Module 6, Slide 1

1
AAPHPPreventive Services Toolkit

• Power Structure Analysis
• -- how to get the bureaucracy and government to
  do what you want them to do
• -- lessons from the fields of organizational
  development, public administration and political
  science adapted to clinical and public health
  settings

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
• PSA is an enhanced brainstorming procedure
  designed to assure that major stakeholders are
  not forgotten
• The secret to success is leverage

4
Why Should I Care about PSA?

• -- Im just a clinician, not a politician or
  rabble-rouser
• Need for UfS services based on lack of
  local/nationalpreventive and therapeutic services
• UfS, at best, can only meet a small portion of
  the need
• If UfS can stimulate local/national
  funding/provision of service much more sight
  can be saved

5
Why is UfS Needed?

• ?? Lack of dollars??
• ?? Lack of political will??
• What could be more important for economic
  development?

6
PSA Rapid and User Friendly

• Initial 1hour brainstorming session
• A few phone calls
• Follow-up ½ hour meeting

7
PSA - Teaching Objectives

• Describe concepts and tools of Power Structure
  Analysis (PSA)
• Conduct a Power Structure Analysis

8
PSA Concepts and Tools

• Stakeholder
• Mindsets
• Character types
• Games
• Sunburst diagram
• Myths and Magic of PSA

9
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

10
Mindsets

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

11
The Hierarchy of Mindsets

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

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Out of the Box

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

13
Character Types

• Zealot
• Advocate
• Statesman
• Conserver

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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

15
Sunburst Diagram
Domains Personal Professional
Culture Administrative Policy/Political
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Personal Domain
Personal Values
Family
Character Type
17
Professional Culture (Technical) Domain
Professional Goals
Colleagues
Peers
18
Administrative Domain
Regulation and Accreditation
Budget and Personnel
Subordinates
Boss
Standard Operating Procedures
19
Policy/Political Domain
Clients/Patients
Authorization and Funding
Community Image
Interest Groups
Legal/ Liability/ Tort
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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

21
To Do a PSA

• Brainstorm Stakeholders (pro, con, indeterminate)
• Use starburst diagram to make sure no important
  stakeholders forgotten
• Identify
• Critical supporters
• Critical opposition
• Potential major players
• Do mini-PSAs on most critical stakeholders
• Identify potential leverage
• Propose strategy
• Determine who is to pay lead role (personal
  domain)

22
Group Exercise

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

23
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

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True or False?

• There are two sides to every issue
• Theres not enough money
• Dollars are our most important resource