1. 10/10/06 AAPHP PSTK PSAModule 6, Slide 1 AAPHP Preventive Services Toolkit Power Structure Analysis -- how to get the bureaucracy and legislature to do what you want them to do

2. 10/10/06AAPHP PSTK PSAModule 6, Slide 2 Power  Power, in an organizational setting, is the ability to get other people to do what you want them to do

3. 10/10/06AAPHP PSTK PSAModule 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

4. 10/10/06AAPHP PSTK PSAModule 6, Slide 4 PSA Rapid and User Friendly  Initial 1-2 hour meeting  Half-dozen phone calls  Follow-up ½ to 1 hour meeting

5. 10/10/06AAPHP PSTK PSAModule 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

6. 10/10/06AAPHP PSTK PSAModule 6, Slide 6 PSA: Concepts and Tools  Stakeholder  Mindsets  Character types  Self deception  Games  Government, American style  Sunburst diagram  Myths and Magic of PSA

7. 10/10/06AAPHP PSTK PSAModule 6, Slide 7 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

8. 10/10/06AAPHP PSTK PSAModule 6, Slide 8 Mindsets  Personal  Technical  Administrative  Policy/Political Personal idiosyncrasy  Organizational Culture Universal Idiosyncratic  (Graham Allison: Essence of Decision)

9. 10/10/06AAPHP PSTK PSAModule 6, Slide 9 The Hierarchy of Mindsets  Personal Idiosyncrasy /organizational cultural  Policy/Political  Administrative  Technical

10. 10/10/06AAPHP PSTK PSAModule 6, Slide 10 ”Out of the Box”  “Out of the box” thinking is often recommended  What is the “box”?

11. 10/10/06AAPHP PSTK PSAModule 6, Slide 11 Character Types  Zealot  Advocate  Statesman  Conserver

12. 10/10/06AAPHP PSTK PSAModule 6, Slide 12 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

13. 10/10/06AAPHP PSTK PSAModule 6, Slide 13 Games People Play–Technical  Low priority activities  Academic habits  “Productivity”

14. 10/10/06AAPHP PSTK PSAModule 6, Slide 14 Games People Play –Administrative  Doing what looks good on paper  Any excuse to cut (or pad) the budget  Obsession with rules and paperwork  Reorganization

15. 10/10/06AAPHP PSTK PSAModule 6, Slide 15 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

16. 10/10/06AAPHP PSTK PSAModule 6, Slide 16 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

17. 10/10/06AAPHP PSTK PSAModule 6, Slide 17 Government, American Style  Federal -- $$$$$$$$$$  State – legal authority  Local – the problem  Federalism – how levels of government relate to each other “layer cake” “marble cake”

18. 10/10/06AAPHP PSTK PSAModule 6, Slide 18 Sunburst Diagram Domains: Personal Professional Culture Administrative Policy/Political

19. 10/10/06AAPHP PSTK PSAModule 6, Slide 19 Personal Domain Personal Values Character Type Family

20. 10/10/06AAPHP PSTK PSAModule 6, Slide 20 Professional Culture (Technical) Domain Professional Goals Colleagues Peers

21. 10/10/06AAPHP PSTK PSAModule 6, Slide 21 Administrative Domain Boss Budget and Personnel Standard Operating Procedures Subordinates Regulation and Accreditation

22. 10/10/06AAPHP PSTK PSAModule 6, Slide 22 Policy/Political Domain Authorization and Funding Interest Groups Legal/ Liability/ Tort Clients/Patients Community Image

23. 10/10/06AAPHP PSTK PSAModule 6, Slide 23 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

24. 10/10/06AAPHP PSTK PSAModule 6, Slide 24 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

25. 10/10/06AAPHP PSTK PSAModule 6, Slide 25 Group Exercise  -- conduct one or more brief PSAs on situations proposed by participants

26. 10/10/06AAPHP PSTK PSAModule 6, Slide 26 Stepwise PSA Process 1.Define your proposal 2.PSA initial meeting 3.Stakeholder research 4.PSA second meeting 1. Determine feasibility 2. Identify opportunities for leverage and synergism 3. Determine needs for additional stakeholder research 4. Develop advocacy strategy

27. 10/10/06AAPHP PSTK PSAModule 6, Slide 27 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

28. 10/10/06AAPHP PSTK PSAModule 6, Slide 28 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

29. 10/10/06AAPHP PSTK PSAModule 6, Slide 29  Q and A