AN INTRODUCTION TO LEADERSHIP AND

MANAGEMENT

Dr. Waddah D’emeh

Definitions

Health Services — specific activities undertaken to maintain or improve health or to prevent decrements of health

Health Systems —formally linked HSOs, possibly including financing arrangements, joined together to provide more coordinated and comprehensive health services

Organization: " Any collection of persons, materials,

procedures, ideas or facts so managed & ordered that in each case the combination of parts makes a meaningful whole that at achieving organization objectives.”

The process of organization implies the arrangement of human & nonhuman resources in an orderly fashion to make a meaningful whole that accomplishes organizational objectives.

Definitions

Health Services Organizations — entities that provide the organizational structure within which the delivery of health services is made directly to consumers, whether the purpose of the services is preventive, acute, chronic, restorative, or palliative

Definitions

Management: The act of any individual who guides others through a series of routines, procedures, or practice guidelines.

The manipulation of people, the environment, money, time, and other resources to reach organizational goals

To forecast and plan, to organize and to command, to coordinate, and to control

“Health System Management is defined as purposeful & efficient use of health system resources and to get members of the health team coordinated to work harmoniously in order to achieve the desired common Goals and Objectives.”

Definitions

Four main elements of management: It is a process or a set of interactive and

interrelated ongoing functions and activities It occurs in a formal organizational setting

(either a single organization or a system) It involves accomplishing organizational

objectives It involves achieving these objectives through

people and the use of other resources

Definitions Managers:

Are formally appointed to positions of authority in organizations or systems

Enable others to do their direct or support work effectively Have responsibility for resource use Are accountable for work results

The variety of managers in these settings can be identified by the level of the organization at which they work

Classification schemes typically identify managers as senior-level, middle-level, and supervisory or first-level

The primary differences between levels of managers are the degree of authority and scope of responsibility

Definitions

Following: is a complementary set of actions taken by individuals that contribute to problem solving, task attainment, and evaluation using healthy and assertive behaviors to support those who are leading or managing.

Definitions

Leadership: Using individual traits and personal power to interact constructively to resolve problems.

Leadership is the art of getting work done through others willingly.

Leaders are in the front, moving forward, taking risks and challenging the status quo.

Not a job title but person behavior.

Definitions

Leader: Anyone who uses interpersonal skills to influence others to accomplish a specific goal

Manager: An employee who is responsible and accountable for efficiently accomplishing the goals of the organization

Functions of Managers

Clarify the organizational structure Choose the means to achieve goals Assign and coordinate tasks Evaluate outcomes and provide feedback

Functions of Leaders

Achieve consensus within the group about goals

Maintain structure that facilitates accomplishing goals

Supply information that helps provide direction and clarification

Maintain group satisfaction, cohesion, and performance

Integrating Leadership and Management

Six distinguishing traits of integrated leader–managers:

1. They think longer term. 2. They look outward, toward the larger

organization.3. They influence others beyond their own

group.4. They emphasize vision, values, and

motivation.5. They are politically of good judgment.6. They think in terms of change and

renewal.

Areas of Competency for All Managers

Communication and relationship management

Knowledge of the health care environment

Leadership Professionalism Business skills

Core of Leadership Competencies

Manager Levels

First-level manager Middle-level manager Top-level manager

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Organizational Culture and Philosophy

Organizational culture — the pattern of shared values and beliefs, along with associated behaviors, symbols, and rituals, that is acquired over time by members of HSOs/HSs

Organizational philosophy —an HSO’s/HS’s explicit and implicit view of itself and what it is Provide services that are unique in society Humanitarian in nature

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Management Functions

The set of social and technical functions inherent in the management process. Includes:

Planning Deciding prospectively what to do to achieve

organizational missions and objectives Organizing

Managers must design an organization that is capable of achieving plans

Staffing Involves a wide range of centralized activities,

programs, and policies related to acquisitions, retention, and maintenance of human resources

Management Functions

Directing Social-behavioral in nature and focuses on

initiating action in the organization or system Controlling

Involves gathering information and monitoring activities and performance, comparing actual results with expected results to take corrective action

Decision-Making Function Intertwined with all other functions

Management Functions

Functions of the Management POSCOD

3.

2. 4.

1. 5.

ORGANISING

PLANNING

DIRECTING

STAFFING

DECISIONMAKING

CONTROLLING

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Management Skills/ Competencies

Three types of skills: Technical skills — abilities to use the methods, processes, and

techniques of managing, includes planning for a new service or facility, devising and operating an incentive-based compensation program, arranging the financing of long-term debt, etc.

Interpersonal skills — abilities to get along well with others, to understand them, and to motivate and lead them in the workplace, knowing how to communicate visions and preferences, how to handle negotiations, and how to manage conflicts

Conceptual skills — abilities to visualize the complex interrelationships in a workplace—relationships between people, between departments or units, between various organizations in a system, and even between an organization or system and its external environment, allows managers to envision the places and roles of their organizations or systems in the larger society

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Competencies needed by senior-level managers (CONT.)

Political Competence — dual abilities to accurately assess the impact of public policies on the performance of the senior-level managers domain of responsibility and to influence public policy making

Commercial Competence — ability of managers to establish and operate value-creating situations in which economic exchanges between buyers and sellers occur

Governance Competence — includes ability to establish a clear vision for the organization or system, to foster a culture that supports the realization of the vision, to assemble and effectively allocate the resources to realize the vision, to lead the organization through various challenges, and to ensure proper accountability to multiple stakeholders

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Management Roles

Henry Mintzberg concluded that management work can be described meaningfully in terms of three roles that all managers play: Interpersonal Roles — figurehead, leader, and

liaison Informational Roles — monitor, disseminator, and

spokesperson Decisional Roles — entrepreneur, disturbance

handler, resource allocator, and negotiator All of Mintzberg’s managerial roles are

integrated, with the manager practicing a combination of these roles according to their level, responsibilities and work environment

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Another Conceptualization of Management Roles

Designer Role —managers establish intentional patterns of relationships

Strategist Role — managers participate with governing bodies to establish missions and organization-wide or system-wide objectives and then develop and implement suitable strategies capable of achieving the missions and objectives

Leader Role — only effective leadership will encourage and help staff be motivated to fulfill established missions and accomplish objectives

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Management competencies

The set of skills and knowledge that managers need in order to do their management work

National Center for Healthcare Leadership Competency Model Applies to first, middle, and senior-level managers Contains 26 specific leadership competencies organized by

three domains of transformation, execution, and people

The importance of specific competencies varies with the manager’s position in the organizational hierarchy; degree of authority; scope of responsibility; and number, types, and skills of subordinates

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Three approaches to understanding leadership

The study of leadership has followed several paths, but it has not yet produced a definitive theory of effective leadership

Theories of leadership can be classified into one of three basic approaches:

1. Inherent traits, skills, abilities, or characteristics explain why some people are better leaders

2. Particular behaviors might be associated with successful leaders

3. An integrative approach that focuses on how leaders, followers, and the situations in which they find themselves interact and work

Models of Leadership Skills (I):

The skills are multiple and intersecting each other.

Developing self awareness Managing Stress

Solving Problems creatively

Model of Leadership Skills(II) :

*Coaching *Self awareness*Counseling * Gaining power*Listening *Empowering others

*Identifying cause *Diagnosing poor

*Appropriate strategies performances*Resolving conflicts *creative

environment*Solving problems creatively

*Rewarding/accomplishment

Communicating supportively

Motivating Others

Managing Conflict

Gaining Power &Influences

Historical Development of Management Theory

Management science like any other professions develops a theory base from many disciplines, such as business, psychology, sociology, and anthropology.

The father of scientific management called Frederick W. Taylor was a mechanical engineer in the Midrale and Bethleheim Steel Plants in Pennsylvania in the late 1800s. Frustrated with what he called "systematic Soldiering" where workers achieved minimum standards doing the least amount of work possible,

Taylor postulated that if workers could be taught the "one best way to accomplish a task," productivity would increase.

Principles of scientific management as identified by Taylor (1911)

Traditional "role of thumb" means of organizing work must be replaced with scientific methods.

In other words, by using time and motion studies and the expertise of experienced workers, work could be scientifically designed to promote greatest efficiency of time and energy.

A scientific personnel system must be established so workers can be hired and promoted based on their technical competence and abilities.

Principles of scientific management as identified by Taylor (1911)

Workers should be able to view how they fit into the organization and how they contribute to overall organizational productivity. Could be accomplished by the use of financial incentives as a reward for work accomplished.

The relationship between managers and workers should be cooperative and interdependent, and the work should be shared equally.

Note: The result of scientific management was productivity and profits rose dramatically.

Management History

Henri Fayol (1925) first identifies the management functions of planning, organization, command, coordination, and control.

Luther Gulick (1937) expanded on Fayol's management functions in his introduction of the "seven activates of management;" planning, organizing, staffing, directing, coordinating, reporting, and budgeting.

Management History Mary Parker Follett, the first theorist to

suggest basic principles of what today would be called "participative decision making, or participative management." In her essay "the giving of orders" (1926), Follett espoused her belief that managers should have authority with, rather than over employees. Follett stated that to do so, a need existed for collective decision making.

Management History

1960, Douglas McCregor theorizing that managerial attitudes about employees (how managers treat those employees) can be directly correlated with employee satisfaction. He labeled this theory X and theory Y. Theory X managers believe that their employees are basically lazy, need constant supervision and direction, and are indifferent to organizational needs. Theory Y managers believe that their workers enjoy their work, are self-motivated, and are willing to work hard to meet personal and organizational goals.

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A Management model for HSOs/HSs

Management can be conceptualized as an input-conversion-output process

Inputs— human and physical resources and technology (Manpower, Money, Materials, Minutes (Time), Knowledge, Techniques, Skills)

Outputs — missions and objectives HSOs/HSs are formal organizational settings where

outputs are produced (mission fulfilled and objectives accomplished) through conversion of inputs (resources)

Managers and the management work that they perform are the catalyst that converts inputs to outputs

HSOs/HSs and their managers interact with their external environments; this makes HSOs/HSs open systems because inputs are obtained from their external environment and outputs go into that environment

Systems View

Labor MaterialMachines

ManagementCapital

Goods or Services

OUTPUTINPUTTransformati

onProcess

Feedback

Management in Health System, Why?

Integration of Health Programs/Departments.

Overload of work & Distribution of work.

Changing Health needs/Health Demands.

Improvement of health care delivery system by applying modern management methods and techniques.

Health System Planning: A process of deciding how the future

should be better than present. For proper utilization of health system

resources. For improvement of health services. National Health Planning defines health

problems, identifies unmet needs, surveys resources, establishes priority goals which are realistic & feasible, projects administrative action for accomplishment.

Plan A blueprint for any action: (What,

How, When, Who to do?)

5 Components: Identification & Prioritization of

Health Problems. Policies Formulation. Objectives establishing. Budget allocation. Time frame.

Planning is a Cyclic Process of PIE

Planning (P)

Implementation (I)

Evaluation (E)

Planning is a Cyclic Process(Steps)

Step-1. Analysis of the Health Situation.

Collection, assessment, interpretation of information and Demographic data through surveillance .

Epidemiology of diseases, Mortality and Morbidity data

Medical Care Facilities, Technical Manpower, Training facilities.

KABP of population about disease prevention and cure.

Planning is a Cyclic Process

Step-2. Establishing Objectives & Goals.

Reduces haphazard activities, uneconomical use of funds, poor performances.

General Objectives/procedures at upper level become more specified and detailed at lower levels.

Resources are directed properly taking into nature of objectives (Short Term/Long Term).

Input-Output analysis are being used for defining goals, objectives and targets.

Planning is a Cyclic Process

Step-3. Assessment of Resources

In terms of men, money, material, time, knowledge, techniques and skills.

A balance is maintained what is required, what is available and how to be utilized.

Planning is a Cyclic ProcessStep-4.Fixing Priorities Prioritizing objectives/activities in

order of importance/ magnitude.

A Good Health manager is a PAPA(Plans well, Analyses critically, Prioritizes Activities and Act timely/promptly).

Formulation of alternate plans.

Planning is a Cyclic Process

Step-5. Writing of formulated Plan

Preparation of detailed plans.

Working guidance to all those responsible for execution eg. Health Care Providers.

Planning is a Cyclic Process

Step-6. Programming and Implementation.

Effective organization like staffing, coordination, communication etc.

A standard operating procedures for specific tasks and roles.

Selection, training, motivation, supervision and monitoring of the manpower

Proper management functions are required here.

Planning is a Cyclic ProcessStep-7. Monitoring: “Tracking the

tract”. Following the activities during their

implementation whether they are proceeding according to predefined schedule or not.

Keeping the track of the course of activities and taking corrective action before gross failure/deviation occurs.

Planning is a Cyclic ProcessStep-8.Evaluation: To assess/measure

the degree of achievements of the stated objectives and targets.

Assessment of adequacy, efficiency, effectiveness etc of final outcomes of a health activity.

Important for feed-back, opportunity for correction of deficiency and gaps during phase of implementation.

Planning Cycle

Implement Integrated Programs

Operate & Monitor Programs

Selection of Best Program

Collect date for Evaluation

Formulation of Health Problems

Prioritization of Health Problems

Establishing Objectives & Goals

Train & Orient personnel

Designing alternative programs with solutions

Integrate best programs and develop plans

Formulation of Individual Solutions YES

Evaluate degree of achievements in TOG(Satisfactory?)

NO

Planning Cycle

Operate & Monitor Programs(Execution)

Assessment of Resources

Collect date for Evaluation

Assessment of Health Situation & Problems (Analysis of Health Data)

Establishing Objectives & Goals

Designing Time Frame

Prioritization of Health Problems (Felt Needs)

YES

Evaluate degree of achievements in TOG(Satisfactory?)

NO