Introduction to Management

Principles of management in the

health care setting
• Health care systems, like other
industries, are composed of
people, resources, infrastructure
etc.
• The basic principles of
management are the same as in
other businesses
What is Management about?

 Getting things done

 Getting things done through people

What is management?

“Getting the right people to do a job,

supporting and allowing them to do their
job”
A manager defined!

A person responsible for working and

through others to achieve objectives by
influencing people and systems in a
changing environment (Cook and
Hunsaker, 2001)
Alternative views of Management

 Scientific approach
 Process approach
 Human relations approach
 Systems approach
 Organisational behaviour approach
 Contigency approach
Scientific approach (early 1900s)-

 Frederick Taylor - apply skills of observation,

quantification, analysis and experimentation
and evaluation to management in order to
improve efficiency.

 Select the best and train them to use the best

methods and pay them well.

 Disadvantage- “What if”

Process approach (classical view)-1908

Henri Fayol
 It views management comprising of the
responsibility to forecast and plan, to organise,
to command coordinate and control.
 Believed that management could and should
be taught
 Most popular view.
 Disadvantage- Too much focus on the process
and not the outcomes
Human relations approach-1940s

 Output and morale went up every time

management varied working conditions.
 The importance of human relations and social
factors on motivation.
Theory X- people are lazy, uninterested in
work/organisation and resist change- control them

Theory Y- people are motivated, have potential for

development and capacity to assume
responsibility- motivate them.
Systems Approach-1960s/70s

 Emphasizes the inter relatedness and

interdependence of parts- what effect does
altering one part of the organisation have on
the whole?
 Managers understand what they are
responsible for and how those responsibilities
benefit or contribute to the organisation.
 Very important in identifying location and
nature of problems.
Organisational behaviour approach

1960s/70s- from human relations approach.

Concerned with individuals, group
behaviour, motivation, development and
receptivity to change AND organisational
structures to enable people to perform.
Disadvantage- too much focus on people
and processes not enough focus on
outcomes.
Contingency approach-1970s

“It all depends on the circumstances”

It argues that different situations call for different
approaches so one can not prescribe “a best
way” to do things.
There is need for constant adaptation.
Eg. People with high need for security and
dislike risk, work better with tight structures
while people with opposite characteristics work
better with looser structures.
Management and leadership

 Managers are at all levels- supervisors,

directors, administrators, executives-
always have a title.
 Leaders are at all levels but do not
necessarily need a title to exert
leadership.
Managers

 Plan
 Control
 Operate within boundaries
 Like order and direction
 Have a title.
Leaders

 Inspire
 Challenge boundaries
 Accept additional responsibilities
 Take risks
 Seek opportunities
 Use personal appeal and charm.
 May have or have no title
What they do

Managers do things right!!

Leaders do the right things!!

Managerial Functions

A Function is defined as a group of activities with a

common purpose.

Simply.......Planning, Implementation, Evaluation

Management has

Continuous functions

Sequential functions
Managerial Functions I-

Managerial activities and behavioral descriptors that

management researchers have identified as being
indispensable.
CONTINUOUS
 Analyze problems

Assess extent of problem

Reasons for deviation
 Make decisions

Corrective actions
Resource allocation
 Communication

Internal/ External
Managerial functions II

SEQUENTIAL
Planning

Organisational

Staffing

Directing

Controlling
Managerial functions (sequential)- Planning

 Forecasting

 Setting objectives

 Identifying strategies

 Programming activities

 Budgeting

 Setting procedures

 Developing policies
Planning continued
Planning is determining the organization’s
goals and deciding how best to achieve
them.
 Planning involves choosing tasks that
must be performed and how and when
they will be performed.
 Planning outlines how to be successful.
 It takes time, coordination, expertise, and
objectivity.
 Effective planning takes much effort and
the ability to take a broad objective view
Planning continued
Successful planning is a process with the following
possible steps:
1) Stating clear organizational objectives
2) Listing alternative ways of reaching objectives – a
manager should list several available alternatives;
3) Develop premises upon which each alternative is
based – these premises are assumptions and these
assumptions will help you work through the alternatives;
4) Choosing the best alternative for reaching objectives –
evaluate the alternatives based on your assumptions and
choose;
5) Develop plans to pursue the chosen alternative – a
manager should develop strategic and tactical plans; and
6) Putting the plans into action – It is useless to make
plans and not implement them
Managerial functions (sequential)- Organizing

- Structure
eg organisational chart

Relations

who reports to whom

supervisor/supervisee

Job descriptions

Qualifications
Organizing continued
Assigning tasks to various individuals or groups; puts plan into action.
Organizing involves using your resources appropriately to reach the
organization’s goals

1) reflect on plans and objectives; you must keep these plans and
objectives in mind at all times.
2) establish major tasks; determine what are the major responsibilities
or tasks;
3) divide major tasks into subtasks; this is a critical step to help you get
to the details;
4) allocate resources; determine how many people and other
resources must be devoted to each area; you may have to form
work groups, committees, or teams to accomplish the tasks; make
sure they have the proper resources to be successful; and
5) evaluate the results of your strategy; take a critical and objective
look at the results.
Managerial functions (sequential)- Staffing

 Selection

 Orientation

 Training

 Development
Staffing continued

The main purpose of staffing is to put right man on

right job at the right time and it involves:
1. Manpower Planning (estimating man power in
terms of searching, choose the person and
giving the right place).
2. Recruitment, selection & placement.
3. Training & development.
4. Remuneration.
5. Performance appraisal.
6. Promotions & transfer.
Managerial functions (sequential)- Directing

 Delegation

 Motivation

 Coordination

 Managing differences

 Managing change
Directing continued
Direction is that inert-personnel aspect of
management which deals directly with
influencing, guiding, supervising, motivating
sub-ordinate for the achievement of
organizational goals. Direction has following
elements:
Supervision
Motivation
Leadership
Communication
Managerial functions (sequential)- Controlling

 Reporting system

 Performance standards

 Measurement of results

 Taking corrective action

 Reward and reprimand

• In the context of management, controlling is making
things happen as planned.
• Controlling involves gathering information and
measuring performance
• In today’s world, controlling is a vital part of being an
effective manager. Circumstances change more
frequently than ever before.
• Today’s world is more complex and turbulent and that
impacts on organizations. Good managers will have
planned and be ready when changes occur.
• However, sometimes circumstances are beyond a
manager’s control and the manager must still be ready
to make quick, good decisions.
supervision

Supervision is a management function that is

planned and carried out in order to guide,
support and assist staff in carrying out assigned
tasks.
involves on-the-job transfer of knowledge and
skills between the supervisor and the one being
supervised.
The aim of supervision is to determine staff
performance in relation to quality and standards
in implementing planned activities.
Mintzberg’s Managerial roles I- responsibilities

INTERPERSONAL
 Staff and management/ team building
 Leadership
 Motivation
Staff
 Differences
 Conflict
Staff and clients
 Client satisfaction
 Organisational image
Management roles II

DECISIONAL
-Vision/Mission
Purpose of existence
-Priorities
not all problems deserve attention now
resource are scarce
Strategies
-What approach should be taken
Resource allocation
Future direction- meeting the challenges of a changing
environment
Managerial Roles III

INFORMATIONAL

Management to staff
Organisational objective (and values)
Strategies (preferred approaches)

Staff to Management
Feedback on implementation, problems

Organisation/the public
Market situation (needs, available services)
The Manager’s Job
Task Skills Elements

Conceptual thinking Abstract thinking Ideas

Administration Technical Things

Leadership Human Relations People

The Management Cycle

Problem
Reference frame
Situation analysis
Experience

Monitoring
and Decision
evaluation /planning

Implementation
Identifying the problem

 Gap between “what is” and “what should be”

 A problem is a difficulty or obstacle seen to
exist between a present situation and a
desired future objective.
 Eg. In the OPD 80% of the nurses arrive after
10am.
 The surgical ward has the highest frequency of
bed sores (30%) in the hospital.
Decision making/planning

 Set objectives
 Find resources
Implement plan

 Delegate responsibilities
 Ensure harmony and teamwork
Evaluate

 Assess gaps between expected and

achieved results.
 Plan to improve.
 Set new objectives
Fayol’s Principles of Management

 Unity of command

 Scalar line of authority from superior to

subordinate

 Span of control

 Staff not to violet line of authority

 Initiative encouraged at all levels

 Division of work
Fayol’s Principles of Management

 Authority and responsibility

 Centralisation of authority
 Discipline
 Subordination of individual interest to group
interest
 Equity
 Stability of tenure of personnel
 Team spirit
Principles of management
Based on Planning, Implementation and evaluation
functions
1. Management by objectives- what and how
much is to be done, where and when?- this calls
for planning decisions
2. Delegation- authority and responsibility to
ensure efficiency and effectiveness- focuses on
implementation.
3. Learning from past experiences-drawing from
gaps between desired results and actual
results- focuses on evaluation.
WHO Conceptual framework for building leadership
and management in health care systems