Health Service Management

Samrawit S. (Mph. PHN & HSM)

_________________________________________

School of public health, department of health policy and management

Email:[email protected]

March, 2025

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 UNIT ONE

Introduction to health policy and

management

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Session objectives:
At the end of this session the student will
able to:
• Define management & other technical terms

• Differentiate between efficiency and

effectiveness
• Differentiate Administration from management

• Discuss types of management

• Understand different managerial roles and

skills
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 Concepts and definitions of terms
Health
• Is the maximization of the biological &
clinical indicators of organ function
• Absence of sickness, injury, infection, pain
• Ability to conduct normal daily activities
• WHO’s defines health in 1948 as “a state
of complete physical , mental, and
social well-being and not merely the
absence of disease or infirmity”.

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 cont.…

• Health services: Are specific activities that are

undertaken to improve or maintain health.
• Organization: Two or more people working
together in a structured way to achieve a
specific goal.
• Health service organizations: Are entities
within which the delivery of health services is
made directly to consumers
• System: is an interrelated set of elements
functioning as a whole
• Health Systems: Are formally
linked/joined HSOs together to provide
more coordinated and comprehensive
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health services.
 Brainstorming

• What is management?
• Art or science?

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 Art vs. Science
• ‘Art’ one normally learns the “how” of a
phenomenon.
• It is the art of getting things done through others
in dynamic and mostly non-repetitive situations.
• Science is an organized knowledge.
• Management as an art as well as science
- It was considered as science because it has an
organized body of knowledge
- It is called an art because managing requires
certain skills which are personal possessions of
managers
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Definition of management

• Although so old as practice & universal

it has no agreed on definition.
• Management is the process of
designing and maintaining an
environment in which individuals
working together
• It is the art of getting things done
through people and other resources.
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Definition of management

• Management is the process of

planning, organizing, directing and
controlling to accomplish
organizational objectives through the
coordinated use of human and
material resources (commonly used
definition)
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 Characteristics of Management

• Universal : It is applied every

where

• Continuous process: Carried out

through out the budget year.

• Dynamic: Changes from one form

to another

• Pervasive: practiced in every

organization
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Administration versus Management

What is the difference ?

• Administration is an overall
determination of policies & major
objectives.

• Management is essentially an
executive function , the active
direction of human effort
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 • Administration
Administrat • President
ion • Vice president
• School
• Department
• Section
Management • Units

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Principles of Management

Henri Fayol Developed 14 Principles

of Mgt:
1) Division of Labor:
• The more people specialize, the more
efficiently they can perform their
work.
2) Authority:
• Managers must give orders so that
they can get things done.
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Principles….
3) Discipline: respecting rules and
regulation
4) Unity of Command: receive instructions
from only one person.
5) Unity of Direction: the entire
organization should move toward a common
objective
 A single plan of action to guide the
organization.
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Principle….
6) Subordination of Individual
Interest to the Common Goal or
interest:
• Prioritizing the interests of
organization over that of employees.

7) Remuneration:
• Motivating employees by providing
different payment mechanism.
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Principle….
8) Centralization VS decentralization
• Sharing authority for their subordinates

9) The Hierarchy:
• Lower managers should inform upper
managers.

10) Order :
• Having materials and people in the right
place at the right time.
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Principle….
11 ) Equity:
• The provision of justice & the fair
and impartial treatment of all
employees.
12 ) Stability of Staff:
• Retaining productive employees
• Reducing staff turnover
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Principle….
13 ) Initiative:
• Given freedom to employees to carry
out their plans, even though some
mistakes may result.

14 ) Team spirit:
• Promoting team spirit among members
to give the organization a sense of unity.

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Managerial roles
• Henry Mintzberg classified management
role in to ten most common roles in 1970.
• He classified the ten roles in to three
categories
Interpersonal role

Informational role

Decisional role

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 Managerial Roles
Interpersonal roles:
§Figurehead: represents the
organization
§Leadership: inspiring others
§Liaison: maintaining relationships
within group

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Informational roles:
• Monitors: receiving information
• Disseminators: share info for
subordinate
• Spokespeople: share info for external
body(outsiders)
Decisional roles:
• Entrepreneurs: designing new initiatives
• Resource allocators: steward resource
• Negotiators: relate with other
organizations
• Disturbance handlers: Dealing with
problems
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Types of manager
• Front - line (first/ low level) /
Supervisory mangers

• Middle managers

• Top/ senior managers

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05/11/2025 26
1. Top- level Managers

• Are mangers who are responsible for

overall management of the
organization.
• Such management includes that of
board of director, executive
committee, and chief executive or
president, or general manger, of an
organization
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Major functions of top level managers

• Establishing general objectives

• Designing major strategies
• Outlining principal policies
• Providing effective organizational
structure
• Making overall control of the
organization
• Sealing with external parties
• Analyzing the changes in the external
environment and respond to it.
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2. Middle- level managers

• Are managers in the midrange of the

organizational hierarchy.

• Includes heads functional areas,

divisional heads, department
managers, branch mangers, etc.

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Major functions of mid-level manager
• Acting as intermediary between top and
operating level management

• Translating long- term plans of top

management into medium range plans.

• Developing specific targets in their areas

of responsibility.

• Coordinating inputs, production and

outputs of operating level management.
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3 . First – line managers

• Managers who are responsible for the

work of operating and do not
supervise other managers.

• Are the “first” or lowest level of

managers in the organizational
hierarchy.

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 Major functions include
• Planning daily and weekly activities

• Assigning operating employees to specific

tasks

• Issuing instructions at the work place

• Following, motivating, and evaluating workers

• Reporting to their superiors.

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 • How do you measure
managerial
performance?

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 Managers’ performance
Managerial performance measures:

• How efficient & effective a

manager is.

• How well a manager determines &

achieves appropriate organizational
objectives.

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Efficiency versus effectiveness
 Efficiency (“Doing things right”)
The ability to minimize the use of resources
The least wasteful use of resources.

 Effectiveness (“ Doing the right thing”).

Degree to which a stated objective is
achieved.
Comparison of objectives with achievement
Doing right things in right way at right times

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 Managerial skills
A) Technical Skills: ability to apply specific
procedures and techniques in a specialize field.
B) Interpersonal Skills: ability to lead, motivate,
manage conflicts and work with others.
C) Conceptual Skills: ability to view the organization
as a whole.
D) Communication skills: ability to share
information with others and reaching on consensus.

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THEORIES OF MANAGEMENT

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Session objectives
• At the end of this session you will be
able to :
• Understand Historical Perspective of
Management
• Discuss Major Approaches of
Management
Classical Management Theory
Quantitative Management theory
Behavioral management theory
Systems Approach/theory
Contingency Approach/theory
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 Management from Historical Perspective

• The idea of "management" is as old as

human society.
• The driving force behind the evolution
of management theory is the search of
better ways to utilize organizational
resources.
• A theory is a coherent group of
assumptions put forth to explain the
relationship between two or more
observable facts.
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 Cont.….
• Theories are perspectives with which people
make sense of their world experiences.
• Provide a stable focus for understanding what we
experience.
– provide criteria for determining what is
relevant.
– enable us to communicate efficiently and thus
move into more and more complex relationships
with other people.
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Early Management Concepts

Industrial revolution
• Minor improvements in management tactics
to increase the quantity and quality of
production.

• Economies of scale - reduction in the cost

of production as the total volume produced
increases.
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Major Approaches to
Management

1. Classical Management Theory

2. Quantitative Management theory

3. Behavioral management theory

4. Systems Approach/theory

5. Contingency Approach/theory

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1. Classical Management
Theory
The classical approach are:
• Scientific management

• Administrative management

• Bureaucratic management

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 Scientific Management
Fredrick Winslow Taylor (1856-1915)
• He is known as the
• "father of scientific
management.“
• Published “Principles of Scientific
Management“(1911).
• One of his many contributions to
modern management is the common
practice of giving employees rest
breaks throughout the day.
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 Scientific management…
“Using scientific methods to define the “one
best way” for a job to be done”
 He Encouraged employers to pay more for
the productive workers at a higher rate than
others
 Thus, workers were urged to exceed their
previous performance standards to earn
more pay. This is the differential rate
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system.
47
Taylor’s Four Management Principles

Scientifically
Scientifically design
design each
each element
element of
of wor
wor

Scientifically
Scientifically select,
select, train,
train, and
and develop
develop the
the
workman.
workman.
Cooperation
Cooperation and
and Proper
Proper remuneration
remuneration ff
fast
fast and
and high-quality
high-quality work
work

Equal
Equal division
division of
of work
work and
and responsibilit
responsibilit
between
between worker
worker and
and manager
manager
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Administrative Theory
• Administrative management provides a
more general theory of management.
• A theory of management that focuses
on the process and principles of
management.
• Developed by Henri Fayol

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 Administrative Theory…
• Henri Fayol (1841-1925)
• Developed Principles and Elements of
Management:- how managers should
accomplish their managerial duties
• PRIMARY FOCUS: Management
(Functions of Administration)
• More Respect for Worker than Taylor
• Workers are motivated by more than
money
• Equity in worker treatment

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 Administrative Theory…
• Henri Fayol
– Believed that the practice of
management was distinct from
other organizational functions.

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 Henri Fayol’s Administrative Theory…

• He argued that management was a

universal process consisting of the
following functions:
• planning
• organizing
• commanding
• coordinating
• controlling
• Positioned communication as a
necessary ingredient to successful
management
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Henri Fayol Developed 14 Principles
of Management:
1) Division of Labor
2) Authority
3) Discipline
4) Unity of Command
5)Unity of Direction
6) Subordination of Individual
Interest to the Common Goal or
interest:
7) Remuneration
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Principle….

8) Centralization VS
decentralization
9) The Hierarchy
10) Order
11 ) Equity:
12 ) Stability of Staff
13 ) Initiative:
14 ) Team spirit:

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Bureaucracy theory
• Max Weber (1864-1920)

• German Sociologist

• Described an ideal or pure form of

organizational structure
• PRIMARY FOCUS: Organizational Structure

• Worker should respect the “right” of

managers to direct activities dictated by
organizational
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 Max Weber…

The exercise of control is based on

knowledge, expertise, or experience.
According to Max Weber, there are three
types of Authority in an organization :-
• Traditional Authority - past customs;
personal loyalty
• Charismatic Authority - personal
character and skills
• Rational Authority - rational
application of rules or laws.
• Bureaucracy allows for the optimal
form of authority - “rational authority”
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 Weber’s Theory of
Bureaucracy
• Concerned with describing the ideal
structure of an organization
• Cornerstone: existence of written
rules

• The rational application of written

rules ensures the promotion of
legitimate authority and the
effective and efficient functioning of
the organization.
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 Features of Bureaucracy
• High degree of Division of Labour
and Specialization.
• A well defined Hierarchy of
Authority.
• It follows the principle of Rationality.
• There are Formal and Impersonal
relations among workers
• Interpersonal relations are based on
positions and not on personalities.
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Cont.…
• There are well defined Rules and
Regulations which must be strictly
followed.
• Well defined Methods for all types of
work.
• Selection and Promotion is based on
Technical qualifications.
• Only Bureaucratic or legal power is
given importance
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2. Quantitative
Management
• Developed during World War II
• The quantitative school focuses on
improving decision making via the
application of quantitative techniques.
• Planners has to use statistics,
optimization models, information
models, and computer simulations in
decision making
• Its roots can be traced back to scientific
management.
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 3. Behavioral school theory
• Concerned with the behavior of people at work.

• Focused on understanding factors that affect

human behavior at work.
• It is often called the human relations
movement because it addresses the human
dimension of work.
• Better understanding of human behavior at work,
such as motivation, conflict, expectations, and
group dynamics, improve productivity.
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 Behavioral school theory
Abraham Maslow, developed one of the most
widely recognized need/motivation theories. His
theory of human needs had three assumptions:
• Human needs are never completely satisfied.

• Human behavior is purposeful motivated by the

need for satisfaction.
• There is hierarchy of need, from the lowest to
highest.

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He broke down the needs hierarchy into
five :
• Physiological needs: food, drink,
wearing...
• Safety needs: security, stability,
protection, and freedom from fear.
• Belonging and love needs: meaningful
relationship with others.
• Esteem needs: self-confidence and wants
to achieve status, reputation, fame, and
glory.
• Self-actualization needs: achieving ones
full potential and dreams
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 ERG Theory
• Developed by Clayton Alderfer.
• He proposed that human needs is
grouped under three categories.
• E= existence needs ⇒
fundamental needs
• R= relatedness needs ⇒
interpersonal relations
• G= growth needs ⇒ personal
creativity or productivity
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 Two-Factor Theory of Fredrick
Herzburg
Hygiene factors (Dissatisfiers): are factors
that can’t motivate employees but can minimize
dissatisfaction. They can only dissatisfy if they
are absent or mishandled
Salary
work conditions
Policy
supervision
interpersonal relations with supervisor
working security
status
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Two-Factor Theory…
• Motivators (Satisfiers) : These are
factors whose presence motivates.
 Recognition
 Responsibility
 Work itself
 Achievement
 Advancement
 Growth
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Implications of Herzberg’s Theory

• Satisfaction is not the opposite of

dissatisfaction.
• There is a need to think carefully about
what motivates employees.
Problems with this theory is one person’s
dissatisfier is another person’s satisfier.
• Fulfillment of dissatisfiers does not
necessarily show satisfaction
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 McClelland theory
• According to McClelland only three
types of needs motivate people.
Achievement: People are motivated
by achievement
Affiliation: People are motivated by
affiliation working in a group.
Power: Those with a high need for
power work best when they are in
charge.

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 4. The System Approach
System is Defined as:
– A set of interrelated and
interdependent parts arranged in a
manner that produces a unified
whole.
• Basic Types of Systems
– Closed systems
• Are not influenced by and do not
interact with their environment (all
system input and output is internal).
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System…

• Open systems
• Dynamically interact to their
environments by taking in inputs
and transforming them into
outputs that are distributed into
their environments.

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Implications of the Systems Approach

• Coordination of the organization’s

parts is essential for proper
functioning of the entire
organization.
• Decisions and actions taken in one
area of the organization will have
an effect in other areas of the
organization.
• Organizations are not self-contained
and, therefore, must adapt to
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 5. The Contingency Approach (1960)

• It emphasizes that there is no one

best way to manage an
organization.
• It depends on various situations
such as
External environment
Technology
organizational characteristics
characteristics of the manager
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Contingency Approach
• There is no one universally
applicable set of management
principles (rules) by which to
manage organizations.
• Organizations are individually
different, face different situations
and require different ways of
managing.

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 Management Functions
1- planning: forecasting what is needed
for the future, setting objectives for the
desired results, and develop strategies
and plans to achieve those goals.
• It is the first management function
and all other functions depend on it.
• Data, knowledge,
experience .....Alternatives
…….proper decision making.
 Contd.
2- Organizing: formulating the organization
structure that clearly define the scope of
responsibilities, relationships, and lines of
authority. This function is very important to
implement the plans effectively & efficiently.

3- Staffing: selecting the personnel to

perform the work and placing them in posts
suitable to their knowledge and skills
(Suitable place concept).
 Contd.
4- Directing: includes motivating the
subordinates, leading them, selecting the
most effective communication channels, and
resolving any arising conflicts. Directing is
a very helpful function for achieving the
organization objectives.

5- Controlling: monitor activities to ensure

achieving them as planned, correcting any
significant deviations, and rewarding
workers .
Management Functions

78
Thank you
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