Health Services

Management
Implementation

By Yemane G/mariam
 Objectives of the session

 By the end of this session, students should:

• Understand basic decisions that happen during
implementation
• Be able to organize and coordinate
activities/resources in health service
organizations
• Be able to apply monitoring and supervision as
a tool for improvement of health service
organizations

2
Outline of presentation

• Definition
• Decisions in implementation function
• Organizing and co-ordination
• Monitoring and redirecting
• Supervision

3
 Definition
 Definition:

• Implementation is one of the broad managerial

functions involving the process of putting planned
activities in a specific program or intervention into
action.
• Managers are required to perform three
interrelated activities under this function:
• Organizing and coordinating resources and
activities
• Monitoring the performance and quality of
health services
• Provision of support to subordinates
(supervision, coaching, mentoring, etc)
4
 Organizing
 Organizing is assigning the tasks developed
during planning to various individuals or groups
within the organization thereby creating a
mechanism to put plans into action.
 It deals with all those activities that result in:
• The formal assignment of tasks and authority
• Coordination of effort
• Differentiation and integration of tasks
 Purpose:
• To make the best use of organizational
resources to achieve organizational goals
5
 Organizing Cont…
 Benefits of organizing
• Assuring more efficient use of organizational
resources through maximal utilization of
individuals’ skills
• Improving employees understanding of job
duties and responsibilities
• Improving employee morale
• Providing a sense of direction for each of the
organization’s functional areas.

6
Organizing Cont…

Organizational Structure 7
 Organizational Structure
 Organizations are networks of people, with ideas
and resources, working towards common goals.
Two types of organizations
 Formal:A relatively stable set of the organizational
structure and the rules that make up the organization
which arises from the firm’s authority structure.
 Informal:is a network of social interactions among an
organization’s employees (unrelated to the firm’s
formal authority or structure)

8
 Organizational Structure Cont…
 Organizational structure
• Is the formal decision-making framework by
which job tasks are divided, grouped, and
coordinated
• Usually represented in a chart form called an
Organizational Chart
 An organization chart displays the organizational
structure and shows:
• Job titles
• Lines of authority
• Relationships between
departments/units/processes 9
Organizational Structure Cont…
 Reading Assignment
• Read on different types of organizational
structure
• Mechanistic structure

• Organic structure

• Contingency organization
10
 Organizational Design
 Organizational design refers to the process of
coordinating the structural elements of
organizations in the most appropriate manner.
 It is about the decisions and actions that result in
organizational structure.
 Organizational design is the creation of an
organization's structure, traditionally classified as:
• Functional organization
• Divisional organization
• Matrix structures
11
 1. Functional organization
 Authority is determined by the relationships between
group functions and activities.
 Functional structures group similar or related
occupational specialties or processes together.
 Examples of functions
• Finance
• Human Resource Development
• Production/Service Provision
 Advantage:
• Facilitates specialization
 Disadvantage:
• Risk of losing sight of overall organizational interest
while focusing on departmental goals
12
 2. Divisional organization
 Corporate divisions operate as relatively
autonomous businesses under the larger
corporate umbrella.
 Divisional structures are made up of self-contained
strategic business units that each produces a
single product.
 A central headquarter, focusing on results,
coordinates and controls the activities, and
provides support services between divisions.
 Divisions accomplish their own division goals.
 Weakness: the tendency to duplicate activities
among divisions is very high.

13
 3. Matrix structures
 In a matrix organization, teams are formed and
team members report to two or more managers
which utilize functional and divisional chains of
command simultaneously in the same part of the
organization.
 It is more applicable to:
• Develop a new product
• Ensure the continuing success of a product to
which several departments directly contribute
• Solve a difficult problem requiring the
involvement of different departments

14
 Matrix structure cont…
 By superimposing a project structure upon the
functional structure, a matrix organization allows
the organization to take advantage of new
opportunities.
 The matrix concept facilitates working on
concurrent projects by creating a dual chain of
command, the project (program, systems, or
product) manager and the functional manager.
 Project managers have authority over activities
geared toward achieving organizational goals while
functional managers have authority over promotion
decisions and performance reviews.

15
 Matrix structure cont…
 Advantage:
• Matrix organizations are particularly appealing to
firms that want to speed up the decision-
making process.
 Weaknesses:
• It may not allow development of long-term
working relationships.
• Using multiple managers for one employee may
result in confusion as to manager evaluation and
accountability.
• The matrix system may elevate the conflict
between product and functional interests.

16
Matrix structure cont…

Health
Institution
Head

HIV TB
Malaria
Physician Control Control
Laboratory Nursing Control
Consultation Project Project
Project

17
Departmentalization

 After reviewing plans, usually the first step in

the organizing process is
departmentalization.
 Once jobs have been classified through work
specialization, they are grouped so that
common tasks can be coordinated.
 Departmentalization is the basis on which
work or individuals are grouped into
manageable units.

18
 Departmentalization cont…

 Methods for grouping work activities

• Departmentalization by function
• Departmentalization by product
• Departmentalization by geographical regions
• Departmentalization by process
• Departmentalization by customer

19
Departmentalization by function
 Organizes by the functions to be
performed

 Functions reflect the nature of the work.

 The advantage of this type of grouping is

obtaining efficiencies from consolidating
similar specialties and people with
common skills, knowledge and
orientations together in common units.
20
Departmentalization by product
 Assembles all functions needed to make and
market a particular product/service under one
executive.
 For instance, a pharmaceutical company’s
stores can be structured around product
groups such as:
• Vaccines
• Antibiotics
• Vitamins
• Hormones
• Others
21
Departmentalization by geographical regions

Groups jobs on the basis of territory or

geography

22
 Departmentalization by process
 Groups jobs on the basis of product or customer flow.
• A patient preparing for an operation would first engage in
preliminary diagnostic tests, then go through the
admitting process, undergo a procedure in surgery,
receive post operative care, be discharged and perhaps
receive out-patient attention.
 This approach tries to bring different activities in a process
to be performed under the sight of a process owner.
 BRR in the current Ethiopian health system is trying to
establish this type of organization at all levels.
 An example for a hospital service:
• Registration
• Consultation
• Investigation
• Treatment
23
Departmentalization by customer

 Groups jobs on the basis of a common set of

needs or problems of specific customers.
 For instance, a hospital may group its
patients as:
• Emergency patients
• Stable patients
• Follow up cases

24
An example from a business firm

25
 Organizing Cont…
 What can be read from an organizational chart?
• Responsibilities of individuals
• Formal reporting relationships, level of hierarchy,
or chain of command/ communication
• How individuals are grouped into sections or
departments
• Span of control
• Decentralization and centralization
 What organizational chart doesn’t show
• human factors (motivation, dissatisfaction)
• Relationship among individual organizational
members

26
 How to design organizational chart?
 Review activities planned to achieve
objectives (Plan document)
 Group similar activities
 Identify the proper personnel for each
activity
 Create a network of relationships among
each activity
 Create a chain of command among each
level
27
 Organizational structure cont…
 Changes in an organizational structure may occur
as a result of:
• Changes in government policy regulations and
system
• Changes in the organizational objectives
• Expansion and contraction of the organization
• Change of the management body
• Inefficiency which may be due to:
• Improper decision
• Conflicts
• Poor relationship
28
Some important terms in Organizing
(reading assignment)

• Work Specialization
• Chain of Command
• Authority, Responsibility, and Accountability
• Delegation
• Span of Management
• Tall vs. Flat Structure
• Centralization, Decentralization, and
Formalization
• Coordination
29
 Coordination
 Is bringing activities into proper relation with
each other.
 Makes rule that everything that needs to be
done is done and no two individuals are trying
to do the same work (i.e., avoiding gaps and
overlaps).
 A process by which team leaders achieve
integrated pattern of group and individual
efforts.

30
 Monitoring and Redirecting
 Monitoring: is a continuous, systematic and critical review of
a program or any of its components with the aim of checking
progress towards achievement of targets and taking timely
corrective actions.
 It is an ongoing collection and analysis of information to see if:
• Required resources are being availed and utilized
• Key activities are being carried out as planned
• Planned changes are happening at the target population
level
 Is important to:
• Identify problems
• Take corrective actions
• Assess trends
 Is the base for effective evaluation and it guarantees
efficiency.
31
 Purpose of monitoring
 The main purpose of monitoring is to maintain work
standard by:
• Measuring performance and identify
deficiencies in set standards
• Tracing the cause of work deficiencies
(technical, administrative, personal or
organizational)
 Monitoring
• Helps to take early and timely correction if
deficiencies are encountered
• Provides guidance about how projects/programs
can be modified
• Identifies issues for evaluation or research
32
 Steps in monitoring
1. Determine what to monitor – Key areas and purpose
2. Determine how to monitor
• Monitoring Plan, formats, data collection, sampling
techniques, reporting
3. Have standards to see if activities are completed as
planned (time frame specified, budget spent, quality of
care standards, management and work process)
4. Measure performance and compare with the standard
5. Identify performance gaps
6. Investigate performance gaps to identify root causes
7. Look for potential solutions, prioritize and implement
corrective measures
33
Information sources for monitoring
 Information sources for monitoring
include but are not limited to:
• Reports and records
• On job supervision
• Checklists to observe performance
• Meeting and discussion with the staff
• Community/client surveys
• Complaints

34
Different Monitoring Activities

 Monitoring of inputs

 Monitoring of process

 Monitoring of outputs

 Monitoring of outcomes and impacts

35
 Monitoring activities cont…
 Monitoring of inputs ensures that
• Staff is available (in accordance with the
assignment)
• Space, equipments, furniture and consumables
are available
• Resource consumption and costs are within
planned limits
• The required information is available
• Community groups or individuals are mobilized
as expected
36
 Monitoring activities cont…
 Monitoring of process ensures that the
• Expected activities performed in accordance
with quality standards
• Meetings are held as planned
• Communication takes place as necessary
• Decisions are timely and appropriate
• Trainings are conducted as scheduled
• Conflicts are controlled

37
 Monitoring activities cont…
 Monitoring of outputs ensures that the
• The number/amount of products and
services are in line with planned targets
•Number of children receiving vaccines
•Number of patients treated

38
 Monitoring activities cont…
 Monitoring of outcomes and impacts
ensures that the
• Expected program effects are being
achieved at the target population level
• Knowledge of people on Tuberculosis
• Prevalence of HIV
• Incidence of malaria

39
Supervision
 Supervision is a process of guiding, helping,
training, and encouraging staff to improve
their performance in order to provide high-
quality health services.
 It is the overall range of measures to ensure
that personnel and their organization carry
out their activities effectively and become
more competent at work.
 It helps to maintain and improve the quality
of health care

40
 Styles of supervision
 Supervision could be conducted in three
different styles each having their own
strengths and weaknesses.
•Autocratic
•Democratic
•Anarchic

41
 Styles of supervision cont…
 Autocratic – characterized by the supervisors
approach “Do what I say!”
• Communication is usually one way – the
supervisor speaks and supervisee are expected
to listen
• Improvement actions are forwarded as orders
rather than agreed upon recommendations
• When applied to the health sector, it is
humiliating and dries up workers initiatives.
• Workers feel insecure
42
 Styles of supervision cont…
 Democratic – characterized by the supervisors
approach “Let us agree on what we are going to do”
• Two way communication and participation of
supervisee in problem assessment and
improvement planning are its characteristics
• Helps people to grow, become responsible, and
show initiatives
• Recent recommendations for different health
systems with the name “Supportive/Facilitative
Supervision”

43
 Styles of supervision cont…
 Anarchic – characterized by the supervisors
approach “Do what you like”
 Applicable to supervisees who are highly
skilled and responsible regarding their work.
 The choice of style should depend on the:
• Kind of work – complexity, difficulty, the need
for quick decision
• Kind of staff – Skill, reliability, experience,
their willingness to accept responsibility

44
 Making a supervisory schedule
 Decide how often it should be done and to which
area it is most needed
 In health systems practicing integrated supervision,
different departments/working units should be
involved in deciding how frequently and when to do
supervision
 Frequency of visits will depend on
• Nature of programs for supervision
• Level of expertise among supervisee
• Stage of the program development
• Availability of transport, personnel and other
resources

45
Preparation for supportive supervision

 Reading assignment
 For better results, supervision should be
preceded by adequate preparation both
by the supervisor and supervisees.
• Preparations by supervisor
• Preparations by supervisee

46
Thank you

47