Introduction to Health Services

Management
 Introduction
Rationale for the course
 Management is universal and essential function in all
kinds of organizations.
 Planning and management skills are needed as most health
professionals find themselves in a managerial position
without proper orientation and training.
 Proper health planning and health services management skill
is an important tool to bring about change in the health
care system, a requirement in most countries of the world.
 Resources are scarce in most countries urging the need for
proper skills in planning and management for effectiveness
and efficiency.

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 Definitions of terms
Health
WHO (1946, 100) defined health as

A state of complete physical, mental, and social

well-being, not merely the absence of disease .

NB- definition of health is based on well being

rather than just not having a disease or infirmity.

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 Cont…
A useful contemporary definition of
Western societies:

The maximization of the biological & clinical

indicators of organ function and the
maximization of physical, mental & role
functioning in everyday life.
What’s the importance ?

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 Force field Model ( Classic Model of
Health, Henric Blum,1983)
1. Discuss in Brief what Force field model of health is ?
2. Explain the four forces that affect health and well-being in the
community of Tigray. Give an example of each force. Which
of these four forces do you think healthcare managers can
control and change the most, in order to improve people’s
health?
3. Discuss in brief health care environment and reason out why
is the external environment so important to healthcare
organizations?
4. Compare and contrast healthcare organizations with other
types of organizations (e.g., universities, government agencies,
airlines, movie theaters, and professional sports teams).

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 Cont…
Negative terms and narrow definitions
 intervene only in life
threatening traumas & illnesses
Positive terms & broad definitions
 a variety of significant interventions to enhance the
health of its members.

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 Cont…
Health care, healthcare, or health care services,
o Is the organization of people, institutions, and resources that
deliver health care services to meet the health needs of target
population
o Is the total societal effort,
effort undertaken in the private and public
sectors, focused on pursuing health.

Health services
 Are specific activities undertaken to maintain or improve
health or to prevent decrements of health.
o Can be preventive, promotive, curative or
rehabilitative in nature.

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 Cont…
Health service organizations (HSOs)
HSOs are-Organizationally structured orgn to deliver
health services directed to consumers.
Health systems
Are formally linked HSOs, possibly including
financial arrangements, joined together to provide
more coordinated & comprehensive health services

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 Management
Historical Background
• Existence of Mgt can be traced back as 3000 Yrs before Christ
 A practice which existed ever since man has been organized
into communities and groups
 (old & universal) to accomplish common goals which were
not capable of doing @individual level.
• Modern Mgt practice- is the history after industrial revolution
of 1800s particularly of 1860s
 But Mgt as distinct and separate subject and with different
theoretical knowledge, principle and objective is a history of
the 20th Century
 Introduction of management into health care system is
even a very recent story ( i.e. 4 - 5 decades)

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 Scientific Management Theory
(1890-1940)
 At the turn of the century, the most notable organizations
were large and industrialized.
 They were ongoing, routine tasks that manufactured a
variety of products and highly prized scientific and
technical matters, including careful measurement and
specification of activities and results. Management tended
to be the same.
 Frederick Taylor developed the :scientific management
theory” which espoused this careful specification and
measurement of all organizational tasks.
 Tasks were standardized as much as possible. Workers
were rewarded and punished.
 This approach appeared to work well for organizations with
assembly lines and other mechanistic, routinized activities.

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 Cont…
 Frederick W.
Taylor

 The father of Scientific

Management
– the 1st Efficiency
Expert.
 Proposed set of
management practices that
are based on facts and
observations.
observations

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 The Scientific Management Perspective…

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 … Administrative
Principles Perspective
 Bureaucratic Management Theory (1930-1950)
Max Weber embellished the scientific management theory
with his bureaucratic theory.
 Weber focused on dividing organizations into hierarchies,

establishing strong lines of authority and control called as

differentiation (through the division of labor and task
specialization) and integration (by the hierarchy of
authority and written rules and regulations)

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 Cont…
 An other subtype of the classic theory
characterized by:
 Clear definition of authority and
responsibility
 A chain of command
 Strict rules, disciplines and control
 Most HSOs are organized along
bureaucratic lines.

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 Human Relations Movement
(1930- 1970)
Eventually, many reacted to the rather dehumanizing
effects of these theories. A major belief included that the
organization would prosper if its workers (HRM)
prospered as well.
The behavioral sciences played a strong role in helping to
understand about HRM the needs of workers and how the
needs of the organization and its workers could be better
aligned. Various new theories were spawn and generate,
many based on the behavioral sciences (some had name
like theory “X”, “Y” and “Z”).
 Redirected attention away from improving efficiency
towards increasing employee growth, development, and
satisfaction

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 1960–Present: The Open
Systems Perspective
Every organization is a system—a unified structure of
interrelated subsystems—and it is open—subject to
the influence of the surrounding environment.

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 Cont…
The inputs are;
Human resources
Materials/supplies
Technology
Equipments
 information
 capital
 patients
Customers

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 Cont…
Conversion [integration]
Conversion of inputs to out puts occurs
when managers integrates structure,
tasks/technology and people in the
context of the organizational culture and
in response to meeting the needs of
internal and external stakeholders.

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 Cont…
Out puts are;

Patient care/customer service

Quality out put/out come
 appropriate costs
 organizational survival
Social responsibility
Education/training
 reputation/image

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 Contingency theory
Proponents of this theory
(Burns & Staker,1961;Lawerence& Lorsch 1967,et al )
Suggest that a more bureaucratic form of organization is more
effective when the environment is relatively simple and stable
,task and technologies are relatively routine and a relatively high
percentage of non professional workers are employed.
In contrast a less bureaucratic form of organization is likely to be
more effective when the environment is complex and dynamic ,
task and technology are non routine and a relatively high
percentage of professional involved .

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 cont…
Contingency theorists do not advocate an either /or
approach but rather view the process as a
continuum from more or less bureaucratic
(mechanistic) to more or less organic.
Contingency has wide application to health
services(Mohr,1982)

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 Cont…
Definition of Mgt.
Scholars have been defined in ways that appear different
but with a strong underlying similarity.
Mary Parker Follet, art of getting things done through
other people.
Harold Koontz
 management is the process of designing and maintaining
an environment ini which individuals working together in
groups, efficiently accomplish selected aims.

George R. Terry, the process of planning, organizing,

leading/directing and controlling the efforts of
organizational members and using all available
organizational resources to reach predetermined
objectives.

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 Mgt defn Cont…
Longest et al 2000-The process composed of
interrelated social and technical functions & activities
occurring in a formal organizational set up for the
purpose of accomplishing predetermined objectives
through the use of humans and other resources.
Mgrs- are people formally appointed to a position of
power and authority in an organization who;
o Accountability for work results
o Responsibility for resource utilization
o enable other to do their direct or support work
effectively

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 Con’t
Common points
 Is a process – a set of interactive & interrelated ongoing
functions and activities

 Involves accomplishing organizational objectives

 Use of human & other resources

 Occurs in a formal organizational setting

N.B People are the most important resources
In conclusion, Management work involves establishing
organizational objectives and creating organizational
environment in which the direct work, aided by support
work, can lead to the accomplishment of predetermined
objectives

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 Components of the external environment :
 General environment
 Political
Policy making, political institutions
 Public expectations
Community, interest groups, media,…
 Ethical /legal issues
 Economic issues
Suppliers, Clients, share holders,..
 Environmental /ecological/ conditions

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 Cont…
 Health care environment
 Public policy
regulation, licensure, accreditation
 Competitors
 Health care financing
 Technology
 Health research and education
 Public health
[sanitation, environmental protection]

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 MANAGEMENT FUNCTIONS

The set of social and technical functions

inherent in the management process includes:

o Planning

o Organizing

o Staffing

o Directing (motivating, leading & communicating)

o Controlling

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 Cont…

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 Management functions Cont…
 Planning is the function that determines in advance what
should be done.
done
 It is looking ahead and preparing for the future.
future It is the
process of deciding the organizational objectives and
charting out ways of attaining those objectives.
“… Planning is not simply a technical exercise...
exercise It is an
ongoing process of learning, adapting to change, and
educating.”
educating
Taylor and Reinke

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 What is planning
The process of determining exactly what the organization
will do to accomplish its objectives.
objectives
• the combination of analyzing & compiling information,
dreaming up ideas using logical imagination & judgment
in order to arrive at a decision on what to do in the future.

• Planning dictates the objectives & activities toward which

managers lead other members of the organization.

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 Planning…..
A process that lays the base for future action

• deciding in advance what to do, how to do, when

to do, where and who will do activities:

– it is charting a course of action for the future

– it bridges the gap b/n where we are now and

where we want to go/be

– is deciding about what should be done in the future

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 What does planning answer?
Planning answers the following questions:
– Where are we now? --assess the present situation
– What are we here for? -----problems at hand
– Where are we going?-------objectives
– With what? -----------------resources
– How? ------------------------strategies & activities
– When? ----------------------period of time

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 Principles of Planning
• Good planning requires a methodological process that clearly
defines the steps that lead to optimal solutions.
The principles are:
1.Comprehensive – options and impacts
2.Efficient – time or money.
3.Inclusive – people affected
4.Informative – results are understood by stakeholders
5.Integrated – individual short-term decisions should
support strategic long-term goals.
6.Logical –arranged in order.
7.Transparent
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 Basic Planning Process

1. Establish the basic framework – scope, stakeholders, schedule.

2. Invite stakeholder input to share ideas and concerns.

3. Create a vision, mission, goal & objective statement.

4. Develop a list of possible options/solutions

using various information resources brainstorming, publications,

experts etc.

5. Evaluate and prioritize options from best to worst.

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 Basic Planning Process…
6. Create an action Plan which identifies who does what,
when and how. This may include
– a long-term strategic plan, and short-term action plans.
– contingency options that are only implemented if warranted
by future conditions.
7. Gather baseline data.
8. Implement activities, policies, and programs.
9. Evaluate program (gather data after
implementing to determine level of achievement).
10. Revise plan as appropriate.

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 Challenges facing planners
Planning occurs at many levels including from day-to day decisions
made by individuals/families, to complex decisions made by
businesses and governments.
• Planning is an art as well as a science. It requires judgment,
sensitivity and creativity. Planning often deals with in-between
issues.
• Planners facilitate change and so must overcome entrenched
practices and interests. We often encounter resistance from people
who assume that what they consider normal must be maintained.
• Planning can be frustrating! There are many ways that a
planning process can fail- inadequate resources, inadequate public
or official support, and unresolved conflicts.

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 Health planning
a process that appraises the overall health needs of a
population and determines how these needs can be met in the
most effective manner through the allocation of resources.

• the process of defining community health problems,

identifying needs & resources, establishing priority
objectives, and setting out the administrative actions needed
to achieve those objectives

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 Rationale for planning
• Focus attention on predetermined objectives

• Provide performance standards & facilitates controlling

• Coping with future uncertainty & changes

• Help foreseeing & identifying potential risks

• Help efficient utilization of resources while achieving

objectives

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 Features of Planning
• is continuous process (cyclic /spiral) and an intellectual activity
• is flexible as it is based on future conditions, which are always
dynamic
• is collective undertaking requiring the participation of all
relevant stakeholders
must be systematic & action oriented
• is needed & practiced at all managerial levels regardless of the
size & type of organization
• A good plan should give:
– Clear vision, mission, goal & objective
– A clear picture of the tasks to be accomplished
– A clear summary of physical, human & technical resources

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 Organizing
 It is the process of developing intentional pattern
of relationship among people and other resources.

 The manager differentiates and integrates the

activities.

 By differentiation is the process of

departmentalization or segmentation of activities.

 Integration is the process of achieving unity of

effort among various departments.

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 Cont…
Staffing
It is the process of filling and keeping the positions
provided for by the organizational structure, filled
with right people at right places at the right time.
It includes several sub function like;
Recruitment
Selection
Transfer and promotions
Training

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 Cont…
Leading;
 According to Keith Davis leadership is
the ability to persuade others to seek
defined objectives enthusiastically.

It is the human factor which binds a

group together and motivates it
towards goals.

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 Cont…
Controlling
Is a process of establishing performance
standards based on the HSO's
objectives,
Measuring actual performance,
comparing it with the intended result ,
and taking corrective action as
necessary.
 In other words, it is regulating
activities in accordance with the plan.

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 Basic Concepts and Principles in
management
1. Concepts
1.1 Effectiveness

 Is the degree to which a stated

objective is being achieved.
 It is doing the right things.

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 Cont…
1.2 Efficiency

 Is balanced use of resources while

achieving the stated objectives.

 Is cost-effectiveness where objectives

are achieved with the lowest
practicable cost.

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 Cont…
1.3 Economy of scarce resources
 Often many, resources are scarce and
costly thus we have to economize.

1.4 Work relations

 Work activities should be designed and
structured so as to support each other
towards the achievement of
objectives.

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 Cont…

1.5 Information

 Is essential to make the right

decision for action.
 Information should be the right
kind, at the right time, and in the
right hands.

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 2. Principles

2.1 Management by objectives

A process in which specific performance
objectives are jointly set by subordinates
and their superiors.
Progress towards objectives is periodically
reviewed and rewards are allocated on
the basis of progress.
Each person’s major area of
responsibilities is clearly defined in terms
of measurable outcome

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 MBO Principles ;
Cascading of organizational goals and
objectives
Specific objectives for each member
Participative decision making
Explicit time period
Performance evaluation and feedback

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 Cont…

2.2 Learning from experience

Any gap between objectives and obtained

results (achievements)
→ analysis →discover causes of the gap

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 Cont…

2.3 Division of labor

Management attempts to bring about
balance of work among different people
concerned.

Assign the right proportion of each kind

of staff to the task at hand

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 Cont…

2.4 Substitution of Resources

when the resources normally used to

provide service become scarce or too
expensive, different resources may be
used to deliver the same service.
E.g: Green development strategy

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 Cont…
2.5 Convergence of work
Working relations should contribute to
the success of each activity and so to
the general goal of the organization

2.6 Functions determine structure

Determining the function & duties of
individual member is followed by
working relations (structure).

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 Cont…
2.7 Delegation
Assigning job activities and corresponding
authority to specific individuals within the
organization.

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 Cont…
2.8 Management by exception
Selectivity in handling information &
prioritized decision making

2.9 Short Decision path

Decision must be made as closely as
possible in time and place to the object of
decision and to those affected by it.

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 Levels of management
Managers are people formally appointed to positions of

authority in organizations or systems who enable others

to do their direct or support work effectively, who have
 responsibility for resource utilization, and

who are accountable for work results.

Although all managers perform the same set of functions,

they actually do so on only three organizational levels.

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 Level of Mgt cont’d
Generally managers are categorized into three levels.
Top level
Middle level
First line: sometimes called as supervisory, front-line and
operating level of management.
The primary difference between levels of

managers are the degree of authority and

the scope of responsibility

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 Levels of management

top

middle

Front line

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 Levels…
Top management:
The CEO and/or president and his/her immediate
subordinates usually called vice-presidents.
Responsible for overseeing the entire organization.
o Are accountable to the governing body
o Establish operating policies and guide the organization
with its environment
Establishes long term goals and oversees the work
of middle level management.
Creates and coordinates alliances and partnerships
with outsiders.
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 Top level Mgrs
They mobilizes (assemble and bring together)
available resources.
The top level management does mostly the work of
thinking, planning and deciding. Therefore, they are
also called as the Administrators and the Brain of the
organization.
organization
They spend more time in planning and organizing.
They prepare long-term plans of the organization
which are generally made for 5 to 20 years.

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 Top level Mgrs
The top level management has maximum authority and

responsibility.
The success or failure of the organisation largely

depends on their efficiency and decision making.

making
They require more conceptual skills and less technical

Skills

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 Middle level Mgrs
o gives recommendations (advice) to the top level management.
management
 It executes (implements) the policies and plans which are
made by the top level management.
 They co-ordinate the activities of all the departments/ units
 They also have to communicate with the top level
Management and the lower level management.
 They spend more time in coordinating and communicating.
 They prepare short-term plans of their departments which are
generally made for 1 to 5 years.
 The middle Level Management has limited authority and
responsibility.
 Require more managerial and technical skills and less
conceptual skills

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 Supervisory/ low level/ team Mgt
Lower level management
directs the workers / employees.
They develops morale in the workers.
 maintains a link between workers and the middle level
management.
informs the workers about the decisions which are taken
by the management.
They also inform the management about the performance,
difficulties, feelings, demands, etc., of the workers.
They spend more time in directing and controlling
Make daily, weekly and monthly plans

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 Supervisory/ low level/ team Mgt ….
They have limited authority but important
responsibility of getting the work done from the
workers.
They regularly report and are directly responsible to
the middle level management.
Along with the experience and basic management
skills, they also require more technical and
communication skills.

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 Levels…
Top management

AKU president

Vice President
Vice President Vice President Vice President For
For For For CHS_RH
Academic Research $co Administration

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 Levels…
First line management
Purchasing and Public health
Property

Property
Purchasing head Head Epidemiology Biostatics

workers workers workers Worker

workers
workers workers

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 Levels…
Classification schemes typically identify managers as top or
senior management, middle level management and
supervisory or first line management.
Sometimes the classification are policy level, administrative
or coordinative level, and operations level.
Griffith distinguishes as decision oriented and
implementation oriented managers.
Decision oriented managers are typically positioned higher
in HSO/HS and help to establish its objectives and address
its most sensitive and difficult decisions, weighing the
importance and permanence of environmental changes,
recommending budget guidelines and resolving serious
disputes.
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 Levels…
Implementation-oriented managers focus more on getting
thing done, often through direct supervision of others or
through leading teams.
Regardless of title, level or orientation, managers have
several common attributes:
They are formally appointed to positions of authority,
They are charged with directing and enabling others to do their
work effectively,
They are responsible for utilizing resources,
They are accountable to superior for results.

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 Levels…
The primary differences between levels of
managers are the degree of authority and the scope
of responsibility at each level.

E.g. senior managers, presidents or chief executive

officers and vice –presidents in HSOs have
authority over and are responsible for entire
organizations---all staff, resources and individual
and organizational results. CEO are accountable to
the governing body.

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 Levels…
Middle level managers report to senior managers.

Each of whom is responsible for smaller segments of

the organization.
Middle level managers, such as College deans and
Heads of Processes have authority over and are
responsible for a specific segment.
First level managers, who generally report to middle
level managers, have authority over and are
responsible for overseeing specific work and
particular group of workers.

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 Levels…
Senior-middle- and first level managers are responsible
for very different types of activities.

But all of these activities are important and no

organization can be successful unless the management
work at each level is done well and unless the work at
each level is carefully integrated with that done at the
other levels.

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 Management skills
are competencies a manager holds to undertake the roles
effectively. (Katz (1955), Hersey and Blanchard (1988))
 ability to translate knowledge into action.
=> manifested in an individuals performance.
not necessarily inborn.
developed through practice and experience.
all levels of managers need some skills and competencies
and the roles that they play in carrying out their work
within an organization.
A manager should posses 3 major skills; these are
conceptual skill, human relation skill, and technical skill.

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 Managerial skills
1. Conceptual skill:
understand the complexities and issues within an
organization and the role and strength of management
within it
Involves the formulation of ideas
Managers understand abstract relationships, develop
ideas, and solve problems creatively.
creatively
ability of a manager to take a broad and farsighted view
of the organization and its future.
enable managers to act according to the goals of the
organization as whole,
allow the manager to view an organization as a whole and
to see how its parts relate to and depend on one another.
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 Management skills…
2. Human relation skill:
consists of the abilities to interact and communicate
successfully with other persons.
Deals with people

Include leadership of subordinates and faculty in

intergroup relationships.
A manager must be able to understand, work with and
relate to both individuals and groups to build a team
environment.
The managers ability to work effectively as a group
member and to build cooperative effort within the group
depends on human relation skills.
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 Management skills…
3. The technical skills;
the ability to use knowledge, methods, techniques
and equipment necessary for the performance of a
specific task.
Deals with things

It is the managers understanding of the nature of

job that people under him have to perform.
Such skills can be acquired through training,
education and work experience.
experience

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 Managerial skills
Management skills by levels of management (Katz 1955)

Technical Human relation Conceptual

Top

Middle

Front
line

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 Discuss about the levels of Mgt
and the attached skills that they
should have

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 Management roles
 A role is an organized set of behaviors
 is a set of expectations that managers should play.
 Henry Mintzberg defines 10 roles that managers are
expected to play and group them in to 3 categories.
1. Interpersonal roles
2. Informational roles
3. Decisional roles

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Managerial Roles

HSM for MPH, 2017 85

 Management roles…
1. Interpersonal roles
 Interpersonal roles provide managers with
opportunities to gather information based on the
use of formal authority.
1.1. Figurehead:
 performs symbolic routine duties of legal or social
nature.
 As a figurehead, a manager routinely performs certain
ceremonial
ceremonia duties including attending inauguration
ceremony, addressing the media or taking people to
dinner, entertaining visitors, officiating a luncheon, etc.

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 Interpersonal roles…
1.2. Leader:
 motivates subordinates, ensures hiring and training of staff.
 As a leader, manager creates the environment, works to improve
employees performance and reduce conflicts, provides feedback
and encourages individual growth, set an example for others to
follow.

1.3. Liaison:
 involves dealing with people outside the organization, such as key
partners with whom good working relationships are required
 maintains self developed network of contacts and informers who
provide favors and information.
 In addition to superiors and subordinates, managers interact with
others-peer level managers in other departments, staff specialists,
suppliers and clients.
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 Management roles…
2. Informational roles
flow from the interpersonal roles
2.1. Monitor:
Managers gather information from their network of contacts,
including those established in their liaison roles
seeks and receives wide variety of special information to develop
through understanding of the organization and environment.
As a monitor, a manager should constantly monitoring the
environment to determine what is going on.
He/she should collect information both directly and indirectly.

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 Informational roles…
2.2. Disseminator
transmits information received from outsiders or
subordinates to members of the organization, that would
not ordinarily be accessible to them.
involving knowledge transfer among staff in the
workplace
2.3. Spokesperson
transmits to outsiders information about organizations
policies, plans, actions, results.
deals with external clients, professionals and interested
parties
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 Management roles…
3. Decisional roles
3.1. Entrepreneur:
searches organization and its environment for opportunities and
initiates projects to bring about change.
Sharing and initiating new ideas or methods that may improve the
work units operations.
He should implement strategy and review sessions involving
improvement.
the initiator of change, often taking risks

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 Decisional roles…
3.2. Disturbance handler:
 dealing with disputes and strikes
 initiates corrective action when organization faces important,
unexpected disturbances.
 Implementing strategy to resolve disturbances and crisis

3.3. Resource allocator:

 fulfills responsibility for the allocation of organizational resources
of all kinds-in effect, makes or approves all significant decisions.
3.4. Negotiator:
 represents the organization in major negotiations.
 Items to be negotiated include contracts with suppliers, trade-off for
resources inside organization and agreements with labor
organizations.
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Why do organizations need managers?
to ensure the organization serves its purpose and is efficient
in the production of goods or services;
to design and maintain the stability of the operations of the
organization;
to take charge of strategy-making and ensure the
organization can adapt to its environment;
environment
to ensure the organization meets the ends of its clients;
to serve as the informational link between the organization
and the outside world;
to act as a formal authority in operating the organization’s
‘status system’.
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The three fundamental ‘rules’ of mgt

There are three tasks of such fundamental importance to

managing other people effectively that you can think of
them as rules. These are:
agree with them precisely what it is you expect them to
achieve;
ensure that both you and they are confident that they have
the skills and resources to achieve it;
give them feedback on whether they are achieving it.

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 Management model for HSOs…
The model shows management as an input-
conversion-output process that takes place with in
HSOs/HSs, which are set within their large
environment.
In the context of an organization or system, within the
larger external environment , several important
relationships are illustrated.
A HSO/HS is a formal setting where outputs are
produced [objectives accomplished] through the use of
[conversion] of inputs [resources].

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 Management model…
Managers and the management work that they perform are
the catalyst that converts inputs into outputs.

A HSO/HS [and its managers] interacts with- are affected

by and affect- the HSO/HS external environment: this
makes HSOs/HSs open systems because inputs are
obtained from the external environment and outputs go in
to it.
See the previous presentation

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 References

1. Harold koontz ,Management a global

perspective .
2. Beaufort B. ,Longest J.,Rakich S.,Kurt
D.Managing health services organizations and
systems,4th ed,2003.
3. P.C.Tripathi, Principles of management

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 .

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