HSM

1. Organization behavior & group
dynamics
Rachel Maina
HSMI

2. Organization behaviour
• Organizational behaviour was defined by Huczynski and Buchanan (2007: 843) as
the term used to describe ‘the study of the structure, functioning, and performance
of organizations and the behaviour of groups and individuals within them’
Characteristics of organizational behaviour – Ivancevich et al (2008: 11)
• It is a way of thinking – about individuals, groups and organizations.
• It is multidisciplinary – it uses principles, models, theories and methods from other
disciplines.
• There is a distinctly humanistic orientation – people and their attitudes, perceptions,
learning capacities, feelings and goals are of major importance.
• It is performance-oriented – it deals with the factors affecting performance and
how it can be improved.

3. Organization behaviour
• The use of scientific method is important in studying variables and relationships.
• It is applications-oriented in the sense of being concerned with providing useful
answers to questions that arise when managing organizations
• Organizational Behavior: OB is a field of study that investigates the impact that
individuals, groups, and structure have on behavior within organizations for the
purpose of applying such knowledge toward improving an organization’s
effectiveness.
• OB studies three determinants of behavior in organizations: individuals, groups,
and structure.
• An organization is an entity that exists to achieve a purpose through the collective
efforts of the people who work in or for it. Organizing is the process of making
arrangements in the form of defined or understood responsibilities and relationships
to enable those people to work cooperatively together.
• Organizations can be described as systems that, as affected by their environment,
have a structure that has both formal and informal elements.

4. Nature Of Organisational Behaviour
• Sociology,
• Psychology
• Social Psychology
• Anthropology
• Political science
Scope Of Organisational Behaviour
• Organizational Behaviour helps to understand the different activities and actions of
people in the organization.
• It also helps to motivate them.

5. scope of organization behaviour
The Scope of the organisational behaviour can be explained with the help of following
points. It covers various areas which are as follows.
oIndividual Behaviour
oInterpersonal Behaviour
oOrganisational Behaviour
Micro level element
• People, structure, technology
Macro level element
• external environment Simply the scope of this mix of elements is the scope of
Organisational Behaviour.

6. Contributing Disciplines to the OB Field
• Psychology is the science that seeks to measure, explain, and sometimes change the
behavior of humans and other animals.
• Sociology studies people in relation to their fellow human beings.
• Social psychology blends the concepts of psychology and sociology. It focuses on
the influence of people on one another.
• Anthropology is the study of societies to learn about human beings and their
activities.
• Political science studies the behavior of individuals and groups within a political
environment.

7. importance of organizational behaviour
1. Skill Improvement
- ability of employees and use of knowledge to become more efficient.
- improves managers as well as other employees work-skill.
2. Understanding Consumer Buying Behaviour
- improve the marketing process by understanding consumer buying behaviour.
3.Employee Motivation
• Organisational Behaviour (OB) helps to understand the basis of Motivation and
different ways to motivate employees properly.
4.Nature Of Employees
• Understanding of personnel and employee nature is important to manage them
properly.OB helps managers understand Introvert,extrovert,motivated,dominating

8. Importance Organizational behaviour
5.. Anticipating Organisational Events
• The scientific study of behaviour helps to understand and predict organisational
events.eg.Annual Business Planning, Demand Management, Product line
management, Production Planning, Resources Scheduling, Logistics etc.
6.Efficiency & Effectiveness
- increase efficiency and effectiveness of the organisation
7.Better Environment Of Organisation
• OB helps to create a healthy, ethical and smooth environment in an organisation.
8.Optimum Or Better Utilization Of Resources
OB helps to understand employees and their work style and skill better way.
• By understanding this, management can train and motivate employees for optimum
utilization of resources.

9. Importance of Organization behaviour
9. The Goodwill Of Organization
• Organisational Behaviour helps to improve Goodwill of organization.
• helps to increase efficiency and productivity of the organisational forces. This may
lead to an increase in the profit of the organisation.

10. Challenges and Opportunities for OB
a) Responding to Globalization
b) Managing Workforce Diversity
c) Improving Quality and Productivity
d) Responding to the Labor Shortage
e) Improving Customer Service and People Skills
f) Empowering People
g) Coping with “Temporariness-managers should live with flexibility,unpredictability
h) Stimulating Innovation and Change
i) Helping Employees Balance Work-Life Conflicts
j) Improving Ethical Behavior

11. Group Dynamics
• A group is a collection of individuals who interact with each other such that one
person’s actions have an impact on the others.
Types of organizational groups
Formal and informal
Informal work groups are made up of two or more individuals who are associated
with one another in ways not prescribed by the formal organization. For example, a few
people in the company who get together to play tennis on the weekend would be
considered an informal group.
A formal work group is made up of managers, subordinates, or both with close
associations among group members that influence the behavior of individuals in the
group.

12. Stages of Group Development
• American organizational psychologist Bruce Tuckman presented a robust model in
1965.On the basis of his observations of group behavior in a variety of settings, he
proposed a four-stage map of group evolution, known as the Forming-Storming-
Norming-Performing Model.Tuckman, B. (1965).

13. Forming
• The group comes together for the first time.
• members may already know each other or may be total strangers.
• there is a level of formality, some anxiety, and a degree of guardedness as group
members are not sure what is going to happen next.
• Ask questions as “Will I be accepted? What will my role be? Who has the power
here?”
• Group members are trying to achieve several goals at this stage, although this may
not necessarily be done consciously.
• This stage is often characterized by abstract discussions about issues to be
addressed by the group; those who like to get moving can become impatient with
this part of the process. This phase is usually short in duration, perhaps a meeting or
two.

14. Storming
• Once group members feel sufficiently safe and included, they tend to enter
the Storming phase.
• Participants become more authentic and argumentative as they express their deeper
feelings and thought
• Group members begin to explore their power and influence,
• Discussions can become heated as participants raise conflicting points of view and
values, or disagree over how tasks should be done and who is assigned to them.
• It is not unusual for group members to become defensive, competitive, or jealous.
Although little seems to get accomplished at this stage, it actually serves an
important purpose:
• During this chaotic stage, a great deal of creative energy is released and available
for use, but it takes skill to move the group from Storming to Norming. In many
cases, the group gets stuck in the Storming phase.The group moves to the nect stage
once they are capable to handle their differences

15. Norming
• Group members are more committed to each other and the group’s goal.
• Feeling energized by knowing they can handle the “tough stuff,” ready to get to
work.
• more cohesive and cooperative, participants find it easy to establish their own
ground rules (or norms) and define their operating procedures and goals.
• tends to make big decisions, while subgroups or individuals handle the smaller
decisions.
• more open and respectful toward each other and willing to ask one another for both
help and feedback.
• begin to form friendships and share more personal information.
• the leader should become more of a facilitator by stepping back and letting the
group assume more responsibility for its goal.
• Since the group’s energy is running high, this is an ideal time to host a social or
team-building event.

16. Performing
• Galvanized by a sense of shared vision and a feeling of unity, the group is ready to
go into high gear.
• Members are more interdependent, individuality and differences are respected, and
group members feel themselves to be part of a greater entity.
• Participants are not only getting the work done, but they also pay greater attention
to how they are doing it.
• They ask such questions as, “Do our operating procedures best support productivity
and quality assurance? Do we have suitable means for addressing differences that
arise so we can preempt destructive conflicts? Are we relating to and
communicating with each other in ways that enhance group dynamics and help us
achieve our goals? How can I further develop as a person to become more
effective?” By now, the group has matured, becoming more competent,
autonomous, and insightful.
• Group leaders can finally move into coaching roles and help members grow in skill
and leadership.

17. Adjourning
• Just as groups form, so do they end. For example, many groups or teams formed in
a business context are project-oriented and therefore are temporary.
• Alternatively, a working group may dissolve because of an organizational
restructuring.
• As with graduating from school or leaving home for the first time, these endings
can be bittersweet, with group members feeling a combination of victory, grief, and
insecurity about what is coming next.
• For those who like routine and bond closely with fellow group members, this
transition can be particularly challenging.
• Group leaders and members alike should be sensitive to handling these endings
respectfully and compassionately. An ideal way to close a group is to set aside time
to debrief (“How did it all go? What did we learn?”), acknowledge one another, and
celebrate a job well done.

18. ORGANIZATION OF HEALTH CARE
SERVICES
Unit 2 HSM

19. Functions of Health Care Organizations
• Providing care
• Stewardship
• Provision of resources (financing, physical and human)
• Organization and management of service delivery
• Wider responsibilities – employers, contracting with local
businesses (Anchor)

20. Formal and Informal Structures
• Formal Structures
1. Formal structures are formed by the organization to help meet
the stated objectives. Through departmentalization and work
division, provides a framework for defining managerial authority,
responsibility and accountability. Different roles and functions,
rank and hierarchy
2. Often these appear on paper in the form of org charts

21. Informal Structures
1. It is a naturally forming social network that develop based on
the reality of day to day interactions between members over time
2. They may be different from the formal structure on paper
3. Has its own communication network known as the grapevine

22. Organization structure in
healthcare
• Types of organization structures
• functional stuctures
• Hybrid structure
• Matrix structure
• Parallel structure
Functional structures
• employees are grouped in departments by speciality with
similar task being performed by the same group,similar group
operating out of the same department ,and similar department
reporting to the same manager.

23. Funtional strucures
• In functional stuctures,all orthopaedics trauma services fall
under orthopaedics trauma services,the same applie in other
functional areas
• Tend to centralize decision making because the functions
coverage is at the top of the organization.
weakness of functional structures
• poor coordination across functions
• decision making responsibilitis can pile up at the top and
overload senior managers likely to uninformed about day to
day operations

24. Functional structures
• Limited general management training because most employes
move up the organizations within functional departments
• They are uncommon in todays rapidly changing healthcare
environment

25. Hybrid structures
• Growth of an organization leads to combination of self
contained units and functional unit referred to hybrid
strucutres .
• it provides simultaneous coordination within product division
• can improves alignment between corporate and service
/product goals
• foster adaption to the enviroinment while still maintaining
effeciency
weakness
conflict between top administration and managers -mangers
resent the administrators instrution into what they see as their
own are of repsonsibility

26. Matrix structures
• is unique and complex ,it integrate both product and functional
structures into one overlapping structures
• Different are responsible for function and product e.g
orthopaedics trauma technologist for the trauma clinic may
report to the head of department orthopaedic truama medicine
as well as Head of department outpatient clinic.
• tend to develope where there are strong outside pressures for a
dual organization focus on product and function,
• appropritate in a higly uncertain environment that changes
frquently but require organizational expertise.
• Weakness
• The dual authority can be frustrasting and confusing for
departemental manegers and employees

27. Matrix structures
• Excellent interpersonal skills are required from the managers
involved
• time consuming -frequent meetings are required to resolve
problems and conflicts : the structure will not work until
participants ca see beyond their own fucntional area to the big
organizational picure
• There is dormancy in the he side of the matrix that is more
closley aligned with the organizational objectives

28. Parallel structures
• These are unique to health care
• It is the result of complex relationship that exists between the
formal authority of the health care organizational and the
authority of the medical staff
• The medical staff is separate are autonomous from the
organization .
• The result is an organizational dilemma:two lines of authority
• One lines extends from the governing body to the chief
executive officer and then to the managerial strucure;The other
line extends from the govenrning body to th medical staff.
• The two intersect in departments such as orthopaedics trauma

29. Parallel strucures
• because decision making involves both managerial and clinical
elements.
• They are found in healthcare institutions with a functional
structure and separate medical governance structure.
They are becoming less popular in healthcare today,healhtcare is
integrating new models that incorporate physician practise under
the organizational umbrella

30. Service line structures
• most common in healthcare today (nugent et al.2008)
• Also known as product -line or service integrated structures.
• clinical services are are organized around patients with specific
conditions.
• Integrated strucures are preferred in large and complex
organizations because the same activity (hiring)is assigned to
several self contained units,which can respond rapidly to the
units immediate needs.
strenghts
• Potential for rapid change in changing environment
• High client satisfaction-each division is specialized and its
outputs can be tailored to the situation

31. Service line managers
• coordinationacross functions (Orthopaedics,Nursing,pharmacy
etc) can easil occur.
• work partners identify with their own service and can
compromise or collaborate with other service functions to
meet service goals and reduce conflict.
• Service goals receive priority under this organizational
structure because employees see the service outcomes as the
primary purpose of their organization.
weaknesses of service-integrated structures
• possible duplication of resources (such as ads for new
positions) and
•

32. service line structures
• lack of in-depth technical training and specialization.
Coordination across service categories (oncology, cardiology,
and the burn unit, for example) is difficult;
• services operate independently and often compete. Each
service category, which is independent and autonomous, has
separate and often duplicate staff and competes with other
service areas for resources.
• In addition, some service lines (e. g., pediatrics, obstetrics,
bariatric surgery, and transplant centers) present special
challenges due to low usage or the need for specialized
personnel (Page, 2010).

33. ORGANIZATION OF HEALTH CARE
• Kenya’s Health sector is one of the 14 devolved functions managed by the 47
county governments as provided in the Fourth Schedule of the 2010
Constitution.
• County health facilities and pharmacies, ambulance services, promoting
primary health care, licensing and controlling facilities that sell food to the
public and veterinary services are some of the health-related roles the 47
counties manage.
• County health facilities and services include county referral hospitals, sub-
county health facilities, environmental health services, communicable disease
control, nutrition, family planning, maternal and child health plus Health
Education.
• There are six different levels of health care facilities. Level 1-5 are managed on
the county level while level six by the National government.
• In the system-the patients may move from one level to the next using a referral
letter.

34. REFERRAL SYSTEM
KMTC -DOTM
RACHEL MAINA

35. Referral system
Referral System
A comprehensive health care system used to manage client health care needs by referring clients from an
initiating facility to an organization, service, or community unit that can better provide the level of care
needed.
Rationale for a Well-Functioning
Most of the population of Kenya is rural and poor. An effective referral system will ensure
health services to all people in Kenya in the following ways:
• Coordination and standardization of referral services
• Continuity of care across the different levels of care
• Cost-effectiveness of health services provided to Kenyan citizens
• Promotion of universal coverage and equity in provision of health services
• Health care planning through performance monitoring of the referral system

36. Benefits of a Well-Functioning Referral System
A well-functioning referral system will have the following benefits:
• Maximize efficiency of the health system by ensuring appropriate use of health
services
• Strengthen lower-level facilities and improve capacity for decision-making by
health workers at all levels
• Create opportunities for balanced distribution of funds, services, and human
resources
• Promote linkages across the different levels of care and between public and
private entities
• Ensure that care is provided at the lowest possible cost

37. Structure of Integrated Health Referral Network in Kenya
The referral system includes six levels of health care:
Level 1 comprises community health services. This is the foundation of the health service delivery
system. Referrals at this level are initiated by Community Health Workers (CHWs) in community units.
Community units (CU) are linked to primary health care facilities to which majority of referrals from this
level are made.
Level 2 health services provide primary care services and form the interface between the
community and the rest of the health system. Level 2 facilities include dispensaries. Dispensaries
are managed by a small number of staff, a large majority being nurses. Like the community
level, dispensaries refer to level 3 facilities and in some cases level 4. Some dispensaries with
larger capacity act as receiving points from other smaller facilities of the same level.
Level 3 facilities also provide primary care services but with additional support. They include
health centres and maternity and nursing homes. Many are currently able to offer in-patient
services, mostly maternity. These facilities mainly receive referrals from level 1 and 2 facilities.

38. Structure of health care system
• Level 4 facilities are the first-level hospitals whose services complement the primary care level.
Together with level 5 facilities, these form the county referral hospitals. Majority of the referrals to
this level are from levels 2 & 3. Facilities at this level offer in- and out-patient services and have
large laboratories that offer diagnostic services that otherwise would not be available at the primary
care facilities. In emergency cases, referrals to this level may also come from Level 1.
• Level 5 facilities are the secondary referral level and offer a broad spectrum of specialized curative
services. At this level, facilities are able to offer advanced services and expertise both for curative
and diagnostic services. Referrals at this level are mainly from level 4 facilities and in emergency
cases lower level facilities
• Level 6 comprises the tertiary-level hospitals whose services are highly specialized. These are the
ultimate referral points, mainly national teaching referral hospitals. The entire cascade and network
of referrals in the Kenyan health system is to this level where very specialized skills, expertise and
services are offered and linkages with local and international universities, facilities, and staff are
forged and maintained.

39. The Health Referral Chain
The referral system links the different levels of care based on the
expected services being provided through the system. The levels
of care include all facilities—public and private, and Faith-Based
Organizations (FBO). In emergency cases though, there may be
referrals from lower level facilities (Levels 1, 2 & 3) direct to
county referral facilities (Levels 4 & 5)

40. Level of service
• The referral system has four levels of service: community, primary care, county referral services, and
national referral services.
• The Community Health Services (Level 1) which comprises all community-based health activities,
organized around the Comprehensive Community Strategy (CCS). This is a non facility based level.
• The Primary Care Facilities (Levels 2 and 3) comprises all dispensaries, clinics, health centres,
and maternity homes.
• The County Referral Health Facilities (Levels 4 and 5) comprise all level 4 and 5 facilities
operating in and managed by the county. All of the county-managed facilities form a county referral
system, which shares specific services to form a virtual network. The county referral systems receive
referrals from primary care facilities in its area of responsibility, from other county facilities in the
county, and from facilities outside the county (horizontal referral) and community units.
• The National Referral Health Facilities (Level 6) include the facilities that provide specialized
health care services, such as hospitals, laboratories, blood banks, and research institutions. These
facilities operate with a defined level of autonomy.

41. Referral system players roles and responsibiliyies
• Key players in the referral process must fulfil their respective roles and responsibilities for the
referral system to function well.
1.MOH has the following responsibilities at the national level:
• Formulate overall referral policy, referral strategy, referral guidelines, and
• standard operating procedures (SOPs) for referrals.
• Support the dissemination and training health workers on the referral guidelines
• and referral SOPs.
• Design and disseminate standard referral tools, such referral forms and registers.
• Provide technical assistance and build capacity to strengthen the referral system
• at the county level.
•

42. key players in referral system
• Undertake overall performance monitoring of the referral system in Kenya.
• Perform needs assessments for specialized services.
• Provide accreditation of specialists.
2.The county health departments have the following responsibilities at the county level:
• Implement the county referral strategy or approach based on the county health system’s capabilities,
clients, and context.
• Ensure collaboration between service providers at the county level through referral forums,
memoranda of understanding for referral services, and establishment and maintenance of referral
networks.
• Undertake referral system performance monitoring and evaluation at the county level.
• Ensure the availability of standard referral tools, such as referral forms, registers
• and other relevant forms for referrals at the facility level.

43. Key players in referral system
• Develop the necessary infrastructure to support the
county referral system.
• Ensure availability of financial, human, and other
resources to support the county referral system.
• Ensure continuous supportive supervision and capacity
building of county facilities in the referral system.
• Ensure availability of accessible and high-quality health
services in the county.
• Coordinate the flow of referral information from
community units and facilities to the health
management in the county

44. Responsibilities of the Client
• The client or the client’s next of kin should be
responsible for the following actions:
• Provide consent for referral. Clients or next of kin who
refuse consent for a referral or transfer should sign a
form indicating that they are acting against medical
advice.
• Facilitate the referral.
• Assume responsibility for the security of the client’s
belongings.
• Consent to be transferred back to the initiating facility
after treatment.

45. Roles and Responsibilities of the Referring Health Worker
• The referring health worker should meet the following responsibilities:
Know what, whom, when, and where to refer as guided by the Clinical
• Management and Referral Guidelines, Health Sector Referral
Guidelines and the directory of health services.
• Complete the standard referral form (refer to annex) with all the
necessary information and attach relevant documentation.
• Explain to the client the need for referral, reasons for choice of doctor
or facility, preparation, expected cost, and possible outcome of
referral.
• Answer queries from the referral coordinator or receiving facility
about the referral,
• if necessary.
• Ensure counselling of the clients on the need for referral and
maintenance of confidentiality.
• Obtain informed consent from the client being referred.

46. Roles and Responsibilities of the Referring Facility
The referring facility assumes the following responsibilities:
• Perform continuous monitoring of the process of referral in the facility, and institute
• corrective measures if necessary.
• Ensure that staff members are adequately trained on the referral process.
• Ensure the continuous supply of standardized referral forms and registers to the health care
providers.
• Keep the directory of health services and facilities in a defined geographic area or a
• referral network.
• Ensure proper recording of all referrals.
• Develop and maintain mechanisms to track referrals in and out of the facility.
• Ensure the availability of transportation for emergency referrals.
• Assign a referral coordinator with clear roles and responsibilities.

47. Roles and Responsibilities of the Receiving
Health Team/Health Worker
• The receiving health team has the following responsibilities:
• Respond promptly to referral consultation requests.
• Adequately prepare to receive the referrals and provide
appropriate management.
• Report in detail all pertinent findings and recommendations to
the referring health worker and, if necessary, the client, on
opinions that affect his or her health care.
• Provide feedback with all required information and
recommendations to the referring health facility and the client.
• Communicate with the client or the client’s family.
• Ensure that the role of the referring health worker is not
undermined by communication or action.

48. Key player in Referral system
• Attend to the emergency referred clients, specimens or parameters regardless of socio-economic
status or referring county/ facility.
• Work with the client to determine subsequent care and treatment needed.
Responsibilities of the Receiving Facility
• The receiving facility has the following responsibilities:
• Continuously monitor the facility’s referral processes to identify gaps and strengths
• and put in place corrective measures where necessary.
• Assign a referral coordinator with clear roles and responsibilities.
• Devise follow-up plans and ensure that the plans are communicated to the
• referring facility and experts.

49. Key players/actors in referral system
• Ensure that staff members are adequately trained on the referral process.
• Ensure that there is a continuous supply of registers and forms to record referrals.
• Provide patient education to clients on the referral processes and appropriate referral behaviour.
• Keep and continually update a directory of services.

50. Key players in Referral system
• Ensure that referred clients are seen by appropriate experts or are provided with
expected services.
• Ensure that all investigations and documents accompanying the referral from the
referring facility protect clients from unnecessary cost.
• Ensure that all prescheduled referrals are processed without undue delay.
• Develop and maintain a mechanism to track referrals in and out of the facility.
• Provide feedback on referrals to the referring facility.