EOH3402 Community Health
Programme Management
Lecture 4
Role of a manager in the health care (HC)
organization and management
Introduction
Healthcare (HC) management is a growing profession
and increasing opportunities in both direct care and
non-direct care settings.
Direct care settings – those organisations that provide
care directly to a patient, resident or client who seek
services from the organisation
Non-direct care settings – support the care of
individuals through products and services made
available to direct care settings.
HC management is one of the fastest growing
occupations, due to the expansion and diversification
of the HC industry.
These managers are expected to be needed in inpatient
and outpatient care facilities, with the greatest growth
in managerial positions occurring in outpatient
centres, clinics and physician practices.
Hospitals may also experience a large number of
managerial jobs because of the hospital sector’s large
size.
HC management is the profession that provides
leadership and direction to organisations that deliver
personal health services, and to divisions, departments,
units or services within those organisations.
HC management provides significant rewards and
personal satisfaction for those who want to make a
difference in the lives of others.
The Needs for Managers and Their
Perspectives
Managers are required to provide leadership, as well as
supervision and coordination of employees.
The scope and complexity of tasks carried out in
provision of services are so great that individual staff
operating on their own couldn’t get the job done. In
order to produce services in HC organisations, many
highly specialised disciplines must be coordinated and
work together seamlessly.
Managers must make certain that organisational tasks
are carried out in the best way possible to achieve
organisational goals and that appropriate resources
such as financing and human resources are adequate to
support the organisation.
HC managers are appointed to positions of authority,
by making important decisions.
Decisions made are related to
Recruitment and development of staff
Acquisition of technology
Service additions and reductions
Allocation and spending of financial resources
Ultimately, decisions made by an individual manager
affect the organisation’s overall performance.
In order to carry out various tasks and make decisions,
managers must consider two domains
External domain – refers to the influences, resources and
activities that exists outside the boundary of the organisation
but that significantly affect the organisation, for example
Community needs
Licensure
Accreditation
Regulations
Stakeholder demands
Competitors
Medicare and medicaid
Managed care organisations / insurers
Internal domain – areas of focus that managers need to
address on a daily basis, for example
Staffing
Budgeting
Quality services
Patient satisfaction
Physician relations
Financial performance
Technology acquisition
New service development
Management: Definition, Functions and
Competencies
Management is defined as “the process, comprised of
social and technical functions and activities, occurring
within organisations for the purpose of accomplishing
predetermined objectives through human and other
resources (Longest, Rakish and Darr, 2000).
A manager is anyone in the organisation who supports
and is responsible for the work performance of one or
more persons (Lombardi and Schermerhorn, 2007).
Managerial positions, by organisational
settings
Physician practice (clinics)
Practice manager
Director of medical records
Supervisor, billing office
Nursing home
Administrator
Director, food services
Admissions controller
Supervisor, environmental services
Hospital
Chief executive officer
Vice president, marketing
Clinical nurse manager
Director, revenue management
Supervisor, maintenance
Managers implement six management functions as
they carry out the process of management
Planning
Organising
Staffing
Controlling
Directing
Decision making
In order to effectively carry out these functions,
managers need to possess several key competencies
Conceptual skills – the ability to critically analyse and
solve complex problems
Technical skills – reflect expertise or ability to perform a
specific work task
Interpersonal skills – enabling a manager to
communicate with and work well with other individuals,
regardless of whether that are peers, supervisors or
subordinates.
Management Positions: The Control in the
Organisational Hierarchy
Management positions are found throughout the HC
organisations.
Management positions exist at all levels, and the
hierarchy of management means that authority is
delegated downwards and that lower level managers
have less authority than higher-level managers, whose
scope responsibility is much greater.
The upper level is referred to as senior management
For example – vice president of Patient Care Services are in
charge of a few different functions, including nursing,
diagnostics, imaging and laboratory services
Compared to
Director of medical records – is responsible only for patients
medical records
Some managerial positions are line managerial positions
because the manager supervises other employees
Some are staff managerial positions as they carry out
work and advice their bosses, but they do not routinely
supervise others
The most common organisational structure for HC
organisations is a pyramid-shaped hierarchy, which
defines the functions carried out and the key
management positions assigned to those functions
The size and complexity of the specific health
organisation will dictate the particular structure.
Larger organisations (large community hospitals,
academic medical centres) will likely have deep
vertical structures reflecting varying levels of
administrative control for the organisation
This is due to
The large scope of services provided
Corresponding vast array of administrative and support
services that are needed to enable the delivery of clinical
services
Other characteristics of this structure include a strict
chain of command and line of reporting
Other administrative structures adopted by the HC
organisation
Matrix or team-based models
Service line management models
Focus of Management: Self, Unit/Team and
Organisation
Effective HC management involves exercising
professional judgment and skills and carrying out the
aforementioned managerial functions are three levels
Self
Unit/team
Organisation wide
First and foremost – the individual manager must be
able to effectively manage himself or herself
The second management focus – this involves
managing others in terms of effectively completing the
work
The third management focus – reflects the fact that
managers must work together as part of a larger
organisation to ensure organisational-wide
performance and organisational viability
The role of the Manager in Talent
Management
Management must have the requisite number and types of
highly motivated employees in order to effectively master
the focal areas of management and carry out the required
management functions
In many HC organisations, human resource management
has been replaced with “talent management” – where the
focus has shifted to securing and retaining the talent needed
to do the job in the best way, rather than simply fill a role
As a result, managers are now focusing on effectively
managing talent and workforce issues because of the link to
organisational performance.
Beyond recruitment, managers are concerned with
developing and retaining those staff who are excellent
performers
Strategies used by managers to develop and maintain
excellent performers
Offering training programmes
Providing leadership development programmes
Identifying employees needs
Measuring employees satisfaction through engagement surveys
Providing continuous education
Enabling job enrichment
Role of the Manager in Ensuring High
Performance
The role of the manager is to ensure that the unit,
service, division or organisation achieves high
performance
Goals and objectives are desired end points for activity
and reflect strategic and operational directions for the
organisation
They are
Specific
Measurable
Meaningful
Time oriented
Pillars of Excellence (Studer, 2003)
The organisation as needing to be results oriented
The pillars are
People (employees, patients and physicians)
Service
Quality
Finance
Growth
Griffith (2000) – high performance organisation is like
championship organisations – where they are expected to
perform well on different yet meaningful measures of
performance
Stakeholders (insurers, state/federal govt, consumer
advocacy groups) are expecting / demanding,
acceptable level of performance in HC organisations –
they want to ensure that services are provided in
A safe
Convenient
Low cost and
High quality environment.
To meet the required reporting requirements of the
aforementioned organisations, HC organisations use
varying method to measure and report the performance
measurement process
This include
Developing and using dashboards
Balanced scorecards
that allow for a quick interpretation on the
performanceacross a number of key measures
Example of balanced scorecard
Role of the Manager in Succession Planning
Succession planning – the concept of taking actions to
ensure that staff can move up in management roles
within the organisation, in order to replace those
managers who retire or more to other opportunities in
other organisations
It is mostly been emphasised at the senior level of
organisations, in part due to the large number of
retirements that are anticipated
Practices to address leadership succession needs
Mentoring programmes for junior management that
senior management participate
Formal leadership development programmes
Role of the Manager in HC Policy
Managers should be knowledgeable about health policy
matters under consideration in the state and federal levels
that affect health services organisations and HC delivery –
this is particularly true for senior-level management
This is necessary in order to influence policy in positive
ways that will help the organisation and limit any adverse
effects
For example
Staying current with HC policy discussions
Participating in deliberations of health policy
Providing input where possible
will allow HC managers’ voices to be heard
HC managers must strive to keep their knowledge
current in order to understand and influence health
policy
This can be accomplished by
Targeted personal learning
Networking with colleagues within and outside of their
organisations
Participation in professional associations
Knowledge gained can be helpful in shaping health
policy in accordance with the desires of HC managers
