"Medical Doctors are Poor Managers". This presentation has tried to do brainstorming for them how to operate as better Health Managers. Leaders lead from the Front. Managers control from the Behind. A Doctor in a facility needs to play the role of both Leader as well as Manager.

1. Health System Management
 Dr Prabir Ranjan
Moharana
MD, DHHM.
Assistant Professor
Department of Community Medicine
ASR Academy of Medical Sciences
(ASRAM,Eluru,AP)
email: drprabir2007@rediffmail.com

2. What is Management?
 “Management is getting the right things done in right
way, in right time, by right persons with right amount
of resources and effective use of resources.”
 “Health System Management is defined as
purposeful & efficient use of health system resources
and to get members of the health team coordinated
to work harmoniously in order to achieve the desired
common Goals and Objectives.”

3. Management in Health System, Why?
 Integration of Health Programs/Departments.
 Overload of work & Distribution of work.
 Changing Health needs/Health Demands.
 Improvement of health care delivery system by
applying modern management methods and
techniques.

4. Targets < Objectives < Goals
 Goal: Ultimate Desired State (ex- MDG: Goal 6-To Combat HIV-
AIDS, Malaria, Tuberculosis & other diseases.
 Objective: Planned end point of a health activity.
Deals with the problem in health activity(ex-Blood Safety
Program, STD control, Health Awareness, Condom Promotion
against spread of HIV).
 Targets: Discrete activity in a health activity. Deals with the
factors involved in a problem (MDG: Goal 6-Target 7-Condom
use in high risk population.
 Indicators: To measure the outputs/progress in a health
activity.

5. What are Health System Resources?
 Manpower
 Money
 Materials
 Minutes (Time)
 Knowledge
 Techniques
 Skills

6. Management Methods(Qualitative)
 Organizational Design: To meet Health needs/demands.
 Personnel Management: Proper person at proper place/
right person for right job.
 Communication: Effective sharing of information between
different levels of hierarchy.
 Information System: Data/Feedback for action(ex-Health
Management Information System(HMIS).
 Management by Objectives(MBO): Result oriented based on
minimum cost and minimum time.

7. Functions of the Management POSCOD
ORGANISING
PLANNING DIRECTING
STAFFING
DECISION
MAKING CONTROLLING

8. Functions of Health System Management
 Planning of course of action/health activities (implementation &
evaluation).
 Organizing resources, Organizational structure and assigning a
specific job chart.
 Staffing: recruitment, training, supervision, monitoring.
 Controlling the quality of activities of the members through
setting up standards for performance.
 Directing and Decision making: issuing orders & instructions.

9. CORBID: Contd.
 Coordinating all the efforts and activities of all the team
members/stakeholders and other sectors.
 Reporting: to higher levels.
 Budgeting: maintaining accounts & spending contingencies.
 Innovation of new work methods.
 Representation/Delegating of organization at different levels.

10. What skills needed in a Good Health Manager?
(Always Hire Skills not Persons)
 Effective Communication Skill: Patience to listen, Ability
to express and emphathise.
 Effective Conceptual Skill: Ability to understand the
complexities of overall organizational activities, goals,
objectives, targets, policies and procedures.
 Effective Human Skill: Through motivation, discipline,
training, performance appraisal, rewarding etc.
 Developing Team-work: Establishing basic trust, oneness,
compatibility, team spirit, conducive organizational climate etc.

11. Who is a Good Health Manager?

Effective Technical Skill: Ability to use knowledge, new
methods, techniques and equipments.

Effective Leadership Skill: To empower employees and
motivate them to work efficiently and effectively to achieve
health system’s goal.
(i) Competitiveness
(ii) Entrepreneurship
(iii) Innovativeness
(iv) Maintaining Order and rationality

12. Models of Leadership Skills (I):
The skills are multiple and intersecting each other.
Developing self
awareness Managerial Stress
Solving Problems
creatively

13. Model of Leadership Skills(II) :
*Coaching *Self awareness
*Counseling * Gaining power
*Listening *Empowering others
*Identifying cause *Diagnosing poor
*Appropriate strategies performances
*Resolving conflicts *creative environment
*Solving problems creatively *Rewarding/accomplishment
Communicating
supportively Motivating Others
Managing Conflict
Gaining Power &
Influences

14. Health Planning: A process of deciding how
the future should be better than present.
 For proper utilization of health system resources.
 For improvement of health services.
 National Health Planning defines health problems,
identifies unmet needs, surveys resources,
establishes priority goals which are realistic &
feasible, projects administrative action for
accomplishment.

15. Plan
 A blueprint for any action.(What, How, When, Who to
do?)
 5 Components:
 Identification & Prioritization of Health Problems.
 Policies Formulation.
 Objectives establishing.
 Budget allocation.
 Time frame.

16. Definitions
 Health Policy: A guideline/logical frame work for
health activities to improve health condition of
people.
 Program: A sequence of activities designed to
implement policies and accomplish policies.
 Schedule is a timeframe to complete the action.
 Procedures: a set of rules.

17. Planning is a Cyclic Process(Steps)
 Step-1. Analysis of the Health Situation.
 Collection, assessment, interpretation of information
and Demographic data through surveillance .
 Epidemiology of diseases, Mortality and Morbidity
data
 Medical Care Facilities, Technical Manpower, Training
facilities.
 KABP of population about disease prevention and
cure.

18. Planning is a Cyclic Process
 Step-2. Establishing Objectives & Goals.
 Reduces haphazard activities, uneconomical use of
funds, poor performances.
 General Objectives/procedures at upper level
become more specified and detailed at lower levels.
 Resources are directed properly taking into nature
of objectives(Short Term/Long Term).
 CBA and Input-Output analysis are being used for
defining goals, objectives and targets.

19. Planning is a Cyclic Process
 Step-3. Assessment of Resources
 In terms of men, money, material, time, knowledge,
techniques and skills.
 A balance is maintained what is required, what is
available and how to be utilized.

20. Planning is a Cyclic Process
 Step-4.Fixing Priorities
 Prioritizing objectives/activities in order of
importance/ magnitude.
 A Good Health manager is a PAPA(Plans well,
Analyses critically, Prioritizes Activities and Act
timely/promptly).
 Formulation of alternate plans.

21. Planning is a Cyclic Process
 Step-5. Writing of formulated Plan
 Preparation of detailed plans.
 Working guidance to all those responsible for
execution eg. Health Care Providers.

22. Planning is a Cyclic Process
 Step-6. Programming and Implementation.
 Effective organization like staffing, coordination,
communication etc.
 A standard operating procedures for specific tasks
and roles.
 Selection, training, motivation, supervision and
monitoring of the manpower:ex-SBA & ENC training.
 Proper management functions are required here.

23. Planning is a Cyclic Process
 Step-7. Monitoring: “Tracking the tract”.
 Following the activities during their
implementation whether they are proceeding
according to predefined schedule or not.
 Keeping the track of the course of activities and
taking corrective action before gross
failure/deviation occurs.

24. Planning is a Cyclic Process
 Step-8.Evaluation: To assess/measure the degree of
achievements of the stated objectives and targets.
 Assessment of adequacy, efficiency, effectiveness
etc of final outcomes of a health activity.
 Important for feed-back, opportunity for correction
of deficiency and gaps during phase of
implementation.

25. Pre-Planning
 Government Interest: Strong Political Will for Policies.
 Legislation: Translating social & health policy to
legislation.
 Organization for Planning- ex Planning Commission in
India
 Administration Capacity: For proper intersectoral
coordination and implementation at district, state &
national level.

26. Planning is a Cyclic Process of PIE
Planning (P)
Implementation (I)
Evaluation (E)

27. Planning Cycle
Implement Integrated
Programs
Operate & Monitor
Programs
Selection of Best Program
Collect date for
Evaluation
Formulation of
Health Problems
Prioritization of
Health Problems
Establishing Objectives
& Goals
Train & Orient personnel
Designing alternative
programs with solutions
Integrate best programs and
develop plans
Formulation of
Individual SolutionsYES
Evaluate degree of
achievements in
TOG(Satisfactory?)
NO

28. Planning Cycle
Operate & Monitor
Programs(Execution) Assessment of Resources
Collect date for
Evaluation
Assessment of Health Situation &
Problems (Analysis of Health Data)
Establishing Objectives
& Goals
Designing Time Frame
Prioritization of Health
Problems (Felt Needs)YES
Evaluate degree of
achievements in
TOG(Satisfactory?)
NO

29. Management Methods(Qualitative)
 Qualitative Method : (Based on principles of
behavioral sciences).
1. Organizational Design
2. Personnel Management
3. Communication
4. Information System(HMIS)
5. Management By Objectives(MBO)

30. Management Methods(Quantitative)
 Quantitative Method (Based on principles of
Economics, Budgeting & Operational Research)
1. Cost-Benefit Analysis
2. Cost-Effective Analysis
3. Cost-Accounting
4. Input-Output Analysis
5. Model

31. Management Methods(Quantitative)
 Quantitative Method (Based on principles of
Economics, Budgeting & Operational Research)
6. System Analysis
7. Network Analysis
8. Planning-Programming-Budgeting-System
9. Work Sampling
10. Decision Making

32. Cost-Benefit Analysis (CBA)
 Cost: A factor of production. Monetary valuation of an
expenditure to obtain an asset/service.
 The benefits are expressed in monetary terms only. A
benefit-to-cost ratio >1 is acceptable.
 It is rarely used to assess health programs because in
health programs the benefits in terms of births/deaths
prevented, illnesses avoided (cost-effectiveness).
 It is a form of economic evaluation and measures “value
for money” to community.

33. Cost-Effective Analysis (CEA)
 Most widely used in Health Programs/Services.
 Similar to CBA but benefits are expressed in terms of
“results/outcomes/improvements in health condition”.

 not in terms of “money”.
 It measures relative cost of alternative ways in
achieving objectives and targets.

34. CEA: contd.
 CEA measures benefits in terms of effectiveness
ie. Improvement in health condition, reduction in
incidence/prevalence of a disease, neonatal
deaths prevented etc.

35. Cost Accounting
 A set of procedures used for determining the cost structure
of various services & activities in a health program
 (1) To analyze cost control operating in each activity/
department/service.
 (2) To detect and reduce wasteful expenditure by proper
planning & allocation of resources.
 (3) To calculate & accumulate Cost Data ie. Cost of
hospitalization, cost of work & production, Cost of pricing,
cost of reimbursement.

36. Input-Output Analysis
 An economic technique.
 Input: Every type of resources utilized eg. Man,
Money, Material, Time etc.
 Output: Number of cases treated in OPD/IPD per
day, Number of immunizations done per week.

37. System Analysis
 A formal analysis of (i) Purpose of a system/
Organisation (ii) Problems within system (iii) Cost
effectiveness, risks of an alternative activity/strategy.
 A system may be a hospital supply system, hospital
management information system, community health
service system etc.


38. Network Analysis
 Graphical presentation and analysis of activities
and their interrelation in the form of diagrams, flow
charts, logical sequences.

39. PERT :(Program Evaluation & Review
Technique)
 A Network analysis.
 Used for control of Time and Cost in complex
programs/projects.
 Listing of activities & tasks and presenting them in
the form of a network with sequential relationship
between them.

40. Network Analysis(PERT)
 4months 2 months
 Start 1 month
 2 months 1 month
 10 months
Plan
Service
Staff
Trained
Equipment
Installed
Staff
Recruited
Equipment
ordered
Service
Started

41. CPM: Critical Path Method
 A Network analysis used for control of Time and
Cost in complex programs/projects.
 A program is broken into component parts and each
part is analyzed in isolation and with relation to
other components.
 The longest path with greatest time constraint is
determined.

42. CPM: Critical Path Method
 The critical path for a program is that step the
activities along that step have “total zero slack”.
 Any delay in start/activity in that critical step/path will
delay the entire program.
 Sum of durations for critical activities represents the
“shortest possible time” to complete a project.
“The path with longest time duration determines the
shortest possible time for completion of a project/program”

43. Network Analysis (CPM)
 4months 2 months 1 month
 Start 3 month 1 month
 2 months 1 month
 10 months
Plan
Service
Staff
Trained
Equipment
Installed
Staff
Recruited
Equipment
ordered
Service
StartedRenovation work

44. Planning-Programming-Budgeting
System
 An economic framework.
 It helps decision makers to prioritize expenses, to
allocate resources and to minimize opportunity cost.
 It helps for grouping of activities related to each
objective.

45. Work Sampling
 Systematic observation & recording of activities of one/more
individuals.
 Carried out at predetermined/random intervals.
 Major parameter is “Time”.
 Useful in hospitals and done for doctors, nurses,
pharmacists, laboratory technicians.
 It analyses appropriateness current staff , job description
and standardizes performance, determines manpower
needs.

46. Decision Making
 Like D/d (Differential Diagnosis) in Medical Practice.
 Best decision is not always made at the top levels of
organization.
 Decision should not be made with incomplete data.
 Pick up and carry out the best decision.