The Five Meta Stakeholders of Health IT

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“Once we get <insert name here> system, all of our tech problems will go away.”

You’ve likely heard this statement and/or have used it in regard to the integration of new health information technology solutions into the process of patient care delivery. During my initial year or two in the health IT field, I had moments of this perspective where I wondered why the tech system could not do this or that function in question. I also heard it often while conducting my research on the information needs of nurses caring for hospitalized patients.

However, almost a decade ago, a report was released by the National Academy of Medicine, Health IT and Patient Safety. Within that report was the introduction to the sociotechnical framework applied to health IT. When I read that report and saw the five meta stakeholders that all need to develop and create a symbiotic relationship, my whole perspective shifted toward one that was more aware of the competing variables (e.g., meta stakeholders).

These competing stakeholders are five dynamic and complex forces:

  1. People
  2. Processes
  3. Technology
  4. Internal Organization
  5. External Organization(s)

All five meta stakeholders need to work together to form the end product that meets the needs of the end user, not just the technology.  So much of the work done to work toward implementation of the new health IT solution or in this case the technology variable, is dependent upon the other four factors, especially the people and the processes.

As we embark forward, there will be times when the analysis of the current state process (#2) (e.g., this is the way we do it), will not be supported in a digital framework in a complimentary way to the way it was done before. Paper based records were static and limited in access. Digital access becomes dynamic and opens the door for more engagement with people (#1). People are beginning to ask for more data and information about their own health. Thus, exploration into a new way of achieving the same or better outcomes becomes a necessary conversation within the organization (#4) while adhering to the requirements of governing local, state, regional and national bodies (#5) (e.g., HHS, CMS, TJC).

Another question I’ve often been asked is if the size or overall influence of the five meta stakeholders are different from one another. In the NAM’s, Health IT and Patient Safety report, all five stakeholders are represented as the same size. I would argue that this should be the guiding principle and approach toward making change in general. However, there will likely be times when one of these stakeholder groups carries more influence than the others.