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High StakesThe Critical Role of Stakeholders in Health Care$

David A. Shore

Print publication date: 2011

Print ISBN-13: 9780195326253

Published to Oxford Scholarship Online: September 2011

DOI: 10.1093/acprof:oso/9780195326253.001.0001

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(p.vii) Preface: Purposes, Analytical Approach, and Source Material

(p.vii) Preface: Purposes, Analytical Approach, and Source Material

High Stakes
Oxford University Press

This 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. These dialogues are far from finished. Part of the nature of productive dialogues is that they are ongoing. This book makes no pretence of being the final word on health care considerations. The health care landscape is in a constant state of flux. 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 written 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 fit neatly into liberal or conservative political agendas. Instead, we believe that our discussion of stakeholder groups and their interrelationships will aid in the articulation and implementation of new policies across the ideological spectrum. Our descriptions of stakeholder conflicts and our prescriptions for their remedy, we hope, will cut through and across oppositional positions. They will encourage dialogue where previously there had been either striking silence or deafening dismissal.

We expect that this book will be controversial. In fact, its relevance will ensure that it will find 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. The premise of this book is that the warring stakeholder parties in health care can be identified by their stated affiliations, their declared interests, and their behaviors. They are also defined by the alliances that they form (p.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, stakeholder groups define the battle lines and determine who “wins” and who “loses” in ongoing struggles. If this book offers new and unique insights into the current state of affairs, it is our use of stakeholder theory that most helped us arrive at these insights.

We are also convinced that stakeholder analysis can help health care leaders understand the forces that get in the way of forming productive relationships with other leaders and organizations. Stakeholder groups often speak past each other or do not speak at all. By understanding the relationships among neighboring stakeholder groups, health care leaders can identify untapped sources of alignment and engagement. However, we want to caution that our discussion is not harnessed to any single methodology or theory. We consider stakeholder theory to be one among many useful analytic tools—one that we have adjusted to better examine the contentious world of health care. As a later chapter will explain, we believe that stakeholder theory is “good to think with.”

Our narrative makes an uncommon use of the first-person pronoun. You will find that at times the first-person singular “I” directs narrative sections, while the plural pronoun “we” drives the analytic portions. The divided use is intentional. When referring to conversations with health care leaders, academic colleagues, students, or executive education participants, the narrative reflects the dialogues that “I” have had with these persons. As for our research and analytic findings, 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 mission 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 prescriptions 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.

No project is ever successfully completed without the alignment and engagement of multiple constituencies. Therefore, I end this preface with the most difficult 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 countless 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 specifically, 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 Thompson Lively. Both have made substantial contributions to my thinking and to this book. Christina’s work on the graphics and (p.ix) Holly’s overall management of this project were superior. I am also indebted to Julio Frenk, dean of the Harvard School of Public Health, for his remarkable vision and ongoing support. I also wish to thank Katherine Schlatter for all her fine efforts. I have had the good fortune of a fine team from Oxford University Press, led by Maura Roessner, Senior Editor; Susan Lee, Senior Production Editor; and Nicholas Liu, Assistant Editor. Finally, and most notably, I wish to thank my collaborator on this book, Dr. Eric Kupferberg. Eric and I have worked and taught together for more than a decade, and I never fail to be amazed by just how smart and analytical he is. I am so pleased that he elected to join me in preparing this manuscript. It has been a delightful and rewarding collaboration.

David A. Shore

Boston, Massachusetts

September 2010 (p.x)