| Course | HLTH 6405 Ethics and Social Justice |
|---|---|
| Week | Week 4 |
| Paper type | Stakeholder analysis |
| Length | About 790 words, 5 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | MS in Health Education and Promotion |
| Updated | October 2026 |
Free sample paper for HLTH 6405 Week 4
Stakeholder Analysis: Who Absorbs the Loss Under Each Option When a Rural Health System Considers Moving Labor and Delivery From Two Hospitals to One, and Which Principle Each Option Protects
Student Name
Walden University
HLTH 6405: Ethics and Social Justice
Instructor Name
Month Day, Year
Stakeholder Analysis: Who Absorbs the Loss Under Each Option When a Rural Health System Considers Moving Labor and Delivery From Two Hospitals to One, and Which Principle Each Option Protects
The Case
Prairie Valley Health, a composite rural health system, operates labor and delivery units at two hospitals 38 miles apart. The smaller hospital handles roughly 140 births annually and has struggled to staff obstetric nurses and keep physician coverage around the clock. The system is considering three options: keep both units, consolidate all births at the larger hospital or consolidate while funding services at the smaller site to reduce the effects. This analysis does not choose. It maps who loses under each option.
The Evidence on What Closures Change
A national study of births from 2004 to 2014 found that in rural counties that do not border a metropolitan area, the loss of hospital obstetric care was followed in the next year by increases in out-of-hospital births of 0.70 percentage points, births in hospitals without obstetric units of 3.06 percentage points and preterm births of 0.67 percentage points, compared with counties that kept services (Kozhimannil et al., 2018). Those are average changes across many counties; they indicate the direction of risk for the smaller hospital's community rather than a forecast for it.
Who Absorbs the Loss
Table 1
Losses by Stakeholder Under Each Option
| Stakeholder | Option A: Keep both units | Option B: Consolidate | Option C: Consolidate with local services | |
|---|---|---|---|
| Pregnant people near the smaller hospital | Little loss; local births continue, with staffing risk | Longer travel in labor; higher risk of births outside a unit, per national evidence | Longer travel in labor, partly offset by local prenatal care and transport support | |
| Pregnant people near the larger hospital | Little loss | Possible crowding as volume rises | Possible crowding as volume rises | |
| Obstetric nurses and staff at the smaller hospital | Continued strain from thin staffing | Job loss or relocation | Some roles move to prenatal and transport services | |
| Physicians covering obstetrics | Continued burden of round-the-clock call at a low-volume site | Concentrated workload at one site | Concentrated workload, with outreach duties | |
| Emergency medical services | Few changes | More transports in labor over longer distances | More transports, with planned protocols | |
| The health system | Ongoing losses and staffing risk at the smaller unit | Lower costs and more stable staffing | Lower costs than A, higher than B | |
| The smaller hospital's town | Keeps a service and its jobs | Loses a service and jobs | Loses births but keeps some jobs and services | |
Entries summarize likely effects; national evidence applies to the obstetric outcomes only.
Whose Interests Each Principle Protects
The options look like disputes about principle, but each principle, applied here, protects particular people.
Justice, understood as concern for the worse off and for fair distribution of burdens, protects pregnant people near the smaller hospital, who already face longer distances to specialty care. It favors Option A or, failing that, Option C.
Beneficence at the level of the whole system protects the larger population served by stable, well-staffed care. It can favor Option B if thin staffing at the smaller unit itself creates safety risks.
Nonmaleficence cuts both ways. Option A risks harm from understaffed deliveries; Option B risks harm from births in cars or in emergency rooms that lack a delivery service, the outcomes the national study measured.
Utility, the aim of producing the best balance of benefits over harms and costs, which public health ethics lists among its general moral considerations (Childress et al., 2002), protects the system's ability to keep other services running, favoring B or C.
Questions the Decision Makers Should Ask
The map suggests questions that matter more than which principle sounds strongest. How far will women in the smaller community actually travel in labor, and in what weather? What is the emergency medical services response time across that distance? Could prenatal visits, ultrasound and postpartum care stay local even if births move? How many of the smaller unit's nurses would accept positions at the larger hospital or in local prenatal services? And who in the smaller community will be at the table when the decision is made? Answers to these questions would change the size of each loss in the table.
What the Analysis Shows
No option spares everyone. Option A places its burden on staff and the system's finances; Option B places it on pregnant people in the smaller community and on emergency services; Option C spreads the burden but costs more than B. A public health framework would ask whether the burdens of the chosen option are minimized and whether those who bear them have a fair voice in the decision (Kass, 2001). That procedural question, who decides and how, is as important as which option is chosen.
References
Childress, J. F., Faden, R. R., Gaare, R. D., Gostin, L. O., Kahn, J., Bonnie, R. J., Kass, N. E., Mastroianni, A. C., Moreno, J. D., & Nieburg, P. (2002). Public health ethics: Mapping the terrain. Journal of Law, Medicine and Ethics, 30(2), 170-178. https://doi.org/10.1111/j.1748-720X.2002.tb00384.x
Kass, N. E. (2001). An ethics framework for public health. American Journal of Public Health, 91(11), 1776-1782. https://doi.org/10.2105/AJPH.91.11.1776
Kozhimannil, K. B., Hung, P., Henning-Smith, C., Casey, M. M., & Prasad, S. (2018). Association between loss of hospital-based obstetric services and birth outcomes in rural counties in the United States. JAMA, 319(12), 1239-1247. https://doi.org/10.1001/jama.2018.1830
HLTH 6405 Week 4 instructions, in plain terms
Week 4 calls for a stakeholder map of a decision with several options, showing who bears the loss under each one rather than choosing an answer. The analysis identifies everyone materially affected, estimates the kind and size of loss each faces under each option and, where available, uses evidence about likely effects. A table is the clearest format. Students then show how each ethical principle, applied to the case, protects particular stakeholders, which reveals that arguments about principle are also arguments about whose interests count. The analysis should stop short of a verdict but may identify questions that would change the size of losses and note the importance of fair process. Sources include empirical studies and ethics frameworks in APA format.
How the HLTH 6405 Week 4 example is put together
The sample states the case: two rural labor and delivery units, a small one delivering about 140 babies a year and three options. An evidence section reports the national study's findings on out-of-hospital, non-obstetric-unit and preterm births after closures in nonadjacent rural counties, framing them as directional rather than predictive. A table lists seven stakeholders and their losses under keeping both units, consolidating and consolidating with local services. A principles section explains that justice protects the smaller community, system-level beneficence and utility protect the wider population and the system's capacity, and nonmaleficence cuts both ways. A section lists questions about travel, emergency response, local prenatal care, staff and community voice. A closing section notes that no option spares everyone.
Where the marks sit in the HLTH 6405 Week 4 rubric
Stakeholder analyses are graded on completeness and on linking principles to people. Faculty reward analyses that identify all materially affected groups and describe each group's loss under each option, and they deduct for analyses that list stakeholders without comparing options. Using evidence to estimate effects, with appropriate caution, earns credit. Showing which stakeholders each principle protects is the distinctive skill of this assignment. Restraint from choosing an option is expected, though procedural observations are welcome. Accuracy in reporting evidence matters. A clear table aids grading. Identifying the questions that would change the analysis shows judgment. APA citations for studies and frameworks complete the requirements.
Common HLTH 6405 Week 4 mistakes, and how to avoid them
Stakeholder analyses often fall short by naming stakeholders without describing what each loses under each option. Another common problem is jumping to a recommendation, which turns the analysis into a position paper. Some students also treat principles abstractly instead of showing whom each protects. To write a stronger analysis, list every group the decision touches. Build a table with options across and stakeholders down. Fill each cell with a specific loss. Add evidence where it exists. Then write one paragraph per principle naming the stakeholders it protects. End with the questions that would change the table. For a stakeholder map of the decision your section assigned, our writers can build the table and the principle analysis.
Get a HLTH 6405 Week 4 example written to your instructions
A worked HLTH 6405 stakeholder analysis is held here, the matrix populated in real consequences and the equity passage kept separate. Should the service change be one your own workplace faces, its board papers and figures never cross into a draft. Send the prompt and the rubric your section posted and the first custom sample comes back free inside 24-48h.
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HLTH 6405 Week 4 questions, answered
Where can I find a free HLTH 6405 Week 4 sample paper?
The complete Week 4 stakeholder analysis of consolidating rural labor and delivery units, with a loss table and three references, can be read here.
What options does the HLTH 6405 Week 4 analysis compare?
Keeping both labor and delivery units, consolidating births at the larger hospital, or consolidating while funding prenatal care and transport at the smaller site.
What does national evidence show about rural obstetric closures?
Where remote rural counties lost hospital obstetric care, births outside hospitals, births in hospitals with no delivery unit and preterm births all rose the next year.
Which principle protects the smaller community?
Justice, understood as concern for the worse off and fair distribution of burdens, favors keeping services or at least funding local support.
Does the analysis recommend an option?
No. It shows that every option places burdens on someone and stresses that those who bear them should have a fair voice in the decision.