Health service management


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Health Service Management Lecture Notes for Health Science and Medical Students

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Health service management

  1. 1. Health Service Management Lecture Notes forSecond Year Public Health Students Dr. Hale Teka ©Medco Bio Medical College, September 2012 Mekelle Campus, Mekelle, Tigray, Ethiopia
  2. 2. Who are these kids?
  3. 3. Who are these youngsters?
  4. 4. 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 dopopular people benefit from their celebrity?
  5. 5. Do you want to be like them? What do you want to be where theywere? Wealth? To be an American or European ? Straight A’s incollege? Or Educated family? To belong to politician parents?
  6. 6. Chapter 01Introduction 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.
  7. 7. Day 1 (October 1, 2012 => 10:00 a.m.-12:00 p.m. )1. Definitions of Management and Health Management2.Historical Development of Management3.Management and Administration4.Management Functions
  8. 8. 1. Definitions of Management and Health Management  Management may be defined as 1. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. • Administration • Management – Determinative – Executive  Functionally involved in – Is a science, an art and a 1. The laying down of the profession general purpose of the  Functionally involved in organization 1. Planning 2. The framing of its major 2. Organizing objectives 3. Staffing 3. The formulation of general 4. Directing plan of procedure 5. Controlling 4. The inauguration of broad program – Or broadly 5. Approval of specific major 1. Planning projects that fall within the 2. Implementing general program 3. Evaluation
  14. 14. • 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
  15. 15. 4. Management FunctionsQ 1. What is Function?Ans. Broad area of responsibility composed of many activities aimed at achieving a predetermined objectiveQ 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)
  16. 16. 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
  17. 17. 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
  18. 18. 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 structure 2. Assessment of manpower required and available. 3. Assessment of their quality, qualification and skills for the job. 4. Appraisal –Strength and shortcomings 5. Conduct development programs
  19. 19. 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
  20. 20. 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
  21. 21. • Management can also have three broad sequential functions – Planning – Implementation and – Evaluation• Two continuous functions of management are – Communication – Decision-Making
  22. 22. • Communication – During the process of planning, implementation and evaluation, it is necessary for sharing ideas/information between the Manager Staff and the Community• Decision making – Planning, implementation and evaluation require decision making as a task.
  23. 23. Day 2 (October 3, 2012 => 10:00 a.m.-12:00 p.m. )5. Management and Environment6. Role and Types of Managers7. Management Skills8. Concepts and Principles of Management
  24. 24. 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.
  25. 25.  Components of the external environment1. Political i. Policy ii. Political institution/organization iii. Government officials/institution2. Economic and Business Communities i. Suppliers ii. Clients iii. Farmers iv. Merchants v. Share-holders
  26. 26. 3. Social i. Community ii. Leaders4. Technological i. Medical equipment ii. Strategies, e.g. Community based distribution5. National and International Issues
  27. 27. 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 role B. Information role C. Decision Making role
  28. 28. 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
  29. 29. B. Information Role-this role is related to communication and information channeling 1. Monitor-Serving as a focal person for all types of communications 2. Disseminator-Communicating selected information to subordinates 3. Spokesperson-Communicating selected information to outsiders
  30. 30. C. Decision Making Role -A manager has a legal authority to decide on matters that are assigned to him based on his job description1. Entrepreneur -designing and initiating changes within the organization2. Disturbance handler -taking corrective action and handling conflicts3. Resource allocator -decides on resources and their distribution4. Negotiator –Negotiating with other parties representing organizational interests
  31. 31. 7. Types of Health Service Managers1. 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 hierarchy2. 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 managers3. Top Managers – Managers responsible for the overall management of the organization – They establish, operating policies and guide the organization’s interaction with its environment
  32. 32. 8. Management Level and Skills1. Technical Skill Low Level  First Line – The understanding of technical element of activities in general and proficiency in specific kind of technical activity2. Human Skill  Middle Level – This is the ability to work with others and win cooperation from the health team other sectors and the community3. Conceptual Skill Top Level (senior) – The ability to visualize the organization as the whole and its relationship with the community and other sectors
  33. 33. 9. Concepts and principles in Management• In the process of fulfilling his/her managerial duties the manager would apply the following concepts and principlesA. Concepts 1. Effectiveness 2. Efficiency 3. Economy of Scarce Resources 4. Work Relations 5. Information
  34. 34. 1. Effectiveness – The degree to which stated objective is being achieved – It is something that management tries to improve2. 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
  35. 35. 4. Work Relations – Work activities should be designed and structured so as to support each other towards the achievement of objectives5. 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
  36. 36. B. Principles1. Management by Objectives2. Learn from Experience3. Division of Labour4. Substitution of Resources5. Convergence of Work6. Functions Determine Structure7. Delegation8. Management by exception9. Shortest decision path
  37. 37. 1. Management by objectives – Management sees that objectives are specified and then that they are achieved – The objectives should state 1. 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
  38. 38. 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 gained3. Division of Labor – Management attempts to bring about balance of work among tht different people concerned4. 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
  39. 39. 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 people6. 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 structure7. Delegation – Delegation takes place when some body’s authority is lent so as to enable that person to take responsibility when the occasion arises
  40. 40. 8. Management by exception• In effect this means two things1. Don’t be overloaded with routine, unnecessary information, be selective2. Make BIG decision firstIn short management by exception means1. selectivity in information2. priority in decision9. 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
  41. 41. Questions For Review
  42. 42. 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?
  43. 43. 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
  44. 44. 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. FigureheadB. LeaderC. Disturbance handlerD. MonitorE. B and C
  45. 45. 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
  46. 46. Q4. Broad area of responsibility composed of many activities aimed at achieving a predetermined objective is called__________ a) Management b) Administration c) Function
  47. 47. 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?