Introduction to Health

Services Management

Department of Health Policy and

Management

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 Session Objectives
At the end of this session you would be able
to:
• Define the Management and related terms
• Distinguish the difference between
management and administration
• Describe the functions of Management
• Explain the principles of management
• Differentiate the attributes of levels of
management
• Identify the roles and skills of manager
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 Terms to discuss
• Management
• Administration
• What meaning would these terms give for you???
• Do you think that they are important to deal with???

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 Definitions
• Some regard it as getting things done.
• Some others consider it the process of reaching
organizational goals by working with and through
people and other resources.
• Others consider it as "The process of directing,
coordinating, and influencing the operations of an
organization so as to obtain desired results and
enhance total performance“.

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 Definitions
• It can also be defined as “the art of getting things
done by a group of people with the effective
utilization of available resources”
(T. Ramasamy 2003).
The definition of management is based on two principles:
• Commitment to achievement, and
• The importance of people and other resources.

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 Definitions …..
 Generally the definition of management concerned
about:
• It is a process – a set of interactive & interrelated
ongoing functions and activities
• It involves accomplishment of organizational goals
• It uses of human & other resources
• It occurs in a formal organizational setting.

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 Administration Vs Management
• The term "Management" and "Administration" are
usually used interchangeably in government and
business organizations. However, there exists some
difference between them.
• Administration: means overall determination of
polices and major objectives whereas,
• Management: is essentially an executive function,
the active direction of human effort. It is the work
that a manager who seeks to get results through
other people.
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 Cont……
• Functionally, administration is determinative and
management is essentially executive function.
• Yet the same person may perform both functions. But
as we go down the hierarchical ladder, the
administrative function became less and less and the
management functions more and more.
• The following figure clearly demonstrates this point.
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 Cont…
• Management function became more and more

• Administrative function became less and less

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 Management Functions/Practices
 They are group of activities with common purpose
 The set of social and technical functions inherent in
the management process includes:
o Planning
o Organizing
o Staffing
o Directing (motivating, leading &
communicating)
o Controlling
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Management Functions

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 Management functions
Planning
Is the function that determines in advance
what should be done.
It is looking ahead and preparing for the
future.
It is the process of deciding the organizational
objectives and charting out ways of attaining
those objectives.
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 Organizing
• It is the process of developing intentional pattern of
relationship among people and other resources.
• The manager differentiates and integrates the
activities.
• By differentiation is the process of
departmentalization or segmentation of activities.
• Integration is the process of achieving unity of
effort among various departments.
• It is in this function that managers distribute
authority to job holders.

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Cont’d…
• The manager differentiates and integrates the
activities

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 Staffing
• It is the process of filling and keeping filled all the
organizational positions, with right people at right
places at the right time.
• It includes several sub function like;
– Recruitment
– Selection
– Transfer and promotions
– Training

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 Directing /leading
is influencing people's behavior through
motivation, communication, group dynamics,
leadership and discipline
It is the human factor which binds a group together
and motivates it towards goals.
The purpose of directing is to channel the
behavior of all personnel to accomplish the
organization's mission and objectives.

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Controlling
Is a process of,
Establishing performance standards based on the
HSO's objectives,
Measuring actual performance,
Comparing it with the intended result ,
And taking corrective action as necessary.
In other words, it is regulating activities in
accordance with the plan

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• In addition to these five or three broad
sequential functions of management, the
following two functions of management are
crosscutting. These are:
• Communication and Decision-Making.
• They are called continuous Management
Functions.

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Communication function is necessary for sharing
ideas/information between the manager, staff, and
the community during the process of planning,
implementation and evaluation.
Decision making is employed during Planning,
implementation, and evaluation functions. Each
one of them requires decision making as an
essential task.

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 Principles of management
1. Management by objectives(MBO)
 A process in which specific performance
objectives are jointly set by subordinates and their
superiors.
 Progress towards objectives is periodically
reviewed and rewards are allocated on the basis of
progress.
 Each person’s major area of responsibilities is
clearly defined in terms of measurable outcome.

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 Principles of management by
objective (MBO)
 Cascading of organizational goals and objectives
 Specific objectives for each member
 Participative decision making
 Explicit time period
 Performance evaluation and feedback

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2. Learning from experience
 Analysis of the results between the objectives and
achievement made shows whether there is any gap
or not.
 If any, the analysis helps to discover causes of the
gap & searching possible solutions for the
following period.
3. Division of labor
 Assignment of the right proportion of each kind of
work to be done by the staff is essential for most
organizations.
 This enhances team approach and specialization to
be developed in the organization.
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4. Substitution of Resources
 when the resources normally used to provide
service become scarce or too expensive, different
resources may be used to deliver the same service.
5. Convergence of work
 Working relations should contribute to the success
of each activity and so to the general goal of the
organization.

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6. Functions determine structure
 Determining the function & duties of individual member is
followed by working relations (structure).
 The function and duties of the individual members of the
team are clearly defined and known to all; The working
relations (the structure) follow.
 The exact nature of authority will be clearly delineated on
the structure.
7. Delegation
• It takes place when some body's authority is lent, so as to
enable that person to take responsibility when formally
assigned manager is absent.
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8. Management by exception
 Selectivity in handling information & prioritized
decision making.
 ‘Don’t postpone decisions until they become
unnecessary.’
9. Short Decision path
 Decision must be made as closely as possible in
time and place to the object of decision and to
those affected by it.

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 Levels , Skills & Roles of Managers
Managers
• Are people formally appointed to positions of authority in
organizations or systems who:
• enable others to do their direct or support work
effectively.
• have responsibility for resource utilization.
• are accountable for work results.
Three levels
– The primary difference between levels of managers are
the
 degree of authority and the scope of
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 Levels of management

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Top level (senior) managers
 Have authority over and are responsible for the
entire organization
i.e. all staff, resources and organizational results
 Are accountable to the governing body
 Establish operating policies and guide the
organization with its environment
 Include individuals with the title of chairperson,
president, chief executive officer, executive vice
president, vice president, or chief operating
officer.
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Middle-level managers
• reporting to senior managers
• There are numerous middle level managers than
top managers
• have authority over & responsibility for a specific
segments of the organization
• Terms such as director or manager usually used
for middle manager—
• e.g director of human resources or western
regional manager.

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First-level (front line) managers
 Front-line managers are supposed to report to middle-level
managers.
 They have authority over & responsibility for overseeing
specific work & a particular group of workers.
 Spend the greatest amount of time actually directing
employees.

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 Management functions Vs Levels of managers

• Planning is the most important function of top

managers.
• Middle managers fulfill all four management
functions about equally.
• Directing is the most important function of
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 Skills
 They are abilities to translate knowledge into
action and manifested in an individual’s
performance.
 Skills are not necessarily inborn, but developed
through practice and experience.
 All levels of managers need some skills and
competencies and the roles that they play in
carrying out their work within an organization.
 There are three distinct types of skills.

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 1.Conceptual skills
• Reflect the mental abilities of managers to
visualize the complex interrelationships in a work
place .
• Permits managers to understand how the various
factors in particular situations fit together &
interact one another .
• Cognitive ability to see the organization as a whole
and relationship among its parts.

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 2.Human relations & communication skills

• Are the abilities of managers to get along well with

other people, to understand them, & to motivate &
lead them in the work place.
• The ability to motivate, facilitate, coordinate, lead,
communicate & resolve conflicts.
• Generally they deal with human beings. Hence this
skill is equally important for all level of managers
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 3.Technical skills
 Are abilities to use the methods, processes, and
techniques of managing
 It includes:
• Methods & techniques
• Specialized knowledge
• Competent use of tools
• techniques to solve problems in that specific
discipline
 Generally, they deal with things. Hence, this
skill is more important for front level managers.
•
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 Essential Managerial Skills

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 Managerial Roles
• Managerial role is the behavioral pattern
expected of someone within a functional unit.
• All mangers have formal authority over their
organizational units & derive status out of that
position.
• The work of managers is viewed as a series of
three broad categories of roles,
(Henry Mintzberg).

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1. Interpersonal roles
Figurehead
 Performs ceremonial & symbolic duties such as
greeting visitors, making speeches at organizational
events, signing legal documents etc.
Leader (influencer)
 direct & motivate subordinates
 seek to motivate, inspire & set examples through
their own behavior

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Liaison
 Allows managers in formal & informal contacts both
inside & outside their organization to establish
relationships that will help them achieve organizational
objectives.
 Interpersonal roles provide managers with opportunities
to gather information.

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2. Informational roles
Monitor role
 Managers gather information from their network
of contacts, including those established in their
liaison roles .
 Filter the information, evaluate it and decide
whether to act as a result of the information.

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Disseminator

 This role grows out of the managers’ access to

information and his ability to choose what to do
with that information.
 Distributes information to those who should
receive it, both outside and inside the
organization.

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Spokesperson
 Is related to the figurehead role
 Communicating the position of their
organizations to internal and external
stakeholders who affect their areas of
responsibilities
 transmit information to people outside the work
unit, keep supervisors informed or representing
the organization in dealing with the external
environment

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3 . Decisional roles
 The authority granted by their organization supported by
their interpersonal and informational roles permits
managers to play decisional role.

Entrepreneur
 are initiators and designers of changes intended to improve
performances in their organizational domains
 act as change agents → initiate improvement projects,
identify new ideas, delegate idea responsibilities to others.
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Disturbance handler
 detect wide variety of problems & decides on and
implements solutions.
 takes corrective action during disputes or crises and
resolves conflicts among subordinates.
 the ability to make good decisions about handling
disturbances is and important determinant of
managerial success.
Resource allocator
 Prioritize tasks and make decisions regarding the use
of limited resources to meet conflicting needs to
achieve goals.
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Negotiator
 Interact and bargain employees, suppliers, regulators,
customers, clients and others.
 Represent departmental interests during negotiations

 Negotiating includes deciding what objectives to seek

through negotiations and how to conduct the negotiations

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 Mintzberg’s 10 managerial roles

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 Managers’ Jobs and the Roles They Fill

When top, middle, and supervisory managers were asked about the
importance of the roles they perform, their answers provided the
data illustrated graphically here.
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 Management and Environment
• Health service organizations exist in the larger
environment.
• They can not be an isolated entity, because, they are
affected by the external environment and vice versa.
• This makes HSOs open systems because inputs are
– obtained from the external environment and
outputs go into the environment
• Management while performing its various functions
continually adopt itself to changes occurring in its
environment.

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 Concepts in Mgt
Effectiveness
• Effectiveness is the degree to which a stated
objective is being achieved.
• It is something that management tries to
improve.
Efficiency
• It is concerned with the balanced use of
resources (money, material, human resource,
time, space and information)
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 Effectiveness and Efficiency

Mg’t concepts
Effective Ineffective

Reach goals &no Not reached goal

Efficient
wastage of and no wastage of
resources resources

Reach goal and Not reached goal

Inefficient
wasting of and wasting of
resources resources
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 References
1. WHO, On Being In charge - A Guide for Middle Level
Management in PHC. Geneva
2. Nick Goodwin, Reinhold Gruen and Valerie Iles,
Managing Health services.

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 Reading Assignment
Management thoughts:
•Classical school
•Behavioral school
•quantitive,system and contingency schools

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