High Stakes: The Critical Role of Stakeholders in Health Care

157 Pages·2011·1.549 MB·English

by  David A. Shore, Eric D. Kupferberg

High Stakes
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HIGH STAKES
THE CRITICAL
ROLE OF
STAKEHOLDERS
IN HEALTH CARE
David A. Shore
with
Eric D. Kupferberg
1
1

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Copyright © 2011 by David A. Shore.
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______________________________________________
Library of Congress Cataloging-in-Publication Data
Shore, David A., 1954- author.
High stakes : the critical role of stakeholders in
health care / David A. Shore ; with Eric D. Kupferberg.
p. ; cm.
Includes bibliographical references.
ISBN 978-0-19-532625-3
1. Medical policy—United States. 2. Medical care—United States.
I. Kupferberg, Eric D., author. II. Title.
[DNLM: 1. Health Care Sector—organization & administration—United States.
2. Economic Competition—United States. 3. Health Services Needs and
Demand—United States. 4. Interpersonal Relations—United States.
5. Negotiating—United States. W 74 AA1]
RA 395.A3S494 2011
362.10973—dc22
2010045919
______________________________________________
Printed in the United States of America
on acid-free paper
9 8 7 6 5 4 3 2 1
To the stakeholders in my life: my parents, Ruth and Milton Shore;
my wife, Charlotte Shore; and my children, Douglas and Alyssa. I am
a very lucky man to have you all.
—David A. Shore
For Susan Shelkrot, Leo Kupferberg, and Harvey J. Kupferberg
—Eric D. Kupferberg
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Preface: Purposes, Analytical
Approach, and Source
Material
Th is book is not a diatribe. It is about a dialogue. Actually, it is the product of several
dialogues: a dialogue between my collaborator and myself, a dialogue with my
students, a dialogue with the participants of our executive education programs, a
dialogue with my colleagues at Harvard University and other academic institutions,
and a dialogue with leaders of health care institutions. Th ese dialogues are far from
fi nished. Part of the nature of productive dialogues is that they are ongoing. Th is
book makes no pretence of being the fi nal word on health care considerations. Th e
health care landscape is in a constant state of fl ux. In fact, we fully anticipate that
the debates and questions will shift between the time of this writing and the time
that the book is published.
Nonetheless, we have writt en this book with the intention of its being relevant
throughout the present and upcoming periods of change. As most readers will fully
appreciate, the challenges and issues facing stakeholder groups in health care are
long-lived. Consequently, this is not a book about health care policy. We do not
endorse any reforms that fi t neatly into liberal or conservative political agendas.
Instead, we believe that our discussion of stakeholder groups and their interrelation-
ships will aid in the articulation and implementation of new policies across the ideo-
logical spectrum. Our descriptions of stakeholder confl icts and our prescriptions
for their remedy, we hope, will cut through and across oppositional positions. Th ey
will encourage dialogue where previously there had been either striking silence or
deafening dismissal.
W e expect that this book will be controversial. In fact, its relevance will ensure
that it will fi nd both favor and opposition from many key participants in health care.
We welcome any heated discussion that may follow as a result of our descriptions
and prescriptions. Arguments, so long as they are well focused and well intentioned,
are essential tools for constructing workable solutions.
Our analysis draws from many sources. Initially, we appropriate a stakeholder
model and analytical frame. Th e premise of this book is that the warring stakeholder
parties in health care can be identifi ed by their stated affi liations, their declared
interests, and their behaviors. Th ey are also defi ned by the alliances that they form
vii
viii and by the groups they oppose. In no other arena are there as many stakeholder
groups as there are in health care. Whether they are fully understood or not, stake-
al
ri holder groups defi ne the batt le lines and determine who “wins” and who “loses” in
e
at ongoing struggles. If this book off ers new and unique insights into the current state
M
e of aff airs, it is our use of stakeholder theory that most helped us arrive at these
c
ur insights.
o
S
d W e are also convinced that stakeholder analysis can help health care leaders
n
a understand the forces that get in the way of forming productive relationships with
h,
c other leaders and organizations. Stakeholder groups oft en speak past each other or
a
o
r do not speak at all. By understanding the relationships among neighboring stake-
p
p
A holder groups, health care leaders can identify untapped sources of alignment and
cal engagement. However, we want to caution that our discussion is not harnessed to
alyti any single methodology or theory. We consider stakeholder theory to be one among
n
A many useful analytic tools—one that we have adjusted to bett er examine the con-
s,
e tentious world of health care. As a later chapter will explain, we believe that stake-
s
o
p holder theory is “good to think with.”
r
u
P O ur narrative makes an uncommon use of the fi rst-person pronoun. You will
ce: fi nd that at times the fi rst-person singular “I” directs narrative sections, while the
a
ef plural pronoun “we” drives the analytic portions. Th e divided use is intentional.
r
P
When referring to conversations with health care leaders, academic colleagues, stu-
dents, or executive education participants, the narrative refl ects the dialogues that
“I” have had with these persons. As for our research and analytic fi ndings, it is a
product of the nearly endless hours that “we” have spent discussing the causes and
possible remedies to the current health care crisis.
My collaborator and I both work on the Forces of Change program at the Harvard
School of Public Health. I founded this program nearly a decade ago with the mis-
sion of translating “theory into practice.” As such, the objective of this book is to
keep one foot in the library and one foot in the street (or board room, government
agency, hospital, physician practice, etc.). By basing our descriptions and prescrip-
tions on our discussions with representatives from multiple professional worlds—
both academic and nonacademic—we have improved our ability to keep that
divided perspective and divided audience present throughout the book.
N o project is ever successfully completed without the alignment and engage-
ment of multiple constituencies. Th erefore, I end this preface with the most diffi cult
section, the acknowledgments. As one might expect from a book on stakeholders,
there are far too many contributors to single each out. I am indebted to the count-
less students and health care executives whom I have had the honor of teaching over
the years at the “Forces of Change: New Strategies for the Evolving Health Care
Marketplace” courses at the Harvard School of Public Health and the Harvard
Extension School. I am equally indebted to the numerous health care leaders
throughout the world whom I have had the opportunity to collaborate with and
learn from over many years. More specifi cally, in terms of the work on this book,
I wish to thank my long-term colleagues at the Harvard School of Public Health,
Holly Zellweger and Christina Th ompson Lively. Both have made substantial con-
tributions to my thinking and to this book. Christina’s work on the graphics and
Holly’s overall management of this project were superior. I am also indebted to Julio ix

Frenk, dean of the Harvard School of Public Health, for his remarkable vision and
P
r
ongoing support. I also wish to thank Katherine Schlatt er for all her fi ne eff orts. e
fa
I have had the good fortune of a fi ne team from Oxford University Press, led by ce
Maura Roessner, Senior Editor; Susan Lee, Senior Production Editor; and Nicholas : P
u
r
Liu, Assistant Editor. Finally, and most notably, I wish to thank my collaborator on po
s
this book, Dr. Eric Kupferberg. Eric and I have worked and taught together for more e
s
than a decade, and I never fail to be amazed by just how smart and analytical he is. , A
n
a
I am so pleased that he elected to join me in preparing this manuscript. It has been a ly
delightful and rewarding collaboration. tica
David A. Shore l A
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Boston, Massachusett s r
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a
September 2010 c
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