This document contains lecture notes on Health Service Management for second year public health students. It covers the following topics over two lecture days: Day 1 topics include definitions of management and health management, the historical development of management, the differences between management and administration, management functions including planning, organizing, staffing, directing, and controlling. Day 2 topics include management and the external environment, the roles and types of managers including first line, middle, and top managers, necessary management skills at different levels, and key management concepts and principles such as effectiveness, efficiency, and management by objectives. The document provides an overview of important concepts in health service management through detailed lecture outlines intended to educate students in this subject area.

1. Health Service Management Lecture Notes
for
Second Year Public Health Students
Dr. Hale Teka
©Medco Bio Medical College,
September 2012
Mekelle Campus, Mekelle, Tigray, Ethiopia
http://www.medcobiomed.com/

2. Who are these kids?

3. Who are these youngsters?

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 do
popular people benefit from their celebrity?

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

6. Chapter 01
Introduction to Health Service Management
 Total Time Allocated for this Chapter = 4 hrs
 Date of Lecture
1. October 1, 2012 => 10:00 a.m.-12:00 p.m.
2. October 3, 2012 => 10:00 a.m.-12:00 p.m.

7. Day 1 (October 1, 2012 => 10:00 a.m.-12:00 p.m. )
1. Definitions of
Management and
Health Management
2.Historical
Development of
Management
3.Management and
Administration
4.Management
Functions

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. 2. Historical Development of Management
A. 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. 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. 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. 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. • 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. • 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. 4. Management Functions
Q 1. What is Function?
Ans. Broad area of responsibility composed of many
activities aimed at achieving a predetermined
objective
Q 2. What are the functions of Management?
Ans. Management has five functions. These are:-
1. Planning (Chapter Two-6 hrs)
2. Organizing (Chapter Three-4 hrs)
3. Staffing (Chapter Four-4 hrs)
4. Directing (Chapter Five-3 hrs)
5. Controlling (Chapter Six-3 hrs)

17. 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

18. 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

19. 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

20. 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

21. 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

22. • Management can also have three broad
sequential functions
– Planning
– Implementation and
– Evaluation
• Two continuous functions of management are
– Communication
– Decision-Making

23. • 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.

24. Day 2 (October 3, 2012 => 10:00 a.m.-12:00 p.m. )
5. Management and
Environment
6. Role and Types
of Managers
7. Management
Skills
8. Concepts and
Principles of
Management

25. 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.

26.  Components of the external environment
1. Political
i. Policy
ii. Political institution/organization
iii. Government officials/institution
2. Economic and Business Communities
i. Suppliers
ii. Clients
iii. Farmers
iv. Merchants
v. Share-holders

27. 3. Social
i. Community
ii. Leaders
4. Technological
i. Medical equipment
ii. Strategies, e.g. Community based
distribution
5. National and International Issues

28. 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

30. 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

31. 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

32. C. Decision Making Role -A manager has a
legal authority to decide on matters that are
assigned to him based on his job description
1. Entrepreneur -designing and initiating
changes within the organization
2. Disturbance handler -taking corrective
action and handling conflicts
3. Resource allocator -decides on resources
and their distribution
4. Negotiator –Negotiating with other parties
representing organizational interests

33. 7. Types of Health Service Managers
1. First Line (or first level) Manager
– Managers who are responsible for the work of operating and
do not supervise other managers
– They are the first or lowest level of mangers in the
organizational hierarchy
2. Middle Managers
– Managers in the mid range of the organizational hierarchy
– They are responsible for other managers and sometimes for
some operating employees
– They report to more senior managers
3. Top Managers
– Managers responsible for the overall management of the
organization
– They establish, operating policies and guide the organization’s
interaction with its environment

35. 8. Management Level and
Skills
1. Technical Skill Low Level  First
Line
– The understanding of technical element of activities in
general and proficiency in specific kind of technical
activity
2. Human Skill  Middle Level
– This is the ability to work with others and win
cooperation from the health team other sectors and the
community
3. Conceptual Skill Top Level (senior)
– The ability to visualize the organization as the whole
and its relationship with the community and other
sectors

37. 9. Concepts and principles in Management
• In the process of fulfilling his/her managerial
duties the manager would apply the following
concepts and principles
A. Concepts
1. Effectiveness
2. Efficiency
3. Economy of Scarce Resources
4. Work Relations
5. Information

38. 1. Effectiveness
– The degree to which stated objective is being
achieved
– It is something that management tries to improve
2. Efficiency
– It is concerned with the balanced use of
resources (money, material, human resources,
time, space, and information)
3. Economy of Scarce Resources
– Some and often many resources are scarce and
costly thus we have to economize

39. 4. Work Relations
– Work activities should be designed and structured so
as to support each other towards the achievement of
objectives
5. Information
– Management needs information if it is to make the
right decision for action.
– At the same time, information can easily handicap
management, if it is not
• The right kind
• At the right time
• In the right hands

40. B. Principles
1. Management by Objectives
2. Learn from Experience
3. Division of Labour
4. Substitution of Resources
5. Convergence of Work
6. Functions Determine Structure
7. Delegation
8. Management by exception
9. Shortest decision path

41. 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

42. 2. Learning from experience
– Analysis of the results between the objectives and
achievement made. For better performance there should
be feedback to learn from the experience gained
3. Division of Labor
– Management attempts to bring about balance of work
among tht different people concerned
4. Substitution of Resources
– Often when the resources that are normally used to
provide service became scarce or too expensive, different
resources may be used to provide the intended results

43. 5. Convergence of Work
– Working relations should contribute to the success of each
activity and so to general effectiveness.
– Theses working relations of activities are
• The logical relations with each other
• Time relations or sequence
• Spatial relations between activities
• Functional and structural-working relations between
people
6. Functions Determine Structure
– When the work is defined i.e. the function and duties of the
individual members of the team are clearly defined and known
to all, the working relations of the structure follow.
– The exact nature of authority will be clearly delineated on the
structure
7. Delegation
– Delegation takes place when some body’s authority is lent so as
to enable that person to take responsibility when the occasion
arises

44. 8. Management by exception
• In effect this means two things
1. Don’t be overloaded with routine,
unnecessary information, be selective
2. Make BIG decision first
In short management by exception means
1. selectivity in information
2. priority in decision
9. Shortest decision path
• This principle deals with issue
– Who should make which decision?
– When and Where?
• Decision must be made as closely as possible in time
and place to the object of decision and to those
affected by it

45. Questions For Review

46. 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?

47. 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

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

49. 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

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

51. 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?