Leadership and Management
Introduction and overview of workshop
Clear the Deck exercise
Group work on differentiation between 10:30-11:00
“Team” versus “Group”
Flip chart, flip chart board
Instruction shown by ppt
LCD, computer for ppt
Count 1-4 and go to each group, and
brainstorm for a while and write down
on stickers and put on the flip chart
under G & T headings
4 groups, two on “Teams” and
two on “Groups”
presentation on it
PPT presentation on Group vs Team
Exercise on Broken Squares
11:30 – 12:30
-Form 5 persons in a group- 12 groups
(count numbers 1-12, and with 60
people will get 5 persons per group of
12-this group will always be the same
whenever exercise of 5 persons come)
According to Game sheet, ask them to
make 5 squares with one observer each
5 Envelopes per 5 persons in a
group- 12 groups
12 Observers’ observations
Winding up by first asking observer,
then participants and facilitator
Ask participants to fill up Team Effective
Critique papers distributed
PPT presentation on “Effective Team 13:30-14:10
Building” and winding up of above two
What did you get from this exercise?
Record on (3) things they learn from Broken Square exercise
Three strengths from Team Effectiveness critique
Three things team needs to work on in order to improve their team effectiveness
Papers on Scavenger Game
Explanation on concept
What is Management?
Papers with nine dots
Managerial skills & competencies
Join the Dots Game
Papers with 12 dots
Explanation on concept
Papers with 16 dots
Tennis court and tennis balls
Explanation on concept
Group work on Lesson Plan for 16:00-17:00
Management of Teams in HSS package
tour (4 groups) & presentations
General Discussions on Day 1
End of Day 1
What is leadership?
09:30 – 11:00
Color stickers, flip chart &
“Silence,” “Blindfold Game”
What do you see?
Explanation on concept
Explanation on concept
“Quick Draw” exercise
Papers with numbers
Explanation on concept
participants on motivation of
Presentation by triads
“Fold you arm” exercise
Explanation on concept
“Answers without questions” 16:00-16:30
Explanation on concept
END of DAY 2
Observers- note down
WHY Management and Leadership development is needed at Health Organization?
The administrative framework of the ministry of health is mostly regarded as a classical pyramidal
structure with four levels, community, township, State and Regional level and central level as in many
other countries. At each level functions and structures should be well determined and management and
leadership should be developed at all levels. As Management is quite a broad concept and embraces
many functions it is regarded as the combination of processes through which an organization attempts
to achieve its goals.
To introduce the concepts of management and leadership
3. Expected Outcomes
On completion of this unit, participants will be able to:
-define the term “management”
-explain management principles and functions
-understand managerial competencies and leadership competencies
-describe the terms “manager” and “leader”
-define the styles of leadership
-make clear the elements of effective leadership
-apply management and leadership principles in managing township health systems
4.1 What is Management?
There are several definitions of management. For instance:
Management is getting things done
Management is a set of functions that help the organization to work cohesively and achieve its
objectives. Management is about getting results.
It is an organized process that guides the utilization of various resources such as human,
financial and material in order to meet a desired organizational goal taking into consideration
consumers’ demands (clients’ needs), and the political and economic situation (emphasis on
Management is referred to the tasks and activities involved in directing an organization or one
of its units
4.2 The Management Functions
Managerial work consists of 11 well-defined but interrelated activities which can be summarized as:
1. Organizing: determination of formal organizational structure through which subdivisions are
defined, arranged and coordinated for the whole organization
2. Policy: determination of policy is the essential starting point; identifying the main goals and
what strategies should be employed to reach them
3. Planning: involves detailed listing of the actions required, the targets, and time tables. Planning
of resources and programmes.
4. Standards: setting of standards in the production, storage and utilization of pharmaceuticals
and equipment. Also standardization of type of health personnel that should be utilized to
provide a certain level of service.
5. Administration: with several subdivisions for vertical and horizontal allocation of resources
towards accomplishment of organizational goals.
6. Information: regular recording and reporting of information on the health needs of population
(morbidity, mortality) and reliable information flow on human resource, logistics and functions
of the programmes.
7. Budgeting: financial planning, accounting and control
8. Personnel: personnel management that includes recruitment, selection, placement, payment,
designation of functions through job description, motivation and counseling, remuneration,
separation and maintenance of favorable working conditions
Training: staff development through in-service training, and continuous personal professional
10. Monitoring and evaluation: keeping track of day to day activities carried out by regular
supervision, review of reports and recognition of problems that may develop. Evaluation is a
more thorough long term process assessing the programme’s inputs, process, outputs and
11. Coordination: important duty of interrelating various parts of work to avoid duplication of
efforts, conflict and to give attention to obvious health gaps in the health programme for
4.3 Branches of Management
Human Resource ManagementFinancial ManagementHealth Information Management
Human Behavioral Management
4.4 Three main roles of Manager
4.4.1. Interpersonal role Managers as figureheads who, because of their authority, are obliged to perform a number of
Managers as leaders, providing guidance and motivation.
Managers as liaison officers, maintaining a web of relationships with individuals and groups.
Managers as disturbance handlers, dealing with involuntary situations and change beyond their
4.4.2. Informational role
Managers as monitors, continually seeking and receiving information as a basis for action.
Managers as disseminators, passing factual information to supervisors, colleagues and
subordinates and transmitting value statements to guide subordinates in making decisions.
Managers as spokespeople, transmitting information into their organization’s environment.
4.4.3. Decision making role
Managers as entrepreneurs, acting as initiators of controlled change in the organization.
Managers as resource allocators, making choices about scheduling their own time, authorizing
actions and allocating people and finance to projects or activities.
Managers as negotiators with other organizations or individuals.
4.5 Managerial Skills
Communication skills -these include leading meetings, facilitation, negotiation, conflict resolution public
speaking, effective writing, cross-cultural communication...
Organising skills-which may cover planning, monitoring, problem-solving, evaluation, co-ordination,
programme management, decision making, time management...
Supervising skills-such as delegation, motivation, performance management, coaching and developing
Skills after some time can become competency where we have Managerial Competencies as follows:
4.6 Managerial Competencies
1. Self Management
2. Strategic Action
3. Global Awareness
4. Team Work
5. Planning and Administration
6. Communication Competency
4.6.1 Self Management
Self identification of strengths/weakness
-developmental needs ….in leadership
….in many other areas
Continued self assessment
Integrity and ethical conduct
Personal drive and resilience
Balancing work and life demands
4.6.2 Strategic Action
Developing broad strategies that can be translated into clear goals and practical action plans
Proactive vs Reactive
Formulation of contingency plans to minimize risks
Understanding the organization
Taking strategic actions
4.6.3 Global Awareness
Staying abreast of important global trends that have significant impact on the organization
Recognition of global trends on the organization's plans and growth
Being sensitive to key cultural differences and understanding the consequences of cultural
differences for the organization
4.6.4 Team Work
• Creating a supportive environment
• Trust/ Productive management conflicts
• Collaboration and constant information sharing
• Problem solving/ decision making
(Forming, Storming, Norming, Performing, Adjourning)
Managing team dynamics
• Ability to cultivate an active network of relationships and relate well to others
4.6.5 Planning and Administration
• Information gathering, analysis & problem solving
• Setting clear and challenging goals
• SWOT analysis
• Adequate control & clear guidance & Swift decision making
• Planning and organizing projects
• Time management
• Budgeting and financial management
4.6.6 Communication Competency
• Informal communication
• Formal communication
• Negotiation (an agreement)
• Free flow of information upward, downward and laterally (feedbacks)
Listening and informing others
• Fostering open channels and negotiating with others
4.7 Who is the Manager?
A manager is the person who has the responsibility of achieving certain outcomes having been given the
authority to utilize the resources of the organization. These resources consist of human, financial,
information and physical assets. Timely use of these resources is essential for effective management. In
an ideal team, its members recognize the authority of the manager and support him/her in a
constructive way. A manager is therefore a person who can organize people to work harmoniously
together and make effective use of resources to achieve laid-down objectives, through a process that
includes planning, implementation, monitoring and evaluation. A distinction should be made between a
manager and an administrator.
Administration is a subset of management. An administrator is somebody who interprets policies and
directives from above for implementation, knows the rules and applies them well. The administrator
and manager do not have to be different people.
5.1 What is leadership?
There is no universally agreeable definition of leadership, if type “leadership” on Google you can find
more than 186,000,000 different pages of reference on web. Out of these,
Leadership has been defined in different literature with different aspects as follows:
Leadership is the key factor differentiating the “average” from the “excellent”
Leadership is action or a process, not position
The activity of leading a group of people or organization or the ability to do this
Leadership is creating a vision
Leadership is the process of influencing and activities of a group in efforts towards goal
achievement in a given situation
the process of persuasion and example by which an individual (or leadership team) induces a
group to take action that is in accord with the leader’s purpose, or the shared purposes of all
Trust is the foundation of leadership. Leaders develop an environment of trust where the organizational
members tend to establish a follower-ship with the leader.
This important process has three important components/ingredients.
2) Followers and
These three components play very important role on the process of leadership.
5.2 Who is a leader?
A leader is defined as any person who influences individuals and groups/teams within an organization,
helps them in the establishment of goals, and guides them toward achievement of those goals, thereby
allowing them to be effective.
A “leader” is a person who manages people by creating high involvement and shared commitment that
stimulates people to overcome obstacles in the way of achieving maximum results.
Leaders are those persons who are able to influence others and who possess managerial authority.
From these definitions a person who will like to become a leader should have four essential
1. Establishing a clear vision
2. Sharing the vision with others so that they will follow willingly
3. Providing the information, knowledge and methods to realize that vision
4. Coordinating and balancing the conflicting interest of all members and stakeholders
We have to be aware that all of us have the capacity of leadership but not all will become leaders.
In health, leadership has been shown to be essential throughout the administrative framework of the
MOH. Leadership is not only the function of those at top level of health system but it requires at every
level of the system. This manual is on developing leadership skills at township level health system.
5.3 Quality of Leadership
Many literatures say leadership must be born and cannot be made but there are abundant evidences to
the alternative. Possibility of leadership in health sector at township level will definitely vary with local
culture, time, place and capability of health professional through education, skills and experience.
Leadership qualities include the ability to inspire others, establish trust, and promote teamwork.
5.4 Leadership Styles
Typical behavior of leader towards group members can be defined as “Leadership Styles” and through
many literatures leadership styles were identified as follows:
Leader has absolute power over their workers or team
Staff and team members have little opportunity to make suggestions
Leader makes decisions and announces them to staff
All authority centering in the leader
Communication seems to be one way from leader to follower
Fast speed with which decisions can be made, for Most people tend to resent being treated this way,
instance in case of emergency- Style saves time
effects on group morale
Decision is usually clear and final.
Leader is in control
This style can remain effective for some routine
and unskilled jobs by controlling
Other, better options may not be considered
High level absentees and turnover of staff
Leader takes suggestions and wishes of all members
All members of the team are seen as important contributors to the final decision
Participation is required to encourage members’ commitment to the decision
Increased morale and support of the team
members- Staff feel involved
It increases job satisfaction and also helps to
develop people’s skills
Decisions receive a high level of support.
Chance of implementation is good.
Slower decisions, diluted accountability for
decisions and may not always be the best solution
Participation takes time and can take more time to
get final result
Most popular decision may not be best option
Laissez faire leadership
The French phrase means “leave it be"
Leader attempts to exercise very little control or influence over group members
Leader leaves team members to work on their own
Gives opportunity for individual development
Lack of group unity and consistency towards
achieving organizational goals
Can be effective when individual team members are
well experiences and skilled self-starters
5.4.4. Bureaucratic leadership
Leader works “by the book”
Follows rules strictly
Leader ensures team members to follow procedures precisely
Appropriate for specified jobs involving serious
and safety risks Eg: where they have to work with
machines in handling toxic substances or where
large sum of money is involved-such as handling
Can become bored
Charismatic leadership is when a person assumes or is given the role of leader based on
his or her charisma or charm
Leader stimulates a lot of enthusiasm in his team and very energetic in driving others
Leader tends to believe more in himself than in his team
His influence derives mainly from his personality
Followers love him and look only into his face
The entire organization might collapse if the leader
Without that person, accomplishment is not
Can be subject to corruption as the leader knows
that the people will likely follow no matter what.
People who follow that leader will ensure goals are
achieved out of respect for the leader.
Focus on getting the job done
Leader tends to be quite autocratic, actively defining the work and roles required, put
structures in place, plan, organize and monitor
Leader does not think much about the well-being of his team
Finish job in time
Less motivated staff
More turnover of staff
Transaction is usually the organization paying the team members in return for their
effort and fulfillment of job
Leader can punish team members if the work does not meet the pre-determined
Team members agree to obey their leader totally in accepting the job
Good to practice for short term task
This is more like a type of management than a true
Limitations for knowledge based or creative work
Leader has integrity, sets clear goals and clearly communicates a vision
Transformational leadership was found to influence team performance and team
Leader challenges each person to be all that they can be and more
Leader sets a good example and expects the best from the team, encouraging
productivity and innovation
Leader encourages, supports and provides stimulating work
Inspires and focus more on team’s interests and needs
Development of whole organization
If the leader leaves it is likely a new one will step
into place and the work will continue until
Although Transformational leadership style is often highly effective, there is no “one size fit for all way”
to lead or manage that fits all situations. A person has to be a good leader considering the followings:
The skill levels and experience of his team
The work involved (routine, or new)
The organizational environment
Leader’s own preferred or natural style
Many motivational experts like to say leaders are made, not born but there are many alternatives to
argue this motto. All of us are natural leaders.
Children-are curious, humble, and always hungry and thirst for knowledge with many brilliant
imaginations. Then they were hearing: “No,” “Don’t,” “Can’t,” “No, don’t do this,” “You can’t do this” by
parents and teachers. Traditional education system doesn’t teach students how to become leaders
instead teaches how to become polite, order takers and intelligently follow rules for the cooperate
To become a good leader we need a process of “unlearning” and have to be brave to unlock the door of
inner attic where your childhood dreams lie, going inside to the heart. (Mark Twain)
As TMO, you are the leader of the township health team which consists of hospital as well as public
health teams. The best way to strengthen leadership ability is to intentionally exercise simple, on-thejob self-improvement strategies.
For instance, when dealing with emergency operation you have doctors, nurses and some other people
to help, what would you do after the successful operation to express gratitude to the team’s work?
Ten easy steps to developing your leadership skills by Sharif Khan
A leader has to start with humility, be humble, and willing to serve others. Naturally nobody
wants to follow someone who is arrogant. Always be curious, hungry and thirst for knowledge,
always trying to better yourself, always improving and growing.
When you are humble and genuine in your interest in people because you want to learn from
them, then people will sense you are genuinely interested in them and listening to them. Then
they will naturally be interested in you and listen to what you have to say.
2. SWOT Yourself:
Every of us know what SWOT is: This is a useful key to gain access to self-knowledge, self
remembering, and self-honoring. Start by listing all your strengths including your
accomplishments. Then write down your weaknesses and what needs to be improved. Make
sure to include any doubts, anxieties, fears and worries that you may have. Try to list the
opportunities you see available to you for using your strengths. Finally write down the threats or
obstacles that are currently blocking you or that you think you will encounter along the way to
achieving your dreams.
3. Follow Your Bliss
Always take time to do what you love doing regardless of how busy you are. Being alive and vital
person vitalizes others. When you are pursuing your passions, people around you cannot help
but feel impassioned by your presence. This will make you a charismatic leader. Whatever it is
that you enjoy doing, be it writing, acting, painting, drawing, photography, sports, reading,
dancing, networking or working on entrepreneurial ventures, set aside time every week, ideally
two or three hours a day, to pursue these activities. Believe me, you’ll find the time. If you were
to video tape yourself for a day, you would be shocked to see how much time goes to waste!
4. Dream big
If you want to be larger than life, you need a dream that is larger than life. Small dreams won’t
serve you or anyone else. It takes the same amount of time to dream small than it does to
dream big. So be Big and be Bold! Write down your One Biggest Dream the one that excites you
the most. Remember, don’t be small and realistic, but be bold and unrealistic! Go for Gold, the
Nobel, the Oscar, the highest you can possibly achieve in your field. After you’ve written down
your dream, list every single reason why you CAN achieve your dream instead of worrying about
why you can’t.
Without a vision we perish. If you can’t see yourself winning that award and feel the tears of
triumph streaming down your face, it’s unlikely you will be able to lead yourself or others to
victory. Visualize what it would be like accomplishing your dream. See it, smell it, taste it, hear it,
feel it in your gut.
Victory belongs to those who want it the most and stay in it the longest. Now that you have a
dream, make sure you take consistent action every day. I recommend doing at least 5 things
every day that will move you closer to your dream.
7. Honor your word
Every time you break your word, you lose power. Successful leaders keep their word and their
promises. You can accumulate all the toys and riches in the world, but you only have one
reputation in life. Your word is gold. Honor it.
8. Get a Mentor
Find yourself a mentor. Preferably there is someone who has already achieved a high degree of
success in your field. Don’t be afraid to ask. You’ve got nothing to lose. You can even find
suitable mentor through a website by filling your profile. Also take time to study
autobiographies of great leaders that you admire. Learn everything you can from their lives and
model some of their successful behaviors.
9. Be Yourself
Use your relationships with mentors and great leaders as models but do not copy or imitate
them like a parrot. Everyone has vastly different leadership styles. Be yourself, your best self,
always competing against yourself and bettering yourself, and you will become a first rate YOU
instead of a second rate of somebody else.
Finally be a giver. Leaders are givers. By giving, you activate a universal law as sound as gravity:
“life gives to the giver, and takes from the taker.” The more you give the more you get. If you
want more love, respect, support, and compassion give love, give respect, give support and give
compassion. As a leader, the only way to get what you want is by helping enough people get
what they want first.
Sir Winston Churchill once said: “We make a living by what we get, we make a life by what we
See the big picture
Create a shared vision
Clarify purpose & priorities
Motivate committed teams
Reflect on yourself and be aware of your impact on others, manage your
emotions effectively, use your strengths, and work on your
Look beyond a narrow focus to take into account conditions outside your
immediate areas of work.
Work with others to envision a better future and use this vision to focus
all your efforts.
Know your own values and what is most important to accomplish.
Hold conversations focused on outcomes; balance advocacy with inquiry;
and clarify assumptions, beliefs, and feelings within yourself and others.
Create the clarity, trust, and recognition necessary to lead to high
performance that can be sustained over time.
Reach agreements from which both sides can benefit.
Enable your work group to own challenges, enlist stakeholders, and
navigate through unstable conditions.
Adapted from: Management Sciences for Health. 2005. Managers who lead:
A handbook for improving health services. Boston.
Strong and effective leadership creates a high degree of involvement and shared commitment that
stimulates people to overcome obstacles to achieve maximum results. Critical success factors of
effective leadership are:
Ability and commitment to motivate people
Excellent interpersonal skills
Ability to learn on the job
Hard work and working smarter
Linking strategic planning to implementation
Facilitating organizational development.
An effective leader will:
Take initiative: This is exercised whenever effort is concentrated on a specific activity, to start
something that was not going on before, to stop something that was occurring, or shift the direction and
character of effort. DHMTs need to take individual and collective initiatives, especially during the current
changes as a result of the reforms.
Enquire: This permits a leader to gain access to facts and data from people or other information sources.
The quality of information may depend on a leader’s thoroughness, keenness and commitment. A leader
who is keen to learn as much as possible about work activities is more likely to gain quality information
than one who ignores the need for enquiry. This is particularly important for DHMTs in view of the
requirements of evidence-based planning and the call for health systems research.
Advocate: This means to take position in support of a cause, e.g. creating awareness on cost sharing. A
leader has convincing abilities and is prepared to take a stand.
Face and handle conflict: A leader should be ready to face conflict and resolve it with the mutual
understanding of those involved, creating respect by doing so. Failure to do so leads to disrespect,
hostility and antagonism.
Make decisions: This involves choosing or selecting between two or more courses of action. It may
involve choosing an intervention or how best available resources can be effectively used. Township
Health Management Team require adequate decision-making skills for planning, especially in the aspect
of resource allocation.
Critique: Good leaders are able to give constructive critique and feedback. DHMTs need to use the
“Critique Approach” when conducting supervision, counselling and guidance of their subordinates.
Transparency: A good leader is open, avoiding doubt through effective communication and information.
In short, a good leader is characterized by decisiveness, integrity, enthusiasm, imagination, willingness
to work hard, analytical ability, understanding of others, ability to spot opportunities, ability to meet
unpleasant situations, ability to adapt quickly to change, and finally, willingness to take risk.
Management or leadership?
Although there appears to be an overlap between management and leadership, it is possible to
differentiate between traditional management styles that are still found in so many organizations and
the forward looking, change-oriented leadership styles that are required to achieve actual reforms.
Focus on stability, avoiding risk
Emphasis on growth & change/acceptable risk
Peacemaker, avoidance of conflict
Peacemaker, conflict risked as inevitable to
Emphasis on skills
Emphasis on attitudes
Win-loose power orientation
All can win through expansion
Extrinsic motivation (stick or carrot)
Intrinsic motivation (the extra mile)
Day after tomorrow
You serve me
I serve you
Externalizes responsibilities, tendency
to “wait and see”
Assumes responsibility to change
Them (tendency to blame, premise of
incompetence in others)
Me and them (trust in innate desire to excel/
Linear thinking, intellect dominates
Systems thinking, balance between intellect
Positional power emphasized
As an individual confidential exercise, judge yourself against the above list of traditional management /
leadership qualities; write down how you rate yourself. Then make a list of the health center level
If it is to improve the performance at the health center level in township health system as the health
center and all its forms and functions is the backbone of the health services and health development in
Motivation: There are over 140 definitions of the term motivation that have been used in various
capacities. Motivation is important because it explains why employees behave as they do.
Work Motivation can be defined as the psychological forces within a person that determine the
direction of a person’s behavior in an organization, a person’s level of effort, and a person’s level of
persistence in the face of obstacles.
Motivation is the result of the interaction of the individual and the situation.
Motivation is the processes that account for an individual’s intensity, direction, and persistence of
effort toward attaining a goal.
Motivation is the force that makes us do things: the result of our individual needs being satisfied (or
met) so that we have the inspiration, energy and will to complete tasks at or above standards.
A Stimulus to Action
Drawing force for activity towards goal
Reason behind a movement for change in action, state or position
Sources of Motivation: Intrinsic and Extrinsic Motivation;
Intrinsically Motivation: is behavior that is performed for its own sake; the source of motivation is
actually performing the behavior.
a. Employees who are intrinsically motivated often remark that their work gives them a sense of
accomplishment and achievement or that they feel they are doing something worthwhile.
b. Motives are intrinsic when an independent third party cannot easily verify them.
Extrinsic Motivation: is behavior that is performed to acquire material or social rewards or to avoid
a. The behavior is not performed for its own sake but rather for its consequences.
b. This form of motivation may be linked to operant conditioning.
c. Motives are extrinsic when they can easily be verified by an independent third party.
People are naturally lazy, they prefer
People are naturally active; they set goals and
People work mostly for money and
People seek many satisfactions in work, pride in
achievement, enjoyment of process, sense of
contribution, pleasure in association and
stimulation of new challenges
The main focus keeping people
productive in their work is fear of
being demoted or fired!
The main force keeping people productive in
their work is desire to achieve their personal and
People remain children grown larger;
they are naturally dependent on
People normally mature beyond childhood; they
aspire to independence, self fulfillment and
What are Some of the Most Powerful Motivators in our Lives?
Sense of accomplishment
Perceived need for change
Chance to make a difference
Opportunity to serve
How can you motivate yourself
How can you motivate others
_ Stick with your passions
_ Associate with highly motivated people
Share your enthusiasm
Set a measurable goal
Hang out with high achievers
Make a compelling case
Flavor tedium with pleasure
Use emotional temptation
Go with your strengths
Set a fire and keep it going
Make it fun
Stay focused on results
Just do something
Keep doing something new and different
1.1. Learning Objectives
At the end of the session, the participant will be able to:
Differentiate between a team and a group.
List the stages of team development.
Understand the approaches of team work in health.
Describe the characteristics of an effectively functioning health team.
Understand the different skills that team members need.
Understand and get involved in the different activities of a health team.
1.2. Differences between a group and a team
What is a group?
A group is defined as of two or more individuals, interacting and interdependent, who have come
together to achieve particular objectives.
What is a Team?
A team is a small number of consistent people committed to a relevant shared purpose, with
common performance goals, complementary and overlapping skills, and a common approach to
their work. Team members are mutually accountable for the outcome. (EPHTI, 2005)
A team is a formal work group in which there is a high level of interaction among group
members who work intensely together to achieve a common goal.
An organized group of people who are dependant on each other, working together with
commitment towards a common objective for which they are mutually accountable.
Key terms of the definition are described below:
Relevant Shared Purpose: The purpose or goal is defined by the members of the team working
collaboratively; within this purpose each team member has specific tasks which are discussed and
Consistent Membership: Members become comfortable with and knowledgeable about each others’
skill levels and more committed to sharing their knowledge and skills to develop fellow team members
as long as the team exists.
Complementary and Overlapping Skills: Include technical or functional expertise, interpersonal skills,
supervisory or management skills.
Commitment to a Common Approach to the following areas: working methods and team process
(documenting each work and individual work, methods for problem solving): roles and responsibilities
(team versus job roles); behavioral expectations; the environment of the team which includes trust of
Mutually Accountable: Everyone is accountable all the time for the accomplishment of the results of the
team, the process and functioning of the team as well as their own responsibilities. Other team
members will compensate or contribute if some members are not able to achieve their specific
Common performance goals: Needs to have a common performance goal that is closely related to the
Differences between a group and a team
Size-2 or more people size can be bigger
Size- 2 or more people, 5-7 the best
Groups are just people assembled together for
Teams can be formed within work groups or from
different functions or sections of the organization.
Group members are
-relaxed and comfortable,
-having informal atmosphere,
-task well understood and accepted,
-members listen well and participate,
-people express feeling and ideas
Teams are high level of interaction among others
-achieving common goal
-stay tight on common interest
Team members are
-brightest and enthusiastic
-concerned about committed to common goal
Group members may not be accountable to the
action of the group. They are only accountable for
individual effort of action
Focus on individual roles, tasks and responsibility,
even though group may cooperate
They communicate the assessment and tasks are
distributed to individuals. Individualized approach
The leader is more responsible and authorized than
Group members are
• Focus is on self
• Told what to do
• Little involvement
• Disagreements avoided
• Training not always applied
• Unresolved conflict
• Not part of decisions
Team members share a common goal and
purpose, therefore, each team member is
mutually accountable for the team’s outcome
Individuals cooperate, communicate and
share responsibility among each other
They discuss as a team and determine goals.
They jointly develop action plan. They have
common approach to work
The leader is equally responsible and authorized
like any member of the team.
Team members are
• Focus is on team
• Direction decided by team
• Total involvement
• Disagreements okay
• Open communication
• Training applied
• Conflict normal
• Part of decisions
All teams are groups but not all groups are teams.
Attitude is an important factor in determining whether you and the people with whom you work
function as a “group” or a ‘team’.
Stages of Team or Group Development
A team is living and dynamic entity. It could progress from an early to a mature phase independent of
the nature of the team or task it must perform. Tuckman’s model (2) proposed the following typical
phases in team development.
a. excitement, anticipation, optimism.
b. members getting to know each other
c. anxiety, fear, or even suspicion about the job ahead… and demonstrate these behaviors.
d. discovering what is considered acceptable behavior
e. determining the group’s real task
f. defining group’s rules
g. questions about purpose
h. non intimate relations
i. members seek leadership
This stage is complete when the members begin to see themselves as part of the group.
Useful activities/tools the team leader can use to help forming groups are:
Clarify the mission
Establish ground rules for team behavior.
Provide any needed training.
a. clarifying member’s expectations
b. understanding members’ interpersonal styles
c. resist collaborating with each other
d. individuals establish their own expertise within the group
e. members test each other’s strength
f. arguing among members, even when they agree to the real issues.
g. defensiveness, competition, withdrawal
h. member ejection may occur
Some members may become dissatisfied and challenge not only the tasks of team and how these will be
carried out, but also the leader’s role and style of leadership. This is the start of intragroup conflicts.
Useful activities/tools in the Storming phase are:
Conflict management techniques.
Clarification/teaching of concepts, tools, team dynamics, meeting methods, and roles.
a. holding the group together
b. dealing with divergent views and criticism
c. dealing with a premature sense of accomplishment.
d. intensified, interpersonal involvement
e. desire for group attention
f. member interdependence
g. dependence on the leader
h. increased trust
i. well established norms
j. rules, roles, standards
k. growing capacity to plan
l. relief that everything is going to work out…and exhibit these behaviors
m. commitment to working out differences
n. giving and receiving feedback constructively
This process should result in the team establishing procedures for handling conflicts, decisions, and
methods to accomplish the team projects.
Useful activities/tools the team can use in the Norming phase are:
1 Continue the fostering of shared responsibility.
Refocus on the agenda or purpose (when necessary)
Provide training on quality
a. sense that “our” group is special
b. acceptance of individual differences
people can be themselves
disagreement/conflict is OK
structure, roles, norms established and accepted
teamwork utilizes the diverse strength of the members
satisfaction with the team’s progress.
trust in one another… and exhibit these behaviors
willingness to take risks.
commitment to process and goals.
Leadership is provided by the team members, best suited for the task at hand. Members have learned
how to work together, manage conflict, and contribute their resources to meet the team’s purposes.
5. Adjourning- A well-integrated group/team is
a. Able to disband when its work is finished.
b. Willing to work together in the future.
c. Celebrate individual/ collective accomplishments
The team dissolves when the team has completed the project. It may be reoriented to continue on a
next phase of the project.
Effective Team Building
Team development is based on the assumption that any group is able to work more effectively if its
members are prepared to deal with such questions as:
How can this team work together more effectively?
How can we better use the resources we represent?
How can we communicate with one another more effectively in order to make better team
What is impeding our performance?
(Mark Alexander, “The Team Effectiveness Critique” University Associates, Instrumentation Kit, 1987)
These questions are answered by Players committed to helping the team with:
Shared Goals and Objectives
Planning is always the first critical stage of any program. Carefully prepared plan helps to attain the
goals/objectives of the team.
These goals and objectives are not a simple understanding of the immediate task, but an overall
understanding of the role of the team in the total organization, its responsibilities, accountabilities, and
the things the team wishes to accomplish. A game plan must be developed, accepted, and followed.
The team wins when everyone focuses on agreed upon goals, has open communication, and achieves
Development and cohesion of a team occurs only when there is a feeling of shared leadership among all
members. No one person can be expected to perform all the required leadership functions. All
members perform both task and maintenance functions. Although some are naturally more taskfocused, others are more maintenance-focused so as to have a balance in the team.
Trust and Conflict Resolution
All teams experience disagreement. The ability to openly recognize conflict and seek to resolve it
through discussion is critical to the team’s success.
Utilization of Resources
The purpose of the team is to do things effectively! In order to accomplish this, the team must establish
an environment that allows individual resources to be used. The roles and responsibilities of each
member of the team should be clearly mentioned from the outset so that each member of the team
knows what to do and duplication of roles will be avoided. Similarly, if the roles are clearly defined, no
important role will be missed by the team.
Control and Procedures
Procedures guide the team’s activities. Procedures include meeting agendas, schedules of actions and
other action-oriented functions of the team. The team determines how it maintains control over what
happens during team meetings. Control includes such things as ground rules of behaviour, steps
followed during meetings, methods for consensus decisions, timelines, and use of resources. Some
teams find they do not need a formal leader, each member regulators his/her own contributions and
behaviours as well as those of others. New teams frequently struggle over this issue and most new
teams are more successful with a designated leader.
This involves open, honest discussions. Members listen to one another and attempt to build one
another’s contributions. Team members achieve effective interpersonal communication through selfregulation.
Problem Solving and Decision Making
There should be agreed-on approaches to problem solving and decision-making. There are many
variations on how to team problem solve.
Experimentation and Creativity
Teams should be prepared to periodically move beyond the boundaries of established procedures and
processes in order to experiment with new ways of accomplishing things. Effective teams use
experimental thinking in order to allow the team greater flexibility in dealing with problems and
The team should periodically examine its processes from both the task and maintenance aspects. The
team should ‘stop’ and ‘look’ at how well it is doing and what, if anything, may be hindering its
operation. Effective team self-assessment is one of the most critical factors leading to team
development. A reward system recognizing individual and team achievements must be established.
In short, in Effective Teams:
People trust each other
Feelings are expressed freely
Conflict is worked through
Process issues are part of work
Commitment is high
Objectives are common to all
Listening is high
People are open
Everyone in the team contributes to decision making
How to measure Team Effectiveness?
Measuring the productivity
Learning, growth and development
Integration with the rest of organization
Team Helping Behaviours
Team Hindering Behaviours
Holding back information and/or feelings
Not open and honest
Protection of own issues or organization area
Riding on ideas
Hidden agendas or aligning self in such a way
that ideas are not clear
Does not contribute ideas or different
Clarifying or restating issues
Supporting only personal issues
Keeping to the subject or task at hand
Playing the power or authority game
Listening to understand
Willingness to be influenced and to change
Unwillingness to compromise
Willingness to give up on interest
Will not admit to problems of that own ideas
could be wrong
Willing to take personal risks in declaring
Will not take personal risks in being direct and
Relation of the Team Members with each other and with the Community
There must be good relationship among team members and between the team and the community. To
establish good relations, a health team needs to work with the community and this comprises of the
following four steps:
Step 1- Listen, learn, and understand
To work with people and help them, it is essential to understand their ways of life. These can be learned
only by living with people, listening and watching. It is not recommended to ask too much questions,
this annoys people. Health team may observe and learn about communities concerning their work and
living standards, family life, social and political structure, population structure, value, beliefs and
customs, and health attitudes.
Step 2- Talk, discuss, and decide
The health team should work with the community towards recognizing its health problems and putting
them in order of priority. Discussion can be formal or informal:
Informal discussion with families, people, political leaders and religious leaders, etc. will produce further
ideas. From these talks it is possible to make a list of the main problems that concerns the community.
Formal meeting conducted by a community leader could be held to try to decide which the most serious
problems are and what can be done about them. This could be difficult and several meetings might be
needed before any clear decision can be reached. In this way the people are encouraged to participate
in solving their own health problems. However, health staff should be cautious in such meetings, as
community leaders are likely to try to persuade the people to agree with them about which problems
should be given priority.
Step 3- Encourage, Organize and Participate
When the people have decided what the main health problems are and agreed to their order of
importance, a plan of action must be prepared. The health team works with the community to put the
plan into action, to make changes that will lead to improvement over a period of time.
Step 4- Inform
Once a plan of action has been proposed, discussed and accepted, the community should be informed
of its objective and of any decisions taken. If people do not know what is intended, they are unlikely to
do anything to help in achieving it.
Skills of the Health Team Leader and Members
A skill is an acquired and learned ability to translate knowledge into performance. It is the competency
that allows for performance to be superior in the field where the worker has the required skill. All health
team members and leaders need to have technical, human relation and conceptual skills. The degree of
skill required may vary between the members and the leaders, for example, conceptual skill is highly
needed by the leader.
Technical Skill: It basically involves the use of knowledge, methods and techniques in performing a job
effectively. This skill is acquired through education and training.
Human Relation Skill: It is the ability to work with other people in a cooperative manner. It involves
understanding, patience, trust and genuine involvement in interpersonal relationships.
Conceptual Skill: It is the ability to view the organization/team as a whole and as a total entity. It also
reflects the mental abilities of team members to visualize the complex interrelationships in work areas,
relationships among people, among various organizations in the health system and even between its
external environments. It permits team members to understand how the various factors in particular
situations fit together and interact with one another.
In addition to the above-mentioned skills, communication, decision-making and problem solving skills
are required for effective functioning of heath team.
It is common experience that personal relations within a team can be difficult. Difficulties are often
caused or made worse by poor communication within the team and between the leader and the team
members. In the same way, difficult relations may cause, or make worse, poor communication. A team
leader should, therefore, pay special attention to the quality of team relations, and of communication as
a means of maintaining good relations.
To encourage communication, the team leader should always observe certain principles:
All team members should be free to express and explain their views and should be encouraged to do so.
A message or communication, whether oral or written, should be expressed clearly and in the language
and terms that can be understood by all concerned.
Communication has two elements - sending and receiving. When the message that is sent is not
received, communication has not taken place. Therefore, the team leader (or other communicator)
should always use some means of checking that the intended effect has taken place.
Conflict or disagreement is normal in human relationships; it should be managed in a way that will
achieve constructive results.
Some Communication Skills and Techniques
Disagreeing with Respect
Reveal discomfort immediately. Don’t store up feelings and then dump them all at once on the other
Stick to the present. It is not helpful to bring up the past during disagreements.
Don’t just complain, but offer a plan for change. The goal is constructive problem solving, not griping.
Use active listening. Before you respond to a person’s statements, repeat it back to him/her using your
Communicate feelings using “I” statements. Think “How does this make me feel?” and state that to the
other person, rather than accusing them of making you feel a certain way. Take responsibility for how
Allow time to finish the disagreement without walking out in a huff, ending with a sarcastic comment,
or becoming violent.
Learn the difference between “time out” and abandonment: “time out” says, “I need a break. Let’s start
the discussion again in ten minutes.” Abandonment is walking out not saying where you are going or
when you will be back to continue the discussion.
Allow for differences in communication style. Do you talk out a problem out loud, or do you reflect on it
quietly and state the conclusion of your thinking?
No audiences. Do not involve another person in your disagreement unless it is a third party you have
both agreed to involve.
No name-calling, threats, or “silent treatment.”
Focus on behavior, not character. “Do not attack another person’s character. Talk only about the
Example of attack on character: “You are thoughtless and stupid.”
Example of focus on behavior: “I am irritated because the work you did was incomplete and did not
include changed we agreed you would make.”
Agree to disagree. It is possible to understand another person’s point of view without agreeing with it.
You may not be able to resolve every issue to your liking, but you can respect another person’s right to a
viewpoint with which you do not agree.
Decision - Making Skill
Making a sound team decision is a challenge for any team. Hence, team members, be it in big or small
team, need to have minimal decision-making skill. Team members need to attain consensus around a
course of action. This means they have to know how to work together to identify options and come to
shared agreement on which options make the most sense.
The decision-making process comprises the following steps:
Identifying an existing problem
List possible alternatives for solving the problem
Select the most beneficial of these alternatives
Implement the selected alternatives
Gather feedback to find out if the implemented alternative is solving the identified problem.
Problem Solving Skill
Many times, people consider problem solving to be the action an individual or a team takes to take care
of a situation. Though action is important, understanding the problem and suggesting for the action is
Generally, the team will undertake the problem solving process as part of the team meetings. Each stage
of the process will involve discussion and coming to various consensus decisions among team members.
Individual members will also take on assignments, usually involving gathering and analyzing information
on some part of problem that they report back to the entire team.
The steps in the problem solving process
Recognize and define the problem
Collect information and analyze current process
Identify possible causes for the problem
Generate alternative actions to eliminate causes
Select the actions that seem best and implement them
Assess the change and learn
Make the change permanent and start over
To coordinate activities or groups of activities is to bring them in to proper relation with each other so as
to ensure that everything that needs to be done is done and that no two people are trying to do the
same job. Coordination helps work to progress smoothly.
Coordination is the means of:
• Distributing authority
• Providing channels of communication and
• Arranging the work so that
The right things are done (what?)
In the right place (where?)
At the right time (when?)
In the right way (how?)
By the right people (by whom?)
When an activity is coordinated, everything works well: a coordinated activity is orderly, harmonious,
efficient and successful. When an activity is not coordinated, it is liable to fail in its objective: an
uncoordinated activity is disorderly, discordant, inefficient and unsuccessful.
Working Environment of the Team Work
Both the internal and external environment should be conducive to achieve the goals and objectives of
the team. Factors in the internal environment that can influence success are like the relation between
the members, relation between the members and the team leader, trust among the members and
leader of the team.
Trust can be gained when the following attributes are present:
Honesty: truth telling, integrity, and no exaggerations among team members;
Openness: a willingness to share opinion, ideas and feelings, even when it is uncomfortable to do so,
receptivity to new information and to the perceptions and ideas of others.
Consistency: predictable behavior and responses. Congruence between what you say and what you do.
Competence: Capable of doing what is expected and can do the job for which he/she is assigned.
Respect: treating all people with dignity and fairness.
Examples of factors in the external environment, which can influence performance of the team, are like
the health policy, the political environment, availability of resources and infrastructure, support and
recognition by the community. External support and recognition can enhance the performance of the
team. The team’s performance will increase when it is recognized for its accomplishments by the greater
organization or by the society.
Motivating and Dissatisfying Factors
Motivation is an inner impulse that makes a person to act in a certain way. There are two groups of
factors that encourage people to apply their ability and energy to work, and that makes people
dissatisfied at work. These are motivators and dissatisfiers.
Some of the common motivators in work are:
Achievement- most people like to do things well. They like to succeed. Their satisfaction in success and
in getting things done well comes largely from achieving what they expect to be able to achieve and
what they aim at achieving.
Recognition – very few people are satisfied with simply knowing in their own minds that they have been
successful. Most people like others also to know of their success.
The work itself-people like to do useful and worthwhile work; helpful to other people and helping
themselves achieve their ideas. The staffs of an organization like to do work that they can see as
contributing to the objectives of the organization.
Responsibility- to have responsibility is to be able to accept the consequences, good or bad, of a
decision or an action. Most people welcome responsibility; some fear it.
Advancement –it is a form of recognition. Recognition without reward is not very convincing. People
prefer recognition that comes in a tangible form such as an increase of salary or more responsibility,
with freedom to use their own initiative, which leads to job satisfaction.
Self - improvement- people like to become mature, to develop as people. Many make great sacrifices to
improve themselves and their families.
Incentives- Incentive is one of the motivating factors to have effective functioning of health team.
Incentives motivate the member for better achievement of the team’s goal/objective. The following are
some of the incentives:
Material and financial incentives
Recognition for better performance given by the superiors and the community
Things that make people displeased with their work are known as dissatisfiers or demotivating factors.
The team members should try to avoid dissatisfying factors and be aware in advance.
Some of the common causes of dissatisfaction are:
Poor personal relations
Poor leadership quality
Bad working conditions
The Danger of Team Work
Whose job is it?
This is a story of four people named Everybody, Somebody, Anybody and Nobody
There was an important job to be done and everybody was asked to do it
Everybody was sure Somebody will do it
Anybody could have done it but Nobody did it
Somebody got angry about that because it was Everybody’s job, but Nobody realized that
Everybody thought Anybody could do it
It ended up that Everybody blamed somebody when Nobody did what Anybody could have
1.3. Learning activity one: Exercise
Broken Squares: Non Verbal Problem Solving Exercise
This exercise is intended to demonstrate the importance of working in teams.
Doing the game/puzzle consists of a set of five envelopes containing pieces of cardboard cut into
different patterns, which, when properly arranged, will form five squares of equal size. One set should
be provided for each group of five persons.
Procedure to prepare a set of cardboard squares, each 6 inches x 6 inches
The square should be 6 inches on both sides.
The halfway should be 3 inches, note all marks are halfway.
All similar pieces labeled A, C, F should be the same size cuttings as shown.
Each set can be made from same color cardboard, or each set can be made from different
The squares can be placed in a row as below:
After cutting the cards as labeled, put all pieces with letters marked into envelopes labeled 1,2,3,4,5.
Envelope 1: contains the pieces labeled as I, H, E
Envelope 4: contains the pieces labeled as D, F
Envelope 2: contains the pieces labeled as A, A, A, C
Envelope 5: contains the pieces labeled as G,B,F,D
Envelope 3: contains the pieces labeled as A, J
Essential elements in the game
There has to be a facilitator
Groups of five participants
One observer has to be assigned to each group
Cardboard squares in envelopes, ready on the table
A. Instructions for Participants in the Game (5 participants in each group)
Each participant has to get an envelope which has pieces of cardboards for forming squares
After opening the envelope, each group has to form 5 squares of equal size
Nobody is allowed to speak when the game is started
Each of you can give pieces to others but you cannot take/ask for a piece from any other person
Time allowed is 10 minutes and you have to make 5 squares of equal size
B. Instructions for Observers of the Game (given earlier before the exercise)
Observe the persons in the group
Notice and write down what the person does any of the tasks, such as behavior of the person
you are observing was helpful or not.
Write what the person did and how it affects the team.
Also observe the entire team and how they did or did not work together.
Do not comment on personality.
Do not assist in doing the game.
If a participant is breaking the rules, gently tell the person or if necessary call the facilitator.
Facilitator has to
1. Read the instructions to all team members.
2. Give each group of five a set of squares in the five envelopes labeled 1, 2, 3, 4, 5.
3. Fix time (10 minutes)
4. Ask the group to start the game.
When the task is completed, ask each group to discuss the following questions
a. In what ways do you think each of you helped/hindered the group in completing the tasks?
b. How did members feel when someone holding a key piece did not see the solution?
c. How did members feel when someone completed the square incorrectly and then sat back without
helping the group further?
d. What made the difference between not solving the game and solving it?
e. What did the observers see?
f. How are some of the things you learn from the game which is true of a real health team life?
(Players/Participants first and observers next)
Ask the participants to use “Team Effectiveness Critique” to assess how well their team functions in the
“Broken Squares” exercise.
Help them score and interpret the critique. Following the assessment, ask the participants to discuss
the effectiveness of the team’s activities in relation to shared goals/objectives, utilization of resources,
trust/conflict resolution, shared leadership, control/procedures, communication, approaches to solving
the problem, experimentation/creativity, and evaluation.
Ask the participants to record:
Three things they learned from the “Broken Squares” exercise.
Three strengths they learned from the team administration of the “Team Effectiveness
Three things that their team/teams needs to work on in order to improve its/their effectiveness.
What are the common problems that health staffs are currently facing?
Health problems are increasing and complex
Limited financial support
Limited human resources
Changes in environment, policies and priorities
Uncertain socio economic conditions
For Health System Strengthening many inputs have been provided to the programme implementing
How do you learn to be a good manager?
By looking into a role model
Trial and error
ANNEX: TOOL and GAMEs For Leadership & Management
Trainer / Facilitator
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games, ice breaker, mind course, energizer, role play, case
study & brain teaser rsm;xnfhoGif;ay;7ygw,f?
Game (6) What Do You See? “oifbmawG
Theme: People perceive things differently and perception relates to learning
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pink with embarrassment)
t=yma7mif -pdwf"gwfusvdkufwm (I’m feeling blue)
tpdrf;a7mif-pdwfxJrSmremvdkvdkufwm (I’m green with envy)
-a'go+zpf (He turned purple with rage)
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Positive meaning of colors
Purity, Wholesomeness, Sacred ritual
White, Off White
Black, Dark Blue
Fertility, Renewal, Wealth
Purity, Wholesomeness, Sacred ritual
Mystery, Occult power, Artistic talent
Mystery, Occult power, Artistic talent
V stands for violet
I for Indigo
B for Blue
G for Green
Y for Yellow
O for Orange and
R for Red
Game (8) The Numbers Game “eHygwfrsm;eJ
Theme: Practice improves learning, Practice makes perfect
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Game (9) Answers without Questions “ar;cGef;r&SdbJa+zjunfhyg”
Theme: Just for fun but has sense of critical thinking and creativity.
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Game (11) Silence “+idrfoufr_”
Theme: See who proves herself as a leader playing this game. Tell the students before you begin that no
one can make any noise throughout the activity. Group them into two teams and have them stand apart
from each other on both sides of the room. Give the students an instruction like, "Line up according to
birth date," or "Arrange yourselves in alphabetical order." The students have to figure out how to make
a proper line without talking. They can gesture with their hands and write on paper, but they cannot
speak. The first team to complete your request correctly wins the round. Continue with as many rounds
as you like. The team that wins the most rounds wins the game.
WHY TEAM FAIL ? Whose job is it?
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There was an important job to be done and everybody was asked to do it
Everybody was sure Somebody will do it
Anybody could have done it but Nobody did it
Somebody got angry about that, because it was Everybody’s job
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But Nobody realized that Everybody thought that Anybody could do it
It ended up that Everybody blamed somebody when Nobody did what Anybody could
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