MPH 610 Week 6 Stakeholder Analysis Example

Stakeholder Analysis: Who Can Make, Stop or Quietly Ignore the Decision to Use a Written Rabies Prophylaxis Protocol in Kessler County

Student Name

Chamberlain University

MPH 610: Integrative Learning Experience (ILE) and Applied Practice Experience (APE) I

Instructor Name

Month Day, Year

Stakeholder Analysis: Who Can Make, Stop or Quietly Ignore the Decision to Use a Written Rabies Prophylaxis Protocol in Kessler County

The Decision

The decision this analysis is anchored to is specific: whether the county health department adopts the written prophylaxis consultation protocol I am drafting, and whether the two emergency departments in the county use it when they call for advice. Adoption on paper requires the health officer's approval. Use in practice requires emergency clinicians to follow the protocol's recommendation, especially the recommendation to wait for a 10-day observation when a vaccinated dog or cat is available, rather than starting prophylaxis at once. A protocol that is approved but not used would leave the current inconsistency in place.

Stakeholders, by Role

Stakeholders are identified by role rather than by name, because roles persist when people change.

Table 1

Stakeholders in the Decision to Use the Protocol

Note. Note. Positions based on meetings and calls during the applied practice experience.

Who Could Stop It

Two roles can stop or stall the protocol. The health officer can refuse approval, though this is unlikely if the protocol follows national and state guidance closely. The more serious risk is the emergency department medical director, who does not need to oppose the protocol to defeat it; a director who neither endorses it nor tells clinicians about it leaves it unused. Clinicians who prefer to start prophylaxis immediately, often out of fear of missing a rare but fatal disease, will continue to do so unless someone they trust explains why observation of a vaccinated, available animal is the recommended course (Rupprecht et al., 2010).

Low Power, High Stake

Patients and families have the highest stake and the least power over the decision. A family whose child was bitten by a neighbor's dog may be frightened and want prophylaxis now, and a clinician may find it easier to agree than to explain observation. The protocol includes a short script for clinicians and program staff explaining, in plain terms, why waiting for observation is safe when the animal is vaccinated and available, and what the family should do if the animal becomes ill or cannot be found. The family's fear is legitimate and the protocol has to answer it, not override it.

Engagement With a Channel

Each stakeholder has a specific channel. The health officer receives the draft through the manager, who has scheduled a review. The medical director is approached through the nurse educator, who has worked with the health department on other reporting rules and is trusted by both sides. Clinicians are reached through shift huddles, a one-page summary posted in each department and the call script itself, which reinforces the protocol each time they call. Pharmacy is informed through the medical director, since fewer unneeded courses of rabies immune globulin reduce costs. Patients are reached through the script.

What Would Signal Success or Failure

Success would be the medical director agreeing to mention the protocol in a staff meeting and allowing it in the department's reference folder, and the technician reporting fewer calls in which clinicians start prophylaxis before calling. Failure would be approval by the health officer without any word from the emergency department. If that happens by week 8, I will report it plainly and recommend that the manager raise the protocol at the hospital's next infection prevention committee, which includes both directors.

References

Rupprecht, C. E., Briggs, D., Brown, C. M., Franka, R., Katz, S. L., Kerr, H. D., Lett, S. M., Levis, R., Meltzer, M. I., Schaffner, W., & Cieslak, P. R. (2010). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations and Reports, 59(RR-2), 1-9.