Injibara Health Sciences

and Business College

Unit 1: Basics of Management in Health

For 4th Nursing Students

By: Ayenew Takele (BSc, MPH, Lecturer in HSM)

Septemeber, 2017 E.C.

Injibara, Ethiopia 1
 Learning Objectives
 Up on completion of this unit, students will be able to:
 Know basics of management and common terms in
management.
 Differentiate management and administration.
 Understand Principles and concepts of management.
 Understand the levels of managerial hierarchy
 Appreciate managerial roles and skills
 Know management practices

2
 Introduction to Management

Questions to Class

What do you think about management?

Do you need to have management skills and

competency as a health professional? Why?

3
 Definition
 Management is defined as:

 Getting things done through people and other

resources.

 Getting people to work harmoniously together

and making efficient use of resources to

achieve objectives.

 Providing direction and leadership.

4
 Definition…
 Management is the process of planning, organizing,

staffing, leading and controlling the work of

organizational members for the attainment of

organizational goals in an effective and efficient

manner using organizational resources.

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 Definition..
 Management work involves establishing

organizational objectives and creating

organizational environment:

 in which the direct work, aided by support

work, can lead to the accomplishment of

predetermined objectives.

6
 Common Points for the Definitions
 Management:

 Is a process – a set of interactive and

interrelated ongoing functions and activities.

 Focuses on accomplishing organizational

objectives.

 Involves use of human and other resources.

 Occurs in a formal organizational setting.

NB. People are the most important resources.

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So why do you need to learn management?

8
Rationale for Learning Management

 Management is universal and essential function in

all organizations.

 Health professionals find themselves in a

managerial position without proper orientation
and training.

 Proper health planning and health services

management skill is an important tool to bring
about change in the health care system.

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 Rationale…

 Resources are scarce urging the need for proper

skills in planning and management for efficient

utilization.

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Management and Administration
 Management and Administration are used
interchangeably in government and business
organizations. However, they don‟t mean the same.

 Administration: determinations of over all

policies and major objectives.

 Management: an executive function , the active

direction of human effort.

 Administration is determinative while management

is executive in function.
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Management and Administration…
 As we go down in organizational hierarchy
management functions become more and more
but administration functions become less and
less.

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 Common Terms in Management
Effectiveness and Efficiency:

 Effectiveness: is the degree to which a stated

objective is being achieved.

 Efficiency: is concerned with the balanced use of

resources to achieve objectives.

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 Common Terms…
Goals, Aims, Objectives and Targets:
 These terms are similar in concept, but differed in
scope and time:

 Goal: is the broad statement; there is generally one

goal for a service.

 Aims: there are a number of aims relating to the

goals.

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 Common Terms…
 Objectives: For each program aim, there may be
a number of objectives, which are specified in
measurable terms.

 Targets: For each objective, there may be various

targets, which specify various points on the way
to the attainment of the objective. They are
defined in relation to a point in time.

15
 Concepts in Management
1. Effectiveness:
 Is the degree to which a stated objective is
being achieved.
 It is doing the right things.
2. Efficiency:
 Is balanced use of resources while achieving the
stated objectives.
 Is cost-effectiveness where objectives are
achieved with the lowest practicable cost.
 It is doing things right.
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 Concepts…

Question to Class?

Which one is more important for health organization?

Effectiveness or efficiency?

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 Concepts…

Efficiency (Means) Effectiveness (Ends)

Resource usage Goal attainment

Low Waste High Attainment

Management strives for:

 Low resource waste (high efficiency)

 High goal attainment (high effectiveness)

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 Concepts…
3. Economy of scarce resources:
 Often many resources are scarce and costly thus
we have to economize when utilize.
4. Work relations:
 Work activities should be designed and
structured so as to support each other towards
the achievement of objectives.
5. Information:
 Necessary to make the right decision for action.
 Should be the right kind, at the right time and in
the right hands.
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 Principles in Management
1. Management by Objectives:

 Management sees that objectives are specified

and then that they are achieved.

 Each person‟s major area of responsibilities is

clearly defined in terms of measurable outcome.

2. Learning from Experience:

 For better performance there should be

feedback to learn from the experience gained.

 Any gap between objectives and obtained

results (achievements). 20
 Principles…
3. Division of Labor:

 Management attempts to bring about balance

of work among different people concerned.

 Assign the right proportion of each kind of staff

to the task at hand.

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 Principles…
4. Substitution of Resources:

 Scarce and or expensive resources should be

replaced by others.

 When the resources normally used to provide

service become scarce or too expensive,
different resources may be used to deliver the
same service.

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 Principles…
5. Convergence of Work:
 Working relations should contribute to the
success of each activity and so to general
effectiveness.
6. Functions Determine Structure:
 The function or authority will be clearly
delineated on the structure.

 Determining the function and duties of individual

member is followed by working relations
(structure).
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 Principles…
7. Delegation:

 When some body's authority is lent.

 Assigning job activities and corresponding authority to

specific individuals within the organization.

8. Management by Exception:

 Selectivity in handling information & priority in decision

making.

9. Shortest Decision-Path:

 Decision must be made as closely as possible in time

and place.
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 Managers
What is a manager?
A manager is a person who plans, organizes, leads
and controls human, financial, and other resources to
meet organizational goals.

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 Manager…
Managers:

 Are people who are formally appointed/selected

to positions of authority in organizations or
systems who:

 Enable others to do their direct or support

work effectively.

 Have responsibility for resources utilization.

 Are accountable for work results.

26
 Managers…

 Managers are the people who plan, organize,

direct, and control so as to manage organizations

and organizational units.

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 Types of Managers
 Based on the degree of authority and scope of

responsibility managers are of three levels.

 Top level

 Middle level

 First level(front-line)

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 Top-Level Managers
 Have authority over and are responsible for the
entire organization:

 all staff, resources and organizational results.

 Are accountable to the governing body.

 Establish operating policies and guide the

organization with its environment.

 Include individuals with the title of chairperson,

president, chief executive officer, executive vice
president, vice president, or chief operating officer.
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 Middle Level Managers
 Are managers in the middle range of organizational
hierarchy.

 Are responsible to other managers and sometimes

for operating employees.

 Are reporting to senior managers.

 Have authority over and responsibility for a specific

segments of the organization.

30
 Middle Level…
 There are numerous middle level managers than

top managers.

 Terms such as director or manager are usually a

part of a middle manager‟s title:

 for example, director of human resources or

western regional manager.

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 First Level Managers
 Are charged with overseeing the non-supervisory

(operating) employees who perform the organization‟s

basic work.

 Sometimes called as supervisory, front-line and operating

level of management.

 Of the three types of managers, supervisory managers

spend the greatest amount of time actually directing

employees.
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 First Level…
 Except for making small, on-the-job adjustments,

they seldom perform planning and organizing

activities.

 Instead, supervisory managers initiate the upward

flow of information that middle and top managers

use to control organizational behavior.

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 Common Attributes of all Managers

 All managers regardless of their level are:

 Formally appointed to positions of authority by

the organization.

 Directing work efforts of others (subordinates and

non subordinates).

 Responsible for utilizing organizational resources.

 Accountable to superiors for work results.

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 Common Attributes…

What Makes them different?

 The difference is in the scope of activities they

oversee: the degree of authority and scope of

responsibility and organizational activity.

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 Managerial Skills
 There are three distinct types of skills:

1. Conceptual skill

2. Human relation skill

3. Technical skills

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 Conceptual Skill
 Ability to perceive an organization or organizational
unit as a whole:

 ability to understand how various functions of

the organization complement one another.

 able to understand how the various factors in

particular situations fit together and interact one
another.

 Most frequently used by top managers.

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 Human Relations Skill
 The ability to work with, understand and motivate

other people as individuals.

 The ability to understand, alter, lead, and control

the behavior of other individuals and groups.

 Enables to build cooperation among the team.

 The most important in managing an organization.

 Equally needed by all managerial levels.

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 Technical Skills
 Are abilities to use the methods, processes, and
techniques of managing.

 It includes:

 Methods and techniques

 Specialized knowledge

 Techniques to solve problems in that specific

discipline.

 The first level managers were more of technical

than the rest levels.

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Managerial skills Vs Managerial levels

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 Managerial Roles
 Managerial role is the behavioral pattern expected
of someone within a functional unit.

 All mangers have formal authority over their

organizational units and derive status out of that
position.
 The work of managers is viewed as a series of
three broad categories of roles, (Henry
Mintzberg,1990):
Interpersonal roles
Informational roles
Decisional roles
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 Interpersonal Roles
 In fulfilling interpersonal roles, managers create
and maintain interpersonal relationships to ensure
the well-being of their organizations or units.

 Includes:

 Figurehead role

 Leader/influencer role

 Liaison role

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 Interpersonal Roles…
A. Figurehead role:

 Managers represent their organizations or units to

other people in the figurehead role.

 Include such as ceremonial and symbolic

activities as greeting visitors, attending awards

ceremonies, signing documents and cutting

ribbons to open new facilities.

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 Interpersonal Roles…
B. Leader (influencer):

 Direct and motivate subordinates.

 Seek to motivate, inspire and set examples

through their own behavior.

 Are expected to be responsible and accountable

for their subordinations action as well as their

own.

44
 Interpersonal Roles…
C. Liaison:

 This role allows managers in formal and informal

contacts both inside and outside their organization

to establish relationships that will help them

achieve organizational objectives.

 Links in horizontal as well as vertical chain of

communications.
45
 Informational Roles
 Involves collecting, receiving and disseminating

information (processing information).

 Related to communication and information

channeling.

 Managers have unique access to internal and

external information networks.

 In informational roles they receive and transmit

information within these networks.

46
 Informational Roles…
A. Monitor/Recipients:

 Receiving information about the organization: filter

the information, evaluate it and choose to act or

react to that information.

 Focal person for all types of information.

 Managers scan the environment surrounding their

organizations or units, seeking information to
enhance performance.

47
 Informational Roles…
A. Monitor…

 Such activities can range from reading periodicals

and reports to trading rumors with managers in

other firms or units.

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 Informational Roles…
B. Disseminator:

 Involves choosing to disseminate the

information: it is communicating selected

information to subordinates.

 Managers pass information to subordinates who

would otherwise have no access to it.

 To share information with subordinates, they may

hold meetings, write memoranda, make telephone

calls, and so forth. 49

 Informational Roles…

C. Spokesperson:

 Represent and speak on behalf of the

organization.

 Communicating selected information to outsiders.

50
 Decisional Roles

 Managers determine the direction to be taken by

their organizations or units.

 A manager legal authority to decide on matters

assign to him based on job description.

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 Decisional Roles…
A. Entrepreneur:

 Are initiators and designers of changes intended to

improve performances in their organizational
domains.

 Act as change agents: initiate improvement

projects, identify new ideas, delegate idea
responsibilities to others.

 Organizations are internally dynamic and

continuously affected by the environment.
52
 Decisional Roles…
B. Disturbance handler:

 Detect wide variety of problems and decides on and

implements solutions.

 They handle both internal and external

disturbances.

 Takes corrective action during disputes or crises

and resolves conflicts among subordinates.

 The ability to make good decisions about handling

disturbances is an important determinant of
managerial success. 53
 Decisional Roles…
C. Resource allocator:

 Decides on resources and their distribution.

 Managers decide who gets what based on

priority setting.

 Prioritize tasks and make decisions regarding the

use of limited resources.

54
 Decisional Roles…
D. Negotiator:

 Negotiating with other parties representing

organizational interests.

 Negotiating includes deciding what objectives to

seek through negotiations and how to conduct the

negotiations.

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Mintzberg’s 10 Managerial Roles

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 Functions of Management
 The set of social and technical functions inherent
in the management process includes:

 Planning

 Organizing

 Staffing

 Leading

 Controlling

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 Functions of Management…

 These are the basic management activities that

make up the management process.

 Planning: determining the long-and short-term

objectives (ends) of the institution or unit and

the actions (means) that must be taken to

achieve these objectives.

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 Functions of Management…
 Staffing- Selecting the personnel to carry out

these actions and placing them in positions

appropriate to their knowledge and skills.

 Organizing- Mobilizing human and material

resources so institutional objectives can be

achieved.

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 Functions of Management…
 Leading- Motivating and directing personnel to

carry out the actions needed to achieve the

institution‟s objectives.

 Controlling- Comparing results with predetermined

standards of performance and taking corrective

action when performance deviates from these

standards.
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 Functions of Management…
 The cross cutting functions of management:

 Decision Making and

 Communication

 Decision-Making-identifying a problem, searching

for solutions, and selecting the alternative that

best achieves the decision maker‟s objectives.

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Functions of Management…

62
 Planning
Learning Objectives: Up on completion of the
session, students will be able to:

 Define planning

 Describe importance of planning

 List elements of planning

 List and explain types of planning

 Describe steps of planning process

 Develop a plan for health care programs

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 Planning
 Is the function that determines in advance what
should be done.

 It is looking ahead and preparing for the future.

 It is the process of deciding the organizational

objectives and charting out ways of attaining those
objectives.

 Planning is a primary management function:

 Through planning managers clearly put and

outline exactly what organizations must do to

be successful. 64
 Planning…
 Planning is a process of setting priorities and

determining performance targets.

 Planning dictates the objectives and activities

towards which managers lead other members of

the organization.

 It is deciding in advance what to do, how to do,

when to do, where and who will do activities.

65
 Planning…
 A plan is a blueprint for goal achievement that
specifies the necessary resource allocations,
schedules, tasks, and other actions.
 Planning is the most fundamental: all other
management functions stem from planning.
 In short, planning is preparing for tomorrow,
today:
 allows managers to determine what they
want and how they will achieve it.
66
 Planning…
 Planning answers the following questions:

 Where are we now? ------- Assess the present

situation.

 What are we here for? ------Problems at hand.

 Where are we going?-------Objectives

 With what? -----------------Resources

 How? ---------------- Strategies and activities

 When? -----------------------period of time.

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 What is Health Planning?

 Health planning is the process of defining

community health problems, identifying needs

and resources, establishing priority objectives,

and setting out the administrative actions needed

to achieve those objectives.

 It is the process that lays the base for future

action.
68
 Health Planning…

 It is a process that appraises the overall health

needs of a geographic area or population and

determines how these needs can be met in the

most effective manner through the allocation of

existing and anticipated future resources.

69
 Rationales for Planning
 Reduces uncertainty.

 Improves efficiency or minimizes wastage.

 Sets the standards for controlling.

 Decision coordination (consider tomorrow).

 Emphasis on organizational objective.

 Gives direction to the organization.

 Eliminates duplication of efforts.

 Reduces guess work.
 Improves communication and coordination of
activities. 70
 Features Planning
 Is an intellectual activity.

 Is a continuous Process (cyclic /spiral).

 Is flexible as it is based on future conditions.

 Must be systematic and action oriented.

 Is collective undertaking requiring the participation

of professionals, community and other stakeholders.

 Is needed and practiced at all managerial levels.

71
 Features of Planning…

 A good plan should give clear vision, mission,

goal and objectives.

 Taproot for the other elements of management

process.

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 Elements of Planning
 Mission or Purpose  Policy

 Vision  Procedure

 Values  Methods

 Goals  Budget

 Aims  Plan of action

 Objectives

 Targets

73
 Elements of Planning…
Mission Statement:
 Is a broad, comprehensive statement defining
organizational purpose or identity.

 It charts the direction for the organization.

 It is defined within the framework of

organization‟s philosophy.

 The mission conveys the rationale behind the

organization needs to exist.

 It defines whom the organization serves.

74
 Elements of Planning…
Mission Statement…

e.g. Mission of Bahirdar City administration health

office:

“To reduce morbidity and mortality through provision

of quality, equitable, promotive, preventive and
curative health services to the inhabitants in the
city administration”.

75
 Elements of Planning…
Vision Statement:
 is an ideal, credible, attractive future for an
organization.

 The “ideal” state that organizations aims to achieve.

 It is defined within the framework of the

organizations philosophy.

e.g: The vision of MOH:

“To see healthy, productive and prosperous society by 2020”

76
 Elements of Planning…
Values:

 Is the philosophy of operation and the organizational

culture being practiced.

– There must be congruence between the

organization values and the strategic plan.

– Value genuinely binds together individuals and

organization.

77
 Elements of Planning…

Values…

Examples:

“Medical secrecy is value of medical profession”

“Service user satisfaction is our university‟s culture”

“Customer first”

“Quality education”

78
 Types of Planning
 Based on scope/breadth of problems there are

three basic types of planning:

Strategic Planning

Tactical Planning

Operational Planning

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 Strategic Planning

 Is the process for defining and determining an

organizations‟ roles, priorities and directions in

periods of time.

 Is process of analyzing and deciding on the

organization's mission, objectives, major strategies

and major resource allocation.

80
 Strategic Planning…
 Strategic planning is:

 Performed by top level mangers and focuses on

overall organizational goal.

 Mostly long range in its time frame, expressed in

relatively non-specific terms.

 Is simplistic and comprehensive in scope.

 Type of planning that provide general direction.

 Referred as allocative planning.

81
 Tactical Planning
 Refers to the process of developing action plans through

which strategies are executed.

 Departmental managers in organizations are often

involved in tactical planning. Examples are:

 Developing annual budget

 Choosing specific means of implementing strategic

plans.

 Deciding on course of action.

82
 Operational Planning
 Is most specific and detailed.

 Concerned with day-to-day activities.

 Short-range and more detailed.

 Used to implement strategic plans.

 First line managers: plan in relation to specific

operations or activities .

e.g. scheduling work activity and allocating resource.

83
 Planning Tools
 Are techniques that help in planning process
 Most commonly used tools include:
 SWOT analysis
 Delphi method
 Nominal group technique
 Scheduling
 Bench marking
 Brainstorming
 Focus group discussion
84
 SWOT Analysis

 Is a strategic planning tool that matches internal

organizational strength and weakness with external

opportunities and threats.

e.g. In a health service organization:

 Strength – availability of resources and trained

human.

 Weakness – lack of managerial talent.

85
 SWOT Analysis…
 Opportunities– clear and supportive government

policies or presence of a functional health

committee in the communities.

 Threats– adverse cultural believes towards

modern medicine and growing cost of essential

drugs.

86
 SWOT Analysis…
 SWOT Matrix – A frame work for selecting
strategies.

87
 Planning Steps
 Planning process involves six sequential steps:

 Situational Analysis

 Problem Prioritization

 Setting Objectives & Targets

 Identifying Potential obstacles & limitations

 Designing Strategies

 Writing Up the plan

88
 1. Situational Analysis
 Refers to environmental scanning.

 Gives improved understanding of the current situation

from various perspectives.

 Answers the question “where are we now?”

 The current situation is described with identification of

health and health related needs and available resources:

– Population characteristics

– Area characteristics and infrastructures

– Policy and political environment

– Health need analysis

89
 2. Problem Prioritization
 Is identifying priority health problems.

 Setting priorities for health services organization in

the light of competing needs and limited resources.

 A problem is a difficulty or an obstacle seen to

exist between the present situation and a desired

future situation.

90
 2. Problem Prioritization…
 Grouping of problems:

– Environmental problems

– Diseases/health problems

– Socio-economic problems

– Health services problems

91
 Criteria for Prioritization
Criteria for problem prioritization:

 Magnitude of the problem: the public health

burden imposed by the problem.

 Degree of severity: consequent suffering,

death and disability.

 Feasibility: in terms of cost effectiveness, social

acceptability and local sustainability.

92
 Criteria…
 Government concern: political acceptability with

consideration of equity and multisectoral approach,

consistency with government plan and budgetary

system.

 Community concern: how much does it relate to

community perceived health needs?

93
 3. Setting Objectives and Targets
 Describing the desired direction of a service

definition in terms of measurable parameters.

 Answers the question “where do we want to go?”

 Importance: clear statement of objectives enables:

 To decide how to achieve them.

 To evaluate how effective one is in achieving and

reaching objectives.
94
 3. Setting Objectives…
 Objectives of a program must be „SMART‟:

 S-Specific: What needs to be achieved is

unambiguous.

 M-Measurable: Possible to determine if the desired

conditions has been achieved.

 A-Agreed: There is a consensus and commitment

to the objectives among the major stakeholders.

95
 3. Setting Objectives…

 R-Realistic/Relevant: Objectives need to be

achievable. Is it feasible; meaningful.

 T-Time bound: A clear understanding of the time

scales associated with each objectives is defined.

e.g. “Reduce service delays by 10% per year over

the next 5 years”.

96
 4. Identify Potential Obstacles and
Limitations

 Situations that may prevent the achievement of

each objectives and targets.

 The limitations may be :

 Resources: Human, equipment, money, time,

Information, space.

 Environmental obstacles: geographical, climate,

technical difficulties, social factors etc.

97
 4. Identify Potential…
 Three groups of obstacles:-

– (1) Obstacles that can be removed.

– (2) Obstacles that can be reduced or modified

– (3) Obstacles that can‟t be changed.

98
 5. Design Strategies

 Strategies are the tactics or techniques that should

be devised or adopted and utilized to facilitate the

achievement of objectives and targets.

 Strategies are ways of achieving objectives and

targets.

99
 5. Design Strategies…
 Potential strategies often include:

 Technology to be applied

 Procedures to be used and

 Defining the role of communities and other

sectors

 For each chosen strategy, the corresponding

activities to be undertaken and the resources
needed should be detailed.

100
 6. Write Up the Plan
 Prepare action plan for the organization for periods of
years.

 It is at this stage that the goals, objectives and

strategies are translated to activities.

 Purpose of writing a plan:

 To request funds or resources from the government or

funding agencies-Effective strategic budgeting.

 For monitoring and evaluating the implementation

process by all concerned.

101
 Outlines of Writing Up a Plan
1. Summary of main points.

2. Introduction

 General background and Statement of the

problem.

3. Objectives and targets:

 should be clearly stated decided before hand.

4. Strategies and activities:

 should be clearly stated using Gannt chart.

102
Writing up….

103
 Outlines…
5. Resources requirement:

 The type and number of resources needed should

be documented.

 How each of the resources are going to be

utilized has to be mentioned.

6. Monitoring and evaluation:

 Mention how monitoring and evaluation is to be

performed: by whom?, when?...

 Indicators of effectiveness should be decided

forehand. 104
Thank You!!!

105