dividuals and/or the group. Focus groups or informal group discussions can engage groups of stakeholders, customers or potential customers in a dialogue to gather information on attitudes, relationships and support for issues.

            As issues and positions of the key stakeholders emerge, more structured tools can assist in quantifying and summarizing stakeholder positions and levels of support or opposition. Medical record reviews can be used to collect information on the process and outcome of patient care and information tracking.  They also provide insights into what is valued and how the processes of patient care operate. Surveys can elicit supplemental data on satisfaction levels, measures of the relationships, measures of quality of care, and health behaviors that are the target of health care interventions.  Surveys may also be used to validate data collected from other sources. The use of semi-quantitative checklists can be used to help quantify stakeholder positions and levels of stakeholder support or opposition. Checklist can also be used to gather and organize basic descriptive data on stakeholder’s organizational structures and processes.

Interview and observational data, focusing on the individual or organizational personnel, relationships, affiliations, customers and the community can be used to create an organizational chart, map or genogram.[17] This visual depiction of the key actors and their relationships evolves as it is refined during interviews with key people and observations of the organization and its affiliates.


Organizing and analyzing data

            Once stakeholders are identified, contact is established and the data collection ensues, data analysis also begins. The framework for analysis is, once again, determined by the aim or purpose of the stakeholder inquiry. Global assessments can inform stakeholders influence toward an organization generally, however, a more precise appreciation of stakeholder influence on and attitude toward the specific topic/issue under consideration is needed in order to inform management issues. Analyses first must evaluate of the level of stakeholder influence and then determine if, at the present time, the stakeholder is in favor of, opposed to, or uncommitted and neutral toward the issue in question.

During an iterative synthesis of multiple data sources, attributions which are confirmed by multiple sources are retained, whereas preliminary findings are deleted when they are refuted by multiple data sources.  Some findings that appear to be important, but which cannot be confirmed from more than one source are noted and discussed by the team.  Additional data that would confirm or refute these items are identified and subsequently collected if possible.  If there is not time to collect additional data, these items can be discussed with the stakeholder for further clarification.

Using quantitative tools can offer a reliable way of obtaining stakeholder assessments that allow for cross comparisons of rankings. Organizing incoming data into tables or maps can help quantify stakeholder interests, assets and/or influence, support or opposition toward change and provide a basis for ranking the level of importance of each. Using structured tools such as Delpi questionnaires, lickert scales or preferential rankings may be used to elicit further additional data by adding to earlier interview or observational qualitative data.[6, 14] The limitations of such tools lie in that they offer a real time interpretation in what may be a rapidly changing environment. The positions and influence of stakeholders are subject to change at any time due to internal or external pressures or events.

Interpretations of data are always provisional and open to ongoing revisions as incoming data dictate. Data collection and analysis are iterative processes, a continual building and refining of understanding until all stakeholders have been identified and assessed. A composite of stakeholder positions, relationships and potential for influence is continually evaluated for validity by triangulating results and explanations across data sources.  Analysis team members, supervisors or other neutral parties need to review assessments to check for bias and to seek consensus on rankings, judgments or scores. Explicit criteria for making such assessments should be established and defined in codebooks prior to analysis in order to reduce research bias.

In some cases feedback of interim data in the form of summary discussions or reports may help build trust and rapport and offer the opportunity for stakeholders to correct inaccuracies, give additional information or qualify earlier responses. The interactive presentation of the assessment findings serves to validate the experiences of the stakeholders and to facilitate a process of communication, learning and planning change.  In other instances feedback is not beneficial as it may influence or change stakeholder attitudes, or be inappropriate if stakeholders are in a position to influence the analysis or analysis outcome.

Interim outputs of matrix tables or maps [6, 14, 20] can be constructed to quantify stakeholder interest in an issue, the resources and/or influences they may bring to bear, their support of opposition to moving in particular directions and what level of importance to give to each. A wide variety of tools and/or processes can be used to map, organize and/or prioritize the positions of stakeholders in relation to a particular issue and to each other. Stakeholder mapping creates a visual depiction of the connections between and among stakeholders; position held in regard to the issue at hand, availability of resources, level of control over decision-making, degree of motivation toward issue/project, etc.. Maps or chart can also reflect the level and degree of connections among actors in terms of responsibility or organization member assessments and feedback.


Presenting findings (outputs)

A variety of figures can be used to present data, including a variety of matrices, charts, position maps, network maps. These tools can function both as a place to organize data and a format for analysis and for understanding and planning future decision-making. Matrices can illustrate characteristics, interests, levels of influence; available resources etc. of each stakeholder and provide a format for cross comparison of traits. At times, with large numbers of stakeholders the maps and figures can become too complex and muddled.

            A forcefield [6] graphic illustration can track characteristics over time, allowing for predictions of future changes based on past decisions. This historical picture can be helpful when analyzing past policies, evaluating previous projects or for assessing and managing relationships with stakeholders for strategic advantage. A multi-dimensional diagram such as this can be repeated at later stages to see changes and new developments in stakeholder opinions and influence.

Analysis over time helps validate approaches to stakeholder management. Stakeholder analysis not only identifies characteristics of stakeholders with regard to the issue of interest, but can also be used to illustrate organizational relationships and predict or help develop stakeholder alliances. Understanding the nature and strength of these relationships can help develop strategies for managing stakeholders. Stakeholder mapping of relationships can show influence, potential influence, conflictual relationships, identify and current and future opportunities and threats and how best to handle them.[3]

The choice of tools or approaches will be determined by the characteristics of the issue or aim of the stakeholder analysis, the context or the environment in which the analysis takes place and the appropriate level of analysis. The goal of the synthesis and analysis is to create a summary description of stakeholders that begins the process of organizational planning, intervention or evaluation. 


Using the findings

            Stakeholder analysis is useful as a management and strategic tool. Best strategies for dealing with stakeholders can be identified and current and future opportunities or threats can be revealed, planned for or dealt with.  Successful stakeholder analysis identifies the “optimal fit” of the ideal level of attention and importance to pay to stakeholders.[9]. Managing stakeholders is best achieved by determining the potential level of threat and cooperation for each type of stakeholder and responding appropriately. For a supportive stakeholder, involvement is a best fit, for the non supportive, a defensive strategy, collaboration for ‘mixed blessing’ stakeholders, (those who exhibit elements of support and threat), and monitoring of marginal stakeholders who represent low threat and low cooperation. The consequences of finding or not finding an optimal fit are illustrated below in Figure 1. As illustrated, a poor fit can mean missed opportunities, facing unnecessary risk and wasted energy.





Figure 1 Strategies for managing stakeholders according to their organizational positions[6]


Optimal fit between diagnosed position and strategy

Suboptimal fit leading to excess attention to low potential stakeholder

Suboptimal fit leading to missed opportunities for gaining support

Suboptimal fit placing venture/organization at risk









Optimal fit

Missed opportunities

Missed opportunities

Missed opportunity



Optimal fit

Missed opportunities

Missed opportunities

And risk




Optimal fit



Resource waste

Resource waste

Resource waste

Optimal fit



For successful implementation of a project or policy the key relationship require careful management. Strategies for dealing with influential stakeholders with strong opposition to the project are necessary, while those stakeholders with considerable available resources but limited interest may need extra attention. Efforts to build strong alliances are critical in relationships with stakeholders who have both high interest and high influence toward a project.

Data and analysis sources may remain as internal documents in the organization for internal management issues, but when the inquiry is for the purpose of evaluation results often become public. It is important to create a careful balance of private and public information to fit with the culture of the organization under review in order to avoid creating ill-will or confusion.


Stakeholder Analysis Matrices:


Figure 2   Stakeholder Assessment [11]


-         identified 4 kinds of stakeholders

-         rates stakeholder importance










Low Priority




Advocate Stakeholders


   Oppose   -5


Stakeholder position

     on issue



                                                  Support  +5


                                                                            0                                       10

                                                                        Least                                 Most


                                                                                  Stakeholder Importance





Figure 3   Resource Assessment [11]                                                            


-         categorizes the kind of resource that could be available to support a strategy

-         rates relative importance of resource  


















                                                      Never     -5



              of Resources




                                                 Always        +5

0                                                                                                10

Least                                      Most




Figure 4  Types of Organizations [11]

            -Where organizations are defined as one of 4 basic types

- Where successful strategy requires that buffeted organizations evolve towards proactive organizations

- Proactive organizations are distinguished by

            a. having a clear agenda tied to a generally acceptable vision

b. incorporating important stakeholders, even those who disagree, into the process

c. operating in a win-win context through cooperation rather than internal completion

            d. always maintaining political and public support















External control





                                                                                    Internal capacity                         High





Figure 5   Issue Portfolio [11]

-         Assesses impact of issues on business strategy by identifying tractability

-         tractability is defined as the prospect that an issue can be attacked by an organization

-         Rates stakeholder (customer, supplier, distributor) support of issue

-         Successful business strategy requires some productive links to stakeholder concerns. Strategy should either reflect issues that are sitting ducks or should reflect issues management intends to make sitting ducks --- by increasing stakeholder support for dark horse issues or developing internal capacity to support angry tiger issues.
























                                                                 High                                 Low


                                                                          Relative Stakeholder



Figure 6  Stakeholder analysis [3]












                    Low                   Medium               High









Figure 7  The uncertainty/importance grid --- stakeholder application[3]




Group will support project





Low importance                                                     Very important                  












Limitations, validity and reliability of the analysis:

            The limitation of stakeholder analysis lies in the fact that information is cross-sectional, or valid for a point in time. In light of the often quickly changing environment of the healthcare environment today care must be taken in drawing conclusions. The time frame of data collection and the time between data collection and data analysis can quickly affect the relevance of the analysis for informing management or decision-making.

            In conducting analysis careful attention needs to be accorded in attempting to interpret responses. Information should be considered in terms of the position of the source within the organization and how stable the position may be, the possibility that responses reflect individual views different than others in the organization or are influenced by implicit or covert positions not revealed to the analyst. It may not be realistic to fully establish the validity or reliability of responses but the careful progress of data collection and analysis can make determining positions more evident.


Future directions

Stakeholder analysis, though specific and defined for the purposes of this chapter, is similar to or embedded within process descriptions and objectives in current management literature. References to “shareholder or stakeholder impact analysis,”[21] “fostering generative relationships,”[13, 22] and “linkage analysis”[12, 14], are all representative of ways of evaluating and managing relationships with key stakeholders. “Alliance Development Metrics” is a stakeholder analysis tool that can be used to develop financial partnerships across organizations [23].

 A recently proposed updated version of a strategic planning model for organizations highlights a continuous cycling process in place of the static, linear formula of traditional strategic planning models.[21] In this new model the ‘shareholder impact analysis’ stage, as are all stages, is iterative and continuous, mimicking the ever changing real world. It is within such a framework that traditional stakeholder analysis can be updated in order to better meet the needs of a rapidly changing health care environment..

Some propose moving beyond mere stakeholder analysis toward “stakeholder synthesis” as a way of bringing business ethics into the decision-making process between stakeholders [24]



Stakeholder analysis is relevant for informing health services delivery and health services management. The systematic approach of traditional stakeholder analysis, with its emphasis on predicting and planning for the future may seem ill suited to a time of constant change and turmoil in health care. But, by highlighting the need for an iterative process and a concentrated time frame for analysis and use of data it remains a useful tool for generating knowledge, understanding behavior and assessing influence.




1.         Blair, J.D. and J.A. Buesseler, Competitive forces in the medical group industry: A stakeholder perspective. Health Care Management Review, 1998. 23(2): p. 7-27.

2.         Rotarius, T., M.D. Fottler, and J.D. Blair, Medical Group Affiliations; interorganizational relationships and organizational performance. Health Care Manager, 2003. 22(1): p. 27-33.

3.         Grundy, T., Accelerating strategic change: the internal stakeholder dimension. Strategic Change, 1997. 6: p. 49-56.

4.         Brugha, R. and z. Varvasovszky, Stakeholder analysis: a review. Health Policy and Planning, 2000. 15(3): p. 239-246.

5.         Simmons, J., P. Iles, and M. Yolles, Identifying those on board 'the moving train': towards a stakeholder-focused methodology for organizational decision making. Systems Research and Behavioral Science, 2005. 22: p. 41-53.

6.         Varvasovszky, Z. and R. Brugha, How to do (or not to do). a stakeholder analysis. Health Policy and Planning, 2000. 15(3): p. 338-345.

7.         Friedman, A.L. and S. Miles, Developing Stakeholder Theory. Journal of Management Studies, 2002. 39(1): p. 0022-2380.

8.         Blair, J.D. and M.D. Fottler, Strategic Leadership for Medical Groups. 1998, San Francisco: Jossey-Bass Publishers.

9.         Blair, J.D. and M.D. Fottler, Challenges in health care management: strategic perspectives for managing key stakeholders. 1990, San Francisco, CA: Jossey-Bass.

10.       Kernick, D., ed. Complexity and Healthcare Organization; a view from the street. Radcliffe Medical Press: San Francisco.

11.       Nutt, P. and R. Backoff, Strategic Management of Public and Third Sector Organizations. 1992, San Francisco: Josey-Bass.

12.       Primozic, K.I., E.A. Primozic, and J. Leben, Strategic Choices; Supremacy, Survival, or Sayonara. 1991, New York: McGraw-Hill Inc.

13.       Senge, P.M., The Fifth Dicipline, the art and practic of the learning Organization. 1990, New York: Bantam Doubleday Dell Publishing Group Inc.

14.       Shortell, S.M. and A.D. Kaluzny, eds. Health Care Management; organization design and behavior. Delmar eries in health services administration, ed. S.J. Williams. 2000, Delmar Thomson Learning: Albany.

15.       Walt, G., ed. Health policy: an introduction to process and power. 1994, Zed Publications: London.

16.       Blair, J.D., et al., The problematic fit of diagnosis and strategy for medical group stakeholders - including IDS/Ns. Health Care Management Review, 1996. 21(1): p. 7-28.

17.       Crabtree, B.F. and W.L. Miller, eds. Doing Qualitative Research. 1999, Sage Publications Inc.: Thousand Oaks.

18.       Daft, R.L. and R.H. Lengel, Fusion Leadership. 1998.

19.       Cooperrider, D.L. and D. Whitney, A Positive Revolution in Change: Appreciative Inquiry, in Appreciative Inquiry, D.L. Cooperrider, et al., Editors. 2001, Stipes Publishing LLC: Champaign IL.

20.       Studin, I., Strategic Healthcare Management; applying the lessons of today's top management experts to the business of managed care. 1995, New York: Irwin Professional Publishing.

21.       Begun, J. and K.B. Heatwole, Strategic Cycling: Shaking Complacency in Healthcare Strategic Planning, in Health Services Management, A.R. Kovner and D. Neuhauser, Editors. 2001, Health Administration Press: Chicago.

22.       Lane, D. and R. Maxfield, Strategy Under Complexity: Fostering Generative Relationships. Long Range Planning, 1996. 29(2): p. 215-231.

23.       Segil, L., Partnering: metrics matter. Financial Executive, 2004. 20(9).

24.       Goodpaster, K.E., T.D. Maines, and M.D. Rovang, Stakeholder thinking: beyound paradox to practicality. Journal of Corporate Citizenship, 2002. 93(19).


 Informational Websites

http://msh.org/   Management Sciences for Health - a nonprofit educational and scientific organization to support public health decision makers in developing countries.

erc.msh.org/quality/ittools/itstkan.cfm  A Quality Guide from the Managers Electronic Resources Center


GUIDANCE NOTE ON HOW TO DO STAKEHOLDER ANALYSIS OF AID PROJECTS AND PROGRAMMES. Overseas Development Administration (http://www.dfid.gov.uk/)                         Social Development Department of the government of the United Kingdom
July 1995

http://www.isixsigma.com/dictionary/Stakeholder_Analysis-198.htm Reference Section on Stakeholder analysis from the business journal iSixSigma

http://www.ctg.albany.edu/publications/guides/and_justice_for_all?chapter=8&section=2   article from center for technology in government works with government to develop information strategies that foster innovation and enhance the quality and coordination of public services.