4.3 From stakeholder identification to analysis
Once you have identified who the stakeholders are the next step is to see whether some of them form into groups that can usefully be considered together. For example, in the case of a new IT system that will automatically record and track the progress of production jobs through a factory we can distinguish those stakeholders who lie within the project (number 4 on the list), those stakeholders who lie outside the project but within the organisation (numbers 1, 2, 3, 6, 7 and 8) and those who are external to the project and the organisation (numbers 5 and 9).
Now read the short description of Riverside House’s situation and try to identify five groups of stakeholders and think about why you have selected them.
Riverside House is a large NHS general practice. For a variety of reasons they decide to move from a paper-based patient records system to a fully computerised one, which will store records of patients’ details and medical history, will issue prescriptions, and share information with other institutions (such as local hospitals, NHS Trusts, and different practices). A standard software package has been used for this purpose in several other local practices, and Riverside House decides to use this also. They contract with a company that has worked with many of the other practices to install appropriate computers, software and networks, to maintain the hardware and software, and to train staff in the system’s use. It is not correct to say that the practice is introducing an IT system where none previously existed: the paper-based system also held information, albeit in a different form and allowing different things to be done. It is more useful to think of them as changing the ‘technology’ of their patient records system from paper- to computer-based. Each ‘technology’ allows users to do some things better and makes them do some things worse.
The stakeholder groups that occurred to us include:
- Receptionists. With the paper system, they were the people who had the clearest relationship with the patients’ information. They had to look it up in the files, get it out for the doctors or nurses, make changes to address details, etc. If doctors and nurses are able to look up details for themselves, receptionists might feel their jobs to be threatened (especially if the system has been ‘imposed’ on them by more senior staff). However, they will still need to enter new and changed details on the system, and generally be the central point for the management of patient information.
- Doctors and nurses. These groups have a similar interest in the working of the new system. Each needs access to the records of the patients they are seeing next. They will be working with those records in a new way in the computerised system, but more or less carrying out the same tasks. The new system should make it easier for them to see patients, and access their records outside of normal working hours when receptionists might have gone home. As the system issues prescriptions, doctors will no longer need to write these by hand.
- Patients. The new system makes it easier for patients to obtain repeat prescriptions as the information is more readily to hand. If they go to the hospital for treatment, their details can be printed out or sent electronically, making it less likely that there will be errors as they are copied from one paper form to another. The new system might mean they have greater access to their records if requested as the records will not be written in many different styles of handwriting; but the fact that they are stored on computer might also make patients more nervous about asking for the information.
- Practice management. Those running the practice find that the system has particular benefits in the collection of various statistics to be passed on to the NHS Trust and to government departments. There is an increasing demand for such statistics: to measure the effective spending of public money; to monitor the success of health education campaigns; to look for trends in various conditions. Computerised patient information makes the collation of such statistics much easier. They may also find that planning for staff use within the practice is easier.
- Computer system retailers/maintainers. Clearly they have benefits in selling their products and services in the first place. However, it is often the case that their interests are rather different from those of the various user groups: changes to the software that might benefit the users could be very difficult or expensive for the system maintainers to carry out; and new features that developers think are a good idea might turn out not to be used by anyone. In this example, it is very clear that the computer people are hired by Riverside House, and so decisions rest with Riverside; within a larger organisation (with internal computer staff), it is often not so clear who should make decisions.
- Wider groups such as local NHS Trust, local hospitals, government, local community, drug companies, etc. who have some interest in the effects of the IT system at Riverside. We have seen some of the interests of local hospitals, NHS Trusts and government already – though it is worth noting that all those groups want to spend as little money as possible, and the computerised system may cost more. The wider local community is affected by any change to the health of their neighbours, friends, family or employees that might be caused by changes at Riverside (the new system will not necessarily make such changes, but it might). And many further groups might be thought about – to pick one example, what if drug companies could pay to have their drug’s name appear first on the list when doctors are creating a prescription?