norms, rules,
beliefs and expectations of external stakeholders in order to add value.
These characteristics can point to reasons and highlight ways in which relationships can
be or why relationships should be sustained with certain stakeholders.

14 0p.cit. 1
15 Grunig, J.E. & Hon, L. 1999. Guidelines for measuring relationships in public relations. The Institute for Public Relations commission on PR
measurement and evaluation. Available at: www.instituteforpr.com.
16 Broom, G.M., Casey, S. & Ritchey, J. 1997. Toward a concept and theory of organization-public relationships. Journal of Public Relations Research,
9(2):83-98.
 Ledingham & Bruning (1998)17 have identified that the following outcomes are good
indicators of successful relationships
 Control mutuality: It is evident that within relationships one party has a degree
of control over the other party. In a successful relationship there is an
understanding between the parties as to who will have what form of power. In
other words there should be agreement as to who has the rightful power to
influence one another.
 Trust: Refers to the confidence the parties have in one another and therefore
their willingness to be open with the other party. The underlying concepts are:
integrity the stakeholders' belief that the organization is fair and just;
dependability - the belief that the organization will act and do as it says it will; and
competence - the belief that the organization is in fact able and has the
proficiency and required expertise to do and deliver what it says it will. The value
of a trustworthy reputation is irreplaceable.
 Satisfaction: Parties within the relationship must act favorably towards one
another because positive expectations with regard to the relationship are
established and reinforced. In this type of relationship outcome, the parties
involved feel that the benefits to the relationship far outweigh the costs.
 Commitment: This is achieved when the organization and stakeholders involved
feel bound towards one another thereby showing that they think it is worth taking
the time to maintain and promote the relationship. There are two aspects to
commitment, namely continuance commitment (a certain line of action) and
affective commitment (an emotional orientation). It is important to note that in a
successful stakeholder relationship there needs to be a positive correlation
between the strength of the alliance and the strategic importance of the
stakeholder (Harrison & St. John, 1996)18
A market mechanism of buyers, sellers and other stakeholders has existed in the health
care sector since the inception of the modern health care system. The narrow view of markets
based solely on costs and profits neglects many positive attributes of the free market such as
the power of invention, innovation and entrepreneurship.

17 Ledingham, J. A., & Bruning, S. D. (1998). Relationship management in public relations: Dimensions of an organization-public relationship. Public
relations review, 24(1), 55-65.
18 Harrison, J. S., & St. John, C. H. (1996). Managing and partnering with external stakeholders. Academy of Management Perspectives, 10(2), 46-60.
 In order to meet demands to decrease costs and errors and increase efficiency and
quality, Health care organizations need to become flexible, adaptable and knowledgeable. Any
individual or institution affected by the operation of the healthcare industry directly or indirectly is
considered a stakeholder. They include patients (customers), healthcare providers (employees),
creditors, shareholders, Insurance companies, government etc. These stakeholders may be in
contact with the health providers on a regular or intermittent basis and are affected by change in
systems, policies and practices in the healthcare industry.
Public organizations can survive and succeed only by satisfying key stakeholders
according to their definition of what is valuable (Bryson 199519; Moore 199520). Bryson gives the
basic analysis technique that offers a fast and helpful method of: distinguishing stakeholders
and their interests, clarifying stakeholders' views of a focal organization (or other entity),
identifying some key strategic issues and beginning the method of distinguishing coalitions of
support and opposition
Bunn, Savage & Holloway (2002)21 propose six strategies to adopt when dealing with
stakeholders that are quite useful
 Leading,
 Collaborating,
 Involving,
 Defending,
 Educating and
 Monitoring.
.Stakeholder analysis provides an organization with information to understand
stakeholders and evaluate them for a specific policy or activity of the organization. It is a
systematic process that can make use of a range of different methodologies for analyzing
stakeholder interests, positions, interrelations influence networks and other characteristics
Identifying the root cause of the problem and possible solutions that might work is actually part
of the problem. Taking key stakeholders into account is a crucial aspect of problem solving.
When organization’s strategies fail it is often because key stakeholders were not involved by the
decision makers (Bryson, 2004)22.

19 Bryson, J. (1995). Strategic Planning for Public and Nonprofit Organizations Revised Edition. San Francisco CA: Jossey-Bass
20 Moore, M. (1995). Creating public value. Cambridge MA: Harvard University Press.
21 Bunn, M. D., Savage, G. T., & Holloway, B. B. (2002). Stakeholder analysis for multi-sector innovations. Journal of Business & Industrial
Marketing, 17(2/3), 181-203.
22 Bryson, J. M. (2004). What to do when stakeholders matter: stakeholder identification and analysis techniques. Public management review, 6(1),
21-53.
 Stakeholder analyses are undertaken with a purpose. The purpose would decide about
what should be analyzed with and who are all to be involved and how. Stakeholder analyses are
done usually as part of policy, plan, or strategy change exercises. In healthcare field these
systematic approaches are used for the following three purposes. Each purpose can be directed
toward current issues as part of strategic planning for the future.
 Analysis is done in order to understand and influence policy
 To facilitate the implementation of organizational goals or objectives both specific
decisions and large scale projects and
 To deterring optimal ways of relating to key stake holders
A systems theory application in stakeholder theory suggests that problems can only be
solved with the support of all the stakeholders in a network consisting of an organization’s
stakeholders. The systems theory emphasizes the development of collective strategies that
optimize the network (Freeman et al. 2001)23.
According to Johnson et al. (2008)24, the success of a strategy depends on three factors:
 Suitability - A Strategy is suitable, if it addresses the key strategic issues and
makes economic sense in the environment considering the organization’s
strategic position and capabilities.
 Feasibility - A strategy is feasible, if the resources required to implement the
strategy are available, can be developed or obtained.
 Acceptability - A strategy is acceptable, if it meets the expectations of the
identified stakeholders. The stakeholder expectations concern the expected
return (financial and non-financial benefits) from the strategy and the expected
level of risk (probability and consequences of a failure).
The evaluation of stakeholder acceptability involves assessment of the likely reaction of
stakeholders to the expected performance of strategy according to each of the success factors.
In this context, the expected performance of strategy should be evaluated by analyzing, how
each stakeholder group perceives not only the feasibility and suitability of the strategy but also
the expected benefits and level of risk associated with the strategy. A strategy is acceptable
only if it meets the expectations of the entire powerful key stakeholders likely to react to any
unmet expectations.
Johnson further adds that, since the expectations of stakeholder groups tend to differ, it
is common for conflict to exist regarding the importance or desirability of many aspects of

23 0p.cit. 8
24 Johnson, G., Scholes, K. & Whittington R. (2008). Exploring Corporate Strategy. Harlow: Prentice Hall.
strategy. Top executives need to find a balance in the relationships among stakeholders within
the network. Compromises often need to be made. Therefore taking not only stakeholder
expectations but also influence into account is an important aspect of strategic choice. Thus
stakeholder management requires balancing and integration of multiple stakeholder
relationships, objectives and values.
In their article Peltokorpi et al. (2008)25, discuss the factors affecting the level of
challenge to change implementation. The authors define the factors based on stakeholder
theory literature and test the derived model’s practical validity for screening change initiatives in
a presented case example from health care sector. According to the defined model, the
following factors need to be evaluated for detecting any challenges to implement change:
 Capability to change,
 Effect on stakeholders’ actions and position,
 Influencing possibilities,
 Goal clarity,
 Change complexity, and
 Management capability
In addition, the special characteristics of health care organizations need to be
understood when identifying any challenges to implement changes according to the factors in
the model.
Patients are the end consumers of a hospital’s services and their experience matters.
Hospitals are an exceptional case when it comes to dealing with stakeholders as they have to
deal with more complex situations and many stakeholders. The environment they operate in is
extremely complex, as they operate not in an entirely free market and have to deal with many
regulations from the government as well. Health care is a multifaceted cluster with a whole
group of loud and influential stakeholders with diversified goals. Balancing the different
stakeholder interests is a true challenge for the governance of a health care organization.
Fottler, Blair etal (1989)26 identified the five most important and powerful stakeholders as
Patients, Medical staffs, Hospital managements Professional staffs, and Boards of trustees for
numerous types of health care establishments, and classified them into one of four distinct
groupings namely, Supportive, Mixed-blessing, Non-supportive, and Marginal..It was suggested

25 Peltokorpi, A., Alho, A., Kujala, J., Aitamurto, J., & Parvinen, P. (2008). Stakeholder approach for evaluating organizational change
projects. International Journal of Health Care Quality Assurance, 21(5), 418-434.
26 Fottler, M. D., Blair, J. D., Whitehead, C. J., Laus, M. D., & Savage, G. T. (1989). Assessing key stakeholders: who matters to hospitals and
why. Journal of Healthcare Management, 34(4), 525.
of involving supportive stakeholders, collaborating with mixed-blessing stakeholders, defending
against non-supportive stakeholders, and monitoring marginal stakeholders.
The medical professionals expectations are primarily related to high clinical quality (often
expressed in terms of new and technologically advanced services and facilities) and adequate
support services. Patients care about clinical quality, but will be more concerned with service
quality and low costs. Hospital management and board of trustees would be more interested to
include cost containment, profitability, maintaining a steady stream of revenue and cash flow,
and effective utilization of all available resources
Apart from these five, one needs to consider the following also as powerful stakeholders
(1)Attendants and Non clinical Care givers (Family members or friends of Patients) (2) Potential
patients (3) Insurance providers (4) Employers (5) Government and (6) Community especially in
India
Active management of various stakeholder expectations is a necessity for a public health
care organization that has a number of key stakeholders with diversified goals to reach. The
importance of stakeholder management is especially high in organizations with governmental
and political guidance. Specifically, the role of board in strategic management needs to be fully
understood for managing and balancing the different stakeholder interests beyond the political
governance model. A partnership model in cooperation between primary health care and
specialized medical care would need fundamental commitment in the governance of strategic
management
Teperi et al (2009)27 argue that competitive principles should apply even for public health
care organizations for continuous improvement of health outcomes and the quality of full cycles
of care. The strategic focus points for health care must be in increasing value for patients — the
health outcomes achieved per euro spent. This is based on the principles of Porter’s model
presented in the book “Redefining Health Care: Creating Value-Based Competition on Results”
(Porter et al. 2006)28. Adoption of this kind of approach constitutes a strategic refocus from
traditional cost effectiveness to value for patients.
A well-managed health organization should deal effectively with the social, political and
legal dynamics of its environment as well as the more traditional product and market-focused
variables found in the economic and technological environment. Management should recognize
that business may be an element of a broader, perpetually ever-changing social structure.

27 Teperi, J., Porter, M. E., Vuorenkoski, L., & Baron, J. F. (2009). The finnish health care system. A Value-Based Perspective. Helsinki, Finland: Sitra.
28 Porter, M. E., & Teisberg, E. O. (2006). Redefining health care: creating value-based competition on results. Harvard Business Press.
 A strong internal stakeholder group of personnel commonly advocate substance
orientation in the organization of health care production. Therefore there is a specific challenge
of combining governance and substance in the strategic management of health care. For a
health care organization, Parvinen et al. (2005)29 suggest a resource based strategy that
emphasizes the importance of the organization’s unique resources and knowhow as sources for
operational excellence. Such a strategic approach promotes participation of the unique
resources in strategic planning for taking the best out of the opportunities arising in the
environment of operation. A creative organization has the capability to brainstorm, innovate and
create something new but still the challenge to manage a creative organization needs to be
acknowledged.
A public health care organization needs to combine strategic management and
execution of political decisions. The political decision making model remains a constant matter
of debate among different stakeholders.
Middle managers in health care typically require education in medicine, but the level of
leadership training is limited in the training program of medical specialists. They need to be
able to accept the stance of the whole organization.Strategy execution requires that middle
managers not only have a sufficient level of authority but a desire to reach the results according
to the goals and resources defined by the top executives.
The mission to help people is naturally strong in public health care. The intuitively
conceivable mission is so inherent that envisioning, value discussion and goal setting require
further boost. It is not intrinsically obvious for all involved that a strategy of a health care
organization could be something else than a manifestation of the axiomatic duties and
operations of the organization.
A strategy should express strategic decisions rather than self-evident facts such as
profitability and efficiency that are not even choices as such. True strategic decisions on long-
term goals require not only thorough understanding of environment and resources but also
stance on efficient execution. Thus a strategy process of a health care organization should pay
special attention to the means of formulating strategic objectives that are of strategic
significance for the organization.
According to Peters (1996)30, Governmental and nonprofit reforms across the world are
prompting the need for more attention to stakeholder analyses He identifies four emerging
models of governance that imply differing reasons for doing stakeholder analyses.

29 Parvinen, P., Lillrank, P. & Ilvonen, K. (2005). Johtaminen terveydenhuollossa. Käytännöt,vastuut, valvonta. Helsinki: Talentum
30 Peters, B. G. (1996). The Future of Governing: Four Emerging Models. Lawrence Kansas: University Press of Kansas.
  The Market model: A move to market-based reforms places a premium on attention to
customers, an important category of stakeholders. Monopoly is seen as the major
reason why governments do not perform better.
 The Participative model: Hierarchy in the government is seen as the key problem. This
can be solved by participation by employees and other stakeholders by more
consultation, negotiation. This will result in flattening hierarchy
 The Flexible model: The problem is seen as the inertia due to the permanence of
government agencies. Government is made more responsive with temporary personnel,
experimentation, and coordination. The emphasis is on “virtual organizations.
 Deregulated Model: Involves freeing up government from too many regulations and red
tape. Deregulated government is expected to respond promptly to key stakeholders.

The need to manage relationships is part and parcel of the need to govern in each of
these models. Feldman and Khademian (2002)31 assert “to manage is to govern.” According to
Bosse, Phillips and Harrison (2009)32, practical application of stakeholder principles leads
organizations to develop cooperative and trusting relationships with their major stakeholders,
leading to higher levels of innovation, efficiency and value creation.
Health care has always been a business concerned with creating value for stakeholders.
Relying on their own version of the separation thesis, health care delivery organizations have
created the perception that they are unique from other enterprises because the output of service
relates to life, death, health and wellness. Health care is different from other industries due to
the complexity of the provider-patient relationship, the asymmetry of knowledge, and patient
vulnerability. Health care will never be a purely commercial transaction.
In recent years, the health care delivery environment has been characterized by its
turbulent, competitive, and uncertain nature. The relationship of the health care delivery
organization with its suppliers, customers, employees, financiers and communities is changing
in response to market conditions brought about by managed care financing. In this time of
transition, the degree to which organizations are able to meet the expectations of these five
stakeholder groups will shape the long-term strategic success of the enterprise.
It could be concluded that the main task of the governance model is to build and
maintain conditions, where the actual health care service production can perform well according
to the strategy of the organization. These conditions require that different stakeholder

31 Feldman, M. & Khademian, A. (2002). To manage is to govern. Public Administration Review 62(5) 541-554.
32 Bosse, Phillips and Harrison (2009); Harrison, Bosse and Phillips (2010)
expectations are considered and managed to ensure a balanced strategy and stakeholder
commitment to any strategic changes. At the same time a risk of leading through compromises
need to be acknowledged.
An efficient leader executes by merging views and reaching commitment to strategy and
goals whereas excessive participation and democracy may lead to inefficient compromising.
Thus active stakeholder management is called for when leading any strategic changes or
processes in an organization. Moreover there are some factors especially prominent in health
care organizations to be considered in strategic management in order to manage any
challenges to change. These factors include strong professions, political governance, skills of
middle management and the self evident nature of public health care organization’s mission.

**********************
 REFERENCE
Bosse, Phillips and Harrison (2009); Harrison, Bosse and Phillips (2010)

Broom, G. M., Casey, S., & Ritchey, J. (1997). Toward a concept and theory of organization-
public relationships. Journal of Public relations research, 9(2), 83-98

Bryson, J. (1995). Strategic Planning for Public and Nonprofit Organizations Revised Edition.
San Francisco CA: Jossey-Bass

Bryson, J. M. (2004). What to do when stakeholders matter: stakeholder identification and

analysis techniques. Public management review, 6(1), 21-53.

Bunn, M. D., Savage, G. T., & Holloway, B. B. (2002). Stakeholder analysis for multi-sector
innovations. Journal of Business & Industrial Marketing, 17(2/3), 181-203.

Campbell, A. (1997). Stakeholders: the case in favour. Long Range Planning, 30(3), 446-449.

Clarkson, M. (1994, May). A risk based model of stakeholder theory. In Proceedings of the
second Toronto conference on stakeholder theory (pp. 18-19).

Clarkson, M. E. (1995). A stakeholder framework for analyzing and evaluating corporate social
performance. Academy of management review, 20(1), 92-117.

Cooper, S. M. (2003). Stakeholder communication and the Internet in UK electricity

companies. Managerial Auditing Journal, 18(3), 232-243.

Feldman, M. & Khademian, A. (2002). To manage is to govern. Public Administration Review

62(5) 541-554.

Fottler, M. D., Blair, J. D., Whitehead, C. J., Laus, M. D., & Savage, G. T. (1989). Assessing key
stakeholders: who matters to hospitals and why. Journal of Healthcare Management, 34(4),
525.

Freeman, E., & Liedtka, J. (1997). Stakeholder capitalism and the value chain. European
Management Journal, 15(3), 286-296.

Freeman, R. E. & McVea, J. (2001). A Stakeholder Approach to Strategic Management. Darden

Graduate School of Business Administration, University of Virginia, Working Paper No. 01-02.

Grunig, J.E. & Hon, L. 1999. Guidelines for measuring relationships in public relations. The
Institute for Public Relations commission on PR measurement and evaluation. Available at:
www.instituteforpr.com.

Harrison, J. S., & John, C. H. S. (1994). Strategic management of organizations and

stakeholders: Theory and cases. West Group.

Harrison, J. S., & St. John, C. H. (1996). Managing and partnering with external
stakeholders. Academy of Management Perspectives, 10(2), 46-60.
Johnson, G., Scholes, K. & Whittington R. (2008). Exploring Corporate Strategy. Harlow:
Prentice Hall.

Ledingham, J. A., & Bruning, S. D. (1998). Relationship management in public relations:

Dimensions of an organization-public relationship. Public relations review, 24(1), 55-65.

Mitchell, Ronald K., Bradley R. Agle and Donald J. Wood (1997), ‘Toward a Theory of
Stakeholder Identification & Salience: Defining the Principle of Who & What Really Counts’,
Academy of Management Review, 22 (4), 853–86.

Moore, M. (1995). Creating public value. Cambridge MA: Harvard University Press.
Nutt, P. (2002). Why Decisions Fail: Avoiding the Blunders and Traps That Lead to Debacles.
San Francisco: Berrett-Koehler Publishers Inc.

Parvinen, P., Lillrank, P. & Ilvonen, K. (2005). Johtaminen terveydenhuollossa.

Käytännöt,vastuut, valvonta. Helsinki: Talentum

Peltokorpi, A., Alho, A., Kujala, J., Aitamurto, J., & Parvinen, P. (2008). Stakeholder approach
for evaluating organizational change projects. International Journal of Health Care Quality
Assurance, 21(5), 418-434.

Peters, B. G. (1996). The Future of Governing: Four Emerging Models. Lawrence Kansas:
University Press of Kansas.

Porter, M. E., & Teisberg, E. O. (2006). Redefining health care: creating value-based
competition on results. Harvard Business Press.

Ramakrishnan, R. (2009). CRM and Stakeholder Management. 20th SKOCH Summit, Hyatt
Regency, Mumbai, 16-17.

Ramakrishnan, R. (2014, October). Governance in Health Care--The Way Ahead. In Presented

by Dr Ramakrishnan at the 21st Thinkers and writers forum On 21st September.

Ramakrishnan, R. (2013). Financial Engineering and Stakeholder Management. Available at

SSRN 2336448.

Ramakrishnan, R. (2013). Financial Innovation and Regulation. Available at SSRN 2336477.

Ramakrishnan, R. (2008, January). Financial Innovation and Stakeholder Management.

In International Seminar, ‘Recent Trends in Capital Market and Financial Innovation',
Bharathidasan University, Tiruchirapalli.

Ramakrishnan, Dr. (2008). Financial Performance and Stakeholder Management. Available at

SSRN 1091547.

Ramakrishnan, R. (2012). Public Private Partnership (PPP) in Indian Health Care. Available at
SSRN 2186897.

Ramakrishnan, R. (2008). Towards Better Stakeholder Management. Corporate Social

Responsibility: Development with Equity.
 Ramakrishnan, R. "Stakeholder Management–A Critical Study on the Opportunities and
Challenges from India." In 23rd AIMS Annual Management Education Convention, pp. 26-27.
2011.

Steyn, B., & Puth, G. (2000). Corporate communication strategy. Heinemann.

Teperi, J., Porter, M. E., Vuorenkoski, L., & Baron, J. F. (2009). The finnish health care
system. A Value-Based Perspective. Helsinki, Finland: Sitra.

Vinten, G. (2000). The stakeholder manager. Management Decision, 38(6), 377-383.

Wheeler, D., & Sillanpa, M. (1998). Including the stakeholders: the business case. Long Range
Planning, 31(2), 201-210.

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