10/10/06 AAPHP PSTK PSA Module 6, Slide 1

AAPHPPreventive Services Toolkit

Power Structure Analysis

-- how to get the bureaucracy and legislature to do what you want them to do

10/10/06 AAPHP PSTK PSA Module 6, Slide 2

Power

Power, in an organizational setting,

is the ability to get other

people to do what you want

them to do

10/10/06 AAPHP PSTK PSA Module 6, Slide 3

Definition of PSA

Power Structure Analysis (PSA) is a rapid and user-friendly protocol for stakeholder analysis designed to

Develop advocacy strategy Determine feasibility of adoption of proposals Identify stakeholder-related leverage and barriers

10/10/06 AAPHP PSTK PSA Module 6, Slide 4

PSA Rapid and User Friendly

Initial 1-2 hour meeting Half-dozen phone calls Follow-up ½ to 1 hour meeting

10/10/06 AAPHP PSTK PSA Module 6, Slide 5

PSA - Teaching Objectives

Describe concepts and tools of Power Structure Analysis (PSA)

Address mindset-related barriers to preventive services

Conduct a Power Structure Analysis

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PSA: Concepts and Tools

Stakeholder Mindsets Character types Self deception Games Government, American style Sunburst diagram Myths and Magic of PSA

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Stakeholder

-- any person or interest group that cares enough about an issue or proposal to either support or oppose it

-- any person or group with an interest in the success of the enterprise

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Mindsets

Personal Technical Administrative Policy/Political

Personal idiosyncrasy Organizational Culture

Universal Idiosyncratic

(Graham Allison: Essence of Decision)

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The Hierarchy of Mindsets

Personal Idiosyncrasy /organizational cultural

Policy/Political Administrative Technical

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”Out of the Box”

“Out of the box” thinking is often recommended

What is the “box”?

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Character Types

Zealot Advocate Statesman Conserver

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Games

Dysfunctional patterns of behavior Self Deception

Usually sincere Rarely ill intentioned

Games almost always damage the efficiency, economy and/or mission of the agency

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Games People Play–Technical

Low priority activities

Academic habits

“Productivity”

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Games People Play –Administrative

Doing what looks good on paper

Any excuse to cut (or pad) the budget

Obsession with rules and paperwork

Reorganization

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Games People Play –Policy/Political

Glib assertions easier than hard facts

Simple myths easier than complex reality

Public servant (or staff) portrayed as lazy or undedicated

Health Care Delivery Games Skimming Dumping Inappropriate Utilization

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Games People Play –Personal/Organizational Culture

“Going with the flow” “getting along”

Reluctance to suggest promising new ideas

Silence in the face of incompetent or inappropriate behavior

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Government, American Style

Federal -- $$$$$$$$$$ State – legal authority Local – the problem Federalism – how levels of

government relate to each other “layer cake” “marble cake”

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Sunburst Diagram

Domains:

Personal

Professional Culture

Administrative

Policy/Political

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Personal Domain

Personal Values

Character Type

Family

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Professional Culture (Technical) Domain

Professional Goals

ColleaguesPeers

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Administrative Domain

Boss

Budget and Personnel

Standard Operating

Procedures

Subordinates

Regulation and Accreditation

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Policy/Political Domain

Authorization and Funding

Interest Groups

Legal/ Liability/ Tort

Clients/Patients

Community Image

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Leverage

The ultimate goal of the PSA exercise is leverage. This is the identification of an advocacy strategy by which one can use the perspective of one or more of the major stakeholders to influence others on your behalf.

-- getting someone in another domain so excited about your proposal that they will advocate for it on your behalf

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Examples of Leverage

Tobacco Control Legislation Getting hotel owners to advocate because of

reductions to their cleaning costs and property damage

Getting restaurant owners to advocate to avoid installing costly air handling systems

Health club services and nutrition counseling Getting marketing to advocate to help

attract low-risk enrollees

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Group Exercise

-- conduct one or more brief PSAs on situations proposed by participants

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Stepwise PSA Process

1. Define your proposal2. PSA initial meeting3. Stakeholder research4. PSA second meeting

1. Determine feasibility2. Identify opportunities for leverage and synergism3. Determine needs for additional stakeholder research4. Develop advocacy strategy

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The Magic of PSA

New Ideas and program options Leverage Health outcomes not otherwise

achievable Prevent you from being “blindsided” Political support for yet other

initiatives

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True or False?

There are two sides to every issue There’s not enough money Dollars are our most important

resource What is good for me or for my

agency is good for the community

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Q and A