Module 6, Slide 1

1
AAPHPPreventive Services Toolkit

• Power Structure Analysis
• -- how to get the bureaucracy and legislature to
  do what you want them to do

2
Power

• Power, in an organizational setting, is the
  ability to get other people to do what you want
  them to do

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
PSA Rapid and User Friendly

• Initial 1-2 hour meeting
• Half-dozen phone calls
• Follow-up ½ to 1 hour meeting

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
PSA Concepts and Tools

• Stakeholder
• Mindsets
• Character types
• Self deception
• Games
• Government, American style
• Sunburst diagram
• Myths and Magic of PSA

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
Mindsets

• Personal
• Technical
• Administrative
• Policy/Political
• Personal idiosyncrasy and Organizational Culture
• Universal
• Idiosyncratic
• (Graham Allison Essence of Decision)

9
The Hierarchy of Mindsets

• Personal Idiosyncrasy /organizational cultural
• Policy/Political
• Administrative
• Technical

10
Out of the Box

• Out of the box thinking is often recommended
• What is the box?

11
Character Types

• Zealot
• Advocate
• Statesman
• Conserver

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
Games People PlayTechnical

• Low priority activities
• Academic habits
• Productivity

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
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
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
Government, American Style

• Federal --
• State legal authority
• Local the problem
• Federalism how levels of government relate to
  each other
• layer cake
• marble cake

18
Sunburst Diagram
Domains Personal Professional
Culture Administrative Policy/Political
19
Personal Domain
Personal Values
Family
Character Type
20
Professional Culture (Technical) Domain
Professional Goals
Colleagues
Peers
21
Administrative Domain
Regulation and Accreditation
Budget and Personnel
Subordinates
Boss
Standard Operating Procedures
22
Policy/Political Domain
Clients/Patients
Authorization and Funding
Community Image
Interest Groups
Legal/ Liability/ Tort
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
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
Group Exercise

• -- conduct one or more brief PSAs on situations
  proposed by participants

26
Stepwise PSA Process

• Define your proposal
• PSA initial meeting
• Stakeholder research
• PSA second meeting
• Determine feasibility
• Identify opportunities for leverage and synergism
• Determine needs for additional stakeholder
  research
• Develop advocacy strategy

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
True or False?

• There are two sides to every issue
• Theres not enough money
• Dollars are our most important resource
• What is good for me or for my agency is good for
  the community