HEALTH SERVICES MANAGEMENT

Learning objectives:
 Define management
 Describe the historical development of management as a field of study
 Describe the characteristics of organisations
 Explain the organisational structure of health services in Uganda
 Describe the principles of management and their application.
 Identify and explain the various functions of management.
 Enumerate the various theories of human motivation and their application to the category
of health workers who work under the supervision of the clinical officer.
 Describe teamwork and team building techniques.
 Identify and recommend leadership practices appropriate to the work situation of the
clinical officer.
 Discuss the role of effective management in the running of health services.
 Describe the steps taken in planning health services in a given catchment’s area.
 Discuss steps of managing resources effectively
 Discuss methods of making various reports
 Explain methods of initiating staff development
 Discuss methods used to evaluate staff performance and health facility.
 Explain pertinent public service regulations in managing staff and services.
 Describe the process of development and project formulation and proposal writing.
 Describe the process of change in an organisation
 Describe the management of health information system
 Outline the concept of quality assurance.

Definitions
Management
 It is a process of setting and accomplishing goals through the use and coordination of
human, technical and financial resources.
 It is getting work done through people and with people in order to achieve the
organisational goals.
Efficiency
 It refers to using the minimum amount of effort or resources needed to achieve an intended
result.
A theory
 An assumption or hypothesis about something

Historical development of management as a field of study

 Management like any other discipline or science has grown over time.
 Its recognition as an important academic discipline begun during the late nineteenth and
early twentieth centuries primarily through the work of Henri Fayol, Max Weber and
Fredrick Taylor who developed a number of theories which guide management thinking to
date.
 There are several theories of management under different categories. Some of these are:

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 o Technical theories that is how to improve efficiency at work
o Administrative theories
o Human relationship theories
o The systems approach
o The contingency theory

Technical theories
 By the 1800s business managers in many industries were concerned with efficiency.
 This led to various engineers and experienced managers to experiment on how further to
improve productivity and efficiency.
 Their systematic attempts to determine the best way to do a job and specify the skills
needed to perform it were characteristic of the way scientists in chemistry and physics
developed and tested theories, and hence it was referred to as “scientific management”
 The following are contributors to technical issues:
1. Scientific management
 Fredrick Taylor who is known as the father of scientific management defined it as: “a
systematic method of determining the best way to do a job and specifying the skills needed
to perform it”.
- He discovered that labourers were deliberately working slowly; for fear that they would be
laid off if they finished the job quickly.
 Thus Taylor proposed the basis of scientific management as:
- Analyse the job to find out how long it should take
- How best to do it
- Train the employees to do the job
- Pay them according to what they accomplish
- He proposed a differential rate pay system where by workers who met high
standards (first class men) would be rewarded with higher wages than those
who fell below the standard.

2. Time and motion studies

 Frank and Lillian Gilbreth define time and motion studies as: “studies that attempt to make
operations more efficient by finding the best way to do them”
 In 1909, the Gilbreths studied the task of brick laying and concluded that much time was
wasted by the workers who had to bend down to pick up each brick, lay it in place, smooth
the motor, and then begin again.
 They designed an adjustable scaffold that eliminated stopping thereby improving the
average work performance from 120 per hour to 300bricks per hour.

3. Assembly line
 Henry Ford 1886-1947 wanted to build a car an average person worker could afford.
 Mass production techniques and the assembly line were his solution because they allowed
him to decrease the unit cost and increase the volume of sales.
 He invented the assembly theory which states that:
“A production method whereby components to be worked on are cycled past a stationary
worker”.
 The making of chassis parts were carried to a stationary assembly point and it took 12 ½
hours to assemble each chassis.
 By using a rope to pull the chassis past workers and stockpiles of components, Ford cut
the labour time to 6hours.

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  With further improvements, assembly time was reduced to 93minutes by April 1914.
Each reduction in time meant dollar savings for Ford.

Theories focusing on administrative issues

 These aimed at managing people, coordinating their work and enhancing their productivity.
1. The classic organisation theory
 Henry Fayol (1841-1925), lived in France and devoted his life to understanding and
improving management work. He focussed on the administrative level of the organisations.
 He described the core functions of management and the principles of administration which
are being followed today.

2. Bureaucratic management
 Max Weber (1864-1920), focused on structuring organisation.
 He introduced bureaucratic management.
 He defined bureaucracy as comprising of the following characteristics:
- Division of labour based on what workers are specialised to perform.
- A well defined ladder of authority so that workers clearly understand to whom they are
responsible.
- Selection and promotion of individuals on the basis of technical competence and
experiences.
- Carrier orientation where by managers should be professionals devoted to the carrier of
management.
- Formal rules and controls should be developed and used to guide and monitor employees’
behaviour.
- There should be a system of rules covering the rights and duties of employees.
- Impersonality, which means rules should be uniformly applied to every body.
Note: Weber did not intend to create the atmosphere of “red tape” and slow response
associated with the word “bureaucracy” today.
- he was concerned with creating a well-run organisation where decisions were made based
on facts and people were rewarded and punished according to their expertise and
performance.

Human relations theories

 Human relations is management approach that emphasizes people and their feelings and
attitudes.
 Elton Mayo (1880- 1949): He found that workers belonged to informal groups that
greatly influenced whether a job would get done on time or whether a managerial
directive would be followed.
 Chester Barnad recognised that an organisation structure did not illustrate the informal
groupings and net works of people that often had an influence on whether an organisation
would run effectively.
 Abraham Maslow (1908- 1970): He was the first to articulate a new approach to
management that focused on workers’ needs. He argued that people did not work
primarily or only for money.
 Douglas McGregor (1906- 1064): He discovered the ideas people had about managing
others, which he referred to as theory X and theory Y.
Theory X:
-It assumes that: the average human being dislikes work and he will avoid it if he can.

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 - Therefore, most people must be controlled, directed and threatened with punishment to
make them put forth adequate effort.
Theory Y
- It assumes that: the expenditure of physical and mental effort in work is as natural as play
or rest.
- Man will exercise self-direction and self-control in his service.
- He does not only accept but also seeks responsibility.
- Under conditions of modern organisational life, the intellectual potentialities of the average
human being are partially utilised.

Systems approach/theory
 The original ideas of systems were developed by Ludwig who said that an organisation is
like a system which is an organized arrangement of interrelated parts.
 Systems theory is a management theory that views the organisation as a whole, constructed
of interrelated parts.

The contingency theory

 This is a management philosophy that focuses on analysing the situation and then finding
its management approach.
 It means that managers should be flexible when designing, organising or when choosing a
management style.
 Certain situations require strict supervision and an authoritarian approach while others may
call for a relaxed and democratic manner.

Why do we study management?

 Improve on skills in general management, e.g. communication, supervision, planning etc.
 Improve the production of the organisation
 Explore and discover ways and means of making workers to be more productive.
 Apply it in every human organisation since management whether good or bad, affects
everybody in one way or another.
 Use less resources to get maximum production
 Use minimum time to get maximum production.

What do the managers manage?

 Managers are directly concerned with 5basic areas abbreviated as 3MTI.
 These are:
- Manpower (better referred to as human resource)
- Money
- Materials e.g. physical facilities, machines etc.
- Time
- Ideas (information)

What are the skills of a manager?

A good manager should have managerial skills, which he can use to manage his institution
smoothly. For a manager to succeed s/he requires the following skills:
1. Technical skills
- This refers to the use of tools, techniques and procedures in specialised manner.

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- S/he must have the know-how of the job or the profession
2. Human skills
- Interpersonal relationships dealing with selecting, motivating and leading other employees.
- S/he must have the ability to work, motivate and counsel the staff under him/her.
- Must be sympathetic, non judgemental and understanding.
- Should relate well and interact effectively with those working under him/her.
- Should have no assumptions i.e. judge situations wisely basing on facts.
- Realise that goals cannot be achieved without people.
3. Conceptual skills:
-This is the ability to see the total organisational picture by integrating and coordinating a
large number of activities.
- Should be able to view situations in many directions.
4. Diagnostic skills:
The ability to get quickly to the true causes of a certain situation through a maze of data,
observation and facts and analyse the causes and anticipate changes.

What makes for Excellency and success in the management of an organisation?

 Tradition: That is looking into the way the things have always been done.
- This may help in giving direction and paving way for degrees of perfection in what ever is
being done.
 Knowledge of your organisation, i.e. being in a position to perceive the reactions of the
organisation as a whole when certain inputs are made for better or for worse.
- It is worth knowing that each organisation has feelings.
 Motivation of personnel i.e. the employees should be made to have a working drive
originating from inside.
 Training of personnel, i.e. undertaking continuing education for the workers in order to
improve their skills, thus enabling them to function more efficiently and effectively.
- The training can be in form of short or long courses depending on the needs of the
individuals.
 Good administration with the organisation: i.e. the type of administration which places
individuals in positions and recognises their input.
 Good workers whose aims concur with the organisation’s aims.
 High standards of achievement in the organisation, i.e. setting standards which the
workers are proud of especially when compared with their counterparts.
 Effective communication with the organisation: i.e. effective listening and speaking by
the management.
 Questioning attitude by the management; in order to discover knew ideas and knowledge
which can be put into use for the improvement of organisational operations.

What makes one a good manager:

1. Experience: This is obtained through working under guidance with experienced people. It
comes slowly at the cost of mistakes.
2. Personality: It influences the way we manage health centres effectively. That is your
willingness to work hard and perseverance determines your ability to inspire others.
3. Technical skills: understanding the technical elements of the job.
4. Human skills: Ability to work effectively as a group member and build cooperation with a
team.
- Ability to recognise ones strengths, weaknesses and preferences.

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Roles of managers
The managers have three key roles to play in whatever organisation in.
1. Interpersonal roles (leading roles)
Here the manager plays roles of:
a. Figure head: Symbolic head obliged to perform routine duties of legal or social nature.
b. Leader; Responsible for motivation of subordinates, staffing, training etc.
c. Liaison; Maintains self-developed network of outside contacts.
2. Informational roles (administrative roles)
a. Monitor: seeks and receives a wide variety of special information (much of it current) to
develop thorough understanding of organisation and environment.
- Emerges as a nerve centre of internal and external information of the organisation.
b. Disseminator: Transmits information received from outsider or from other subordinates to
members of the organisation.
c. Spokes person: Transmits information to outsiders on organisation’s plans, policies, action,
results etc.
3. Decisional roles (fixing roles)
a. Entrepreneur: Searches organisation and its environment for opportunities and initiates
“improvement projects” to bring about change.
b. Disturbance handler (shock absorber): Responsible for corrective action when the
organisation faces important unexpected disturbances.
c. Resource allocator: Responsible for the allocation of the organisational resources of all
kinds
d. Negotiator: Responsible for representing the organisation at major negotiations.

REFERENCES
Management: Functions and responsibilities (1990) Row publishers New York.
V.W. Sitati (1997) Highlights in management. SAS enterprise.