DDHA 9901 Week 7 Stakeholder Map Example

Who Has a Reason to Say the Discharge Summary Problem Is Imaginary: A Stakeholder Map Sorted by What the Current Arrangement Gives Each Group

Student Name

Walden University

DDHA 9901: Practice-Based Problem Identification

Instructor Name

Month Day, Year

Who Has a Reason to Say the Discharge Summary Problem Is Imaginary: A Stakeholder Map Sorted by What the Current Arrangement Gives Each Group

The Rule for Sorting

This map sorts the groups involved in Larchmont Health's discharge summary problem by what the present arrangement gives them and costs them, and by how visible the problem is from where they sit. Larchmont is a composite two-hospital system. Groups appear as roles rather than as individuals. Visibility matters most: a group that never encounters the failure has no dishonest motive for denying it, and its denial tells us about the organization's blind spots rather than about anyone's interests. The longest section concerns the groups who would dispute the framing, each paired with the counter-account they would bring.

The Map

In the salience framework of Mitchell et al. (1997), managers notice groups that can force outcomes, whose claims seem rightful and whose demands cannot wait. The independent practices have legitimacy and urgency but little power inside Larchmont, which helps explain why a problem they experience every week has never been formally recorded.

Table 1

Groups, What the Arrangement Gives and Costs Them, and Visibility

Roles and the characteristics recorded for them come from one interview per role and from the term's evidence log.

The Disputers and What They Would Bring

Hospitalists are likely to say the problem is not theirs. Their counter-account is the signature data, which show summaries signed within two days in most cases, far inside every deadline that applies to them. The account is accurate, and the problem framing should accept it. The evidence shows the failure is in delivery, not signing, and the identification paper should say so plainly rather than implying that hospitalists are slow.

Health information management is likely to say there is no shortfall, pointing to its completion rate, which meets the federal record completion rule. The response is that the completion rule measures whether summaries are finished, not whether they reach the next clinician, and that the benchmark comparison showed Larchmont performing well on completion while falling short against its own contract term on transmission.

The interface team is likely to argue that the sending process works and that failures come from practices without secure addresses or from inaccurate registration data. Their counter-account is largely supported by the evidence: the system sends summaries automatically when the data are right. The disagreement is about framing, not facts. The interface team would frame the problem as a data quality issue outside its responsibility; the identification paper should frame it as a gap that falls between several groups, none of which owns the whole transfer.

Patient access staff may say that the primary care field is reported by patients and that many do not know or do not state their clinician. A study of summaries at another health system found the outpatient follow-up provider frequently missing (Were et al., 2009), which suggests the weakness is common rather than peculiar to Larchmont's registration desk. The response is that the field can be verified at registration or by case managers before discharge, and that the evidence log found it blank for 11% of discharges.

The transitions committee is the most important disputer, because it has already framed the problem around a platform. It would not deny the problem but would contest the finding that the cause is registration data and unregistered practices rather than the absence of a product. Its counter-evidence would be vendor material describing improved delivery at other hospitals. The response is that those results came from settings where the causes may differ and that a platform depending on the same registration field would inherit the same failure.

The Group Without a Voice

Patients are the group most affected by the content of the summary and least represented in any discussion of it. Kripalani et al. (2007) linked failures of information transfer at discharge to risks for patients, yet no patient group or advisory council has been asked about this problem at Larchmont. The map records that absence rather than speaking for them.

Putting the Map to Work

The map will shape how the identification paper is presented. Each disputer's counter-account will be acknowledged in the paper, with the evidence that answers it, so that no group reads the paper as blaming it for a failure that belongs to the whole path. The paper will be shared first with the physician liaison and accountable care leadership, who see the problem most clearly from inside, and then with the other groups together.

What the Map Shows

No group owns the whole path from signature to delivery. Each group can accurately say that its own part works, and each is measured on its own part. That is the structural reason the problem has persisted, and it is the finding the stakeholder map adds to the case.

References

Kripalani, S., LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., & Baker, D. W. (2007). Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. JAMA, 297(8), 831-841. https://doi.org/10.1001/jama.297.8.831

Mitchell, R. K., Agle, B. R., & Wood, D. J. (1997). Toward a theory of stakeholder identification and salience: Defining the principle of who and what really counts. Academy of Management Review, 22(4), 853-886. https://doi.org/10.2307/259247

Were, M. C., Li, X., Kesterson, J., Cadwallader, J., Asirwa, C., Khan, B., & Rosenman, M. B. (2009). Adequacy of hospital discharge summaries in documenting tests with pending results and outpatient follow-up providers. Journal of General Internal Medicine, 24(9), 1002-1006. https://doi.org/10.1007/s11606-009-1057-y