Health Service Management Lecture Notes

for

Second Year Public Health Students

©Medco Bio Medical College, September 2012

Mekelle Campus, Mekelle, Tigray, Ethiopia

http://www.medcobiomed.com/

Dr. Hale Teka

Who are these kids?

Who are these youngsters?

Who are these famous adults?Why do you think they were famous?Did they follow the same way to be at the top?

Do they have something in common? What do popular people benefit from their celebrity?

Do you want to be like them? What do you want to be where they were? Wealth? To be an American or European ? Straight A’s in college? Or Educated family? To belong to politician parents?

Chapter 01

Introduction to Health Service Management

Total Time Allocated for this Chapter = 4 hrs Date of Lecture 1. October 1, 2012 => 10:00 a.m.-12:00 p.m. 2. October 3, 2012 => 10:00 a.m.-12:00 p.m.

Day 1 (October 1, 2012 => 10:00 a.m.-12:00 p.m. )

1.Definitions of Management and Health Management

2.Historical Development of Management

3.Management and Administration

4.Management Functions

1. Definitions of Management and Health Management

Management may be defined as1. Getting things done!2. Process of reaching organizational goals by

working with and through people and other resources

3. The process of directing, co-ordinating, and influencing the operations of an organization so as to obtain desired results and enhance total performance

Health Management, therefore, is The application of management

principles for health care

2. Historical Development of ManagementA. Development of Management Thought• The problem of organizing men to achieve the desired

objective is not new. It is as old as civilization itself. • The Practice of Management has existed ever since man

has been organized into communities.• The study of management as a separate and distinct

subject with different theories and techniques is a product of 20th century

• Most writers agree that the origin of this discipline was the work of Frederick Winslow Taylor during the scientific Management movement that developed around 1900

B. Pre-Scientific Management Era Thousands of years a go-The Chinese, The

Babylonians, The Egyptians, The Greek, The Romans and the Hindus philosophers wrote extremely interesting books and propounded theories which are followed even today.

Development of management as a science is of recent origin, even though its practice is as old as civilization

With the advent of industrial revolution management of enterprises assumed an increasingly important role

C. Importance of Management Management is universal and necessary function It is essential for all kinds of organizations. This is

because every organization requires:-The making of decisions The coordinating of activities The handling of people and Evaluating the performance directed toward

its objectives Management is a social science and deals with the

behavior of people in the organization

3. Management and Administration

• The term “Management” and “Administration” are used interchangeably in government and business organizations.

• However, they don’t mean the same. • Administration- is essentially overall

determination of polices and major objectives• Management- is essentially an executive

function, the active direction of human effort

• Administration– Determinative Functionally involved in1. The laying down of the

general purpose of the organization

2. The framing of its major objectives

3. The formulation of general plan of procedure

4. The inauguration of broad program

5. Approval of specific major projects that fall within the general program

• Management– Executive – Is a science, an art and a

profession Functionally involved in1. Planning 2. Organizing3. Staffing 4. Directing 5. Controlling – Or broadly 1. Planning 2. Implementing 3. Evaluation

• The same person may perform both administrative and managerial functions at the same time but to different extent

• The Administrator would devote a greater part of his/her time to the broader administrative responsibilities, but will also participate (though limited extent) in executing those polices

• Similarly, Manager determines policies in a limited sphere and so perform administrative function

• As we go down the hierarchical ladder, the administrative function becomes less and less and the management function more and more

4. Management Functions Q 1. What is Function? Ans. Broad area of responsibility composed of many

activities aimed at achieving a predetermined objective

Q 2. What are the functions of Management?Ans. Management has five functions. These are:-1. Planning (Chapter Two-6 hrs)2. Organizing (Chapter Three-4 hrs)3. Staffing (Chapter Four-4 hrs)4. Directing (Chapter Five-3 hrs)5. Controlling (Chapter Six-3 hrs)

A. Planning • A plan is a predetermined course of

action which provides purpose and direction of an organization.

• Planning is foreseeing future circumstances and requirements, then, setting objectives, making long and short term plans and determining the policies to be followed with standards to be set

• In planning, managers receive and store information, monitor and disseminate the information. A manager makes decisions on strategy and allocation of resources and initiate planned changes

B. Organizing • This is the identification and classification of the

required activities, the grouping of activities necessary to attain objectives, the assignment of each grouping to a manager with authority and the provision of coordination

• In organizing, structures are created, relationships established and resources are allocated for the accomplishment of activities

• In organizing, plans are reviewed, tasks to be performed are listed, tasks are grouped into jobs that can be done by an individual, departments are created, work is assigned to individuals and authority is delegated

C. Staffing • Staffing involves manning the organizational

structure through proper and effective appraisal, selection and development of people to fill the roles designed into the structure.

• Staffing is also known as Human Resource Management. In other words, it is the management function devoted to acquiring, training, appraising, and compensating employees.

• Staffing process involves:1. Development of organizational structure2. Assessment of manpower required and

available.3. Assessment of their quality, qualification and

skills for the job.4. Appraisal –Strength and shortcomings5. Conduct development programs

D. Directing/Leading • Leading is the process of influencing people

so that they will contribute to organization and group goals

• Directing involves the initiation of action and it entails three elements that are action oriented in nature.

• These are– motivation, – communication and– leadership

E. Controlling • This is the measurement and correction of

performance in order to ensure that enterprise objectives and plans devised to attain them are accomplished

• Controlling is a function of every manager both at lower and upper level since all have responsibility for the execution of plans.

• In controlling we must:– Establish standards – Measure performance– Correct deviations

• Management can also have three broad sequential functions – Planning – Implementation and– Evaluation

• Two continuous functions of management are– Communication –Decision-Making

• Communication – During the process of planning, implementation

and evaluation, it is necessary for sharing ideas/information between the ManagerStaff and the Community

• Decision making– Planning, implementation and evaluation require

decision making as a task.

Day 2 (October 3, 2012 => 10:00 a.m.-12:00 p.m. )

5. Management and Environment

6. Role and Types of Managers

7. Management Skills

8. Concepts and Principles of Management

5. Management and Environment

• Health service organizations are affected by the external environment and vice versa

• Management performs all the functions of management in interaction with its environment

• Organizations are open systems!• Management while performing its various functions continually

adopt itself to changes occurring in its environment

• Organizations process inputs (human resource, materials, Finances, Information, Technology, and Time) into outputs in the form of goods (products), services and deliver them to the environment.

Components of the external environment 1. Political

i. Policyii. Political institution/organization iii. Government officials/institution

2. Economic and Business Communitiesi. Suppliersii. Clientsiii. Farmersiv. Merchantsv. Share-holders

3. Social i. Community ii. Leaders

4. Technological iii. Medical equipment iv. Strategies, e.g. Community based

distribution

5. National and International Issues

6. Role and Types of Health Managers

• Defining managers by their managerial roles was presented and developed by Henry Mintzberg in 1970s

• Managerial roles are categorized into three major areas with further classification A. Interpersonal roleB. Information roleC. Decision Making role

A. Interpersonal Role-shows the interpersonal contact that a manger does which is vital in his/her daily activities.

• Interpersonal roles are designated by 1. Figurehead- this role symbolizes the legal authority

of the manager such as: attending ceremonies, signing documents…

2. Leader- this role holds him accountable, responsible, and motivator of the staff he is working with

3. Liaison- this role enables the manager creates links in horizontal as well as vertical chain of communications that facilitate communication in and out side the organization

B. Information Role-this role is related to communication and information channeling1. Monitor-Serving as a focal person for all types

of communications 2. Disseminator-Communicating selected

information to subordinates3. Spokesperson-Communicating selected

information to outsiders

C. Decision Making Role -A manager has a legal authority to decide on matters that are assigned to him based on his job description

1. Entrepreneur -designing and initiating changes within the organization

2. Disturbance handler -taking corrective action and handling conflicts

3. Resource allocator -decides on resources and their distribution

4. Negotiator –Negotiating with other parties representing organizational interests

7. Types of Health Service Managers 1. First Line (or first level) Manager– Managers who are responsible for the work of operating and do not

supervise other managers– They are the first or lowest level of mangers in the organizational

hierarchy

2. Middle Managers– Managers in the mid range of the organizational hierarchy– They are responsible for other managers and sometimes for some

operating employees– They report to more senior managers

3. Top Managers – Managers responsible for the overall management of the organization – They establish, operating policies and guide the organization’s

interaction with its environment

8. Management Level and Skills

1. Technical Skill Low Level First Line– The understanding of technical element of activities in general

and proficiency in specific kind of technical activity

2. Human Skill Middle Level– This is the ability to work with others and win cooperation

from the health team other sectors and the community

3. Conceptual Skill Top Level (senior)– The ability to visualize the organization as the whole and its

relationship with the community and other sectors

9. Concepts and principles in Management

• In the process of fulfilling his/her managerial duties the manager would apply the following concepts and principles

A. Concepts1. Effectiveness2. Efficiency3. Economy of Scarce Resources4. Work Relations 5. Information

1. Effectiveness– The degree to which stated objective is being achieved– It is something that management tries to improve

2. Efficiency– It is concerned with the balanced use of resources

(money, material, human resources, time, space, and information)

3. Economy of Scarce Resources– Some and often many resources are scarce and costly

thus we have to economize

4. Work Relations – Work activities should be designed and structured so as to

support each other towards the achievement of objectives

5. Information – Management needs information if it is to make the right

decision for action. – At the same time, information can easily handicap

management, if it is not• The right kind• At the right time• In the right hands

B. Principles1. Management by Objectives2. Learn from Experience 3. Division of Labour4. Substitution of Resources5. Convergence of Work 6. Functions Determine Structure7. Delegation 8. Management by exception9. Shortest decision path

1. Management by objectives– Management sees that objectives are specified

and then that they are achieved– The objectives should state1. What is accomplished?2. How much of it?3. Where is it to be done?4. When it is to be completed?– Therefore a clear statement of objectives makes it

possible to evaluate how effective one is in approaching and reaching the objectives

2. Learning from experience– Analysis of the results between the objectives and

achievement made. For better performance there should be feedback to learn from the experience gained

3. Division of Labor– Management attempts to bring about balance of work

among tht different people concerned

4. Substitution of Resources– Often when the resources that are normally used to

provide service became scarce or too expensive, different resources may be used to provide the intended results

5. Convergence of Work – Working relations should contribute to the success of each activity

and so to general effectiveness. – Theses working relations of activities are

• The logical relations with each other• Time relations or sequence• Spatial relations between activities • Functional and structural-working relations between

people

6. Functions Determine Structure– When the work is defined i.e. the function and duties of the individual

members of the team are clearly defined and known to all, the working relations of the structure follow.

– The exact nature of authority will be clearly delineated on the structure

7. Delegation – Delegation takes place when some body’s authority is lent so as to

enable that person to take responsibility when the occasion arises

8. Management by exception• In effect this means two things1. Don’t be overloaded with routine, unnecessary

information, be selective 2. Make BIG decision first In short management by exception means1. selectivity in information 2. priority in decision 9. Shortest decision path• This principle deals with issue

– Who should make which decision?– When and Where?

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

Questions For Review

Q. Why do you learn the course Health Service Management?

Q. Do you think Learning Health Service Management is important to foster equitable health care and justice in health?

Q. Assume that you are working as a manager of certain health center in Tigray. A supervisor from Regional Health Bureau came to you. on behalf of your team, you explained to him every thing he claimed to know about your health center. Which one of your managerial role are you playing in this scenario?

a) Disseminator b) Monitor c) Spokesperson d) Entrepreneur

Q. While working as head of certain health center Amina who is a newly hired nurse at your health center mistreats patients and she usually insults them. You spotted her while committing the same mistake and you called her to your office. You told her being in the most rewarding profession, she is one of the God’s army and God’s choice to save patients from suffering and her services are earthly divine. Besides patients are likely to accept her orders to take medication if she keeps humble and treats them respectfully. After she heard this she become motivated and told you that she will be happy to accept your comments and serve the patients in a nice way. You played which of your managerial roles in this case?

A. Figurehead B. Leader C. Disturbance handlerD. Monitor E. B and C

Q. Which one of the following is FALSE?a) Management branch of social science that deals

with human behavior b) Management is indispensible part of every

organization to enhance total performance c) Management and administration are words of

the same meaning which can be used interchangeably

d) Management is as old as human history

Q4. Broad area of responsibility composed of many activities aimed at achieving a predetermined objective is called__________a) Management b) Administration c) Function

Q. What are functions of Management?Q. What are the 10 roles of Management?Q. Outline the difference in between

Management and Administration?Q. What are the two indispensible components

of every function of management?