INTRODUCTION TO

LEADERSHIP AND
MANAGEMENT TABITHA
LUMUMBA

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 COURSE OUTLINE

 Concept of Management
 Definition
 Theories of management
 Principles of management
 Leadership and Principles of Management.
 Managerial skills
 Functions of Management.
 Managing Resources
 Managing Nursing Care Services.
 Change management
 Conflict management

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 DEFINATIONS OF
MANAGEMENT
 Management may be viewed as:
 A social position
 A function
 The people who discharge it
 An authority
 A discipline
 A field of study
Management is:
 The people charged with the responsibility of running an
organization
 The process by which resources are mobilized, combined and
coordinated effectively to achieve organizational objectives.
 Getting things done.
 Getting work done through the efforts of other 3
 MANAGEMENT THEORIES

Management theories describe how managers

conduct activities, and keep institutions
operating in an effective way in order to meet
their objectives.
The four main classifications are:
 Classical Theories (Scientific Management)
 Human Relations or Behavioral Approach Theories
 Systems Theories
 Contingency Theories

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 A. CLASSICAL THEORY

It described management as a science

The objective was to develop basic principles
that could guide the design, creation and
maintenance of organizations. The emphasis was
on efficiency and effectiveness
Consists of two main branches:
 Scientific management
 Administrative management

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 CLASSICAL THEORY

Scientific management
 Concerned with improving performance of individual workers
Fredrick Taylor
 He was an engineer and instrumental in conducting research
on methods of training workers for increased production. He
introduced innovations in how jobs were designed and how
workers were trained to perform.
 Steps in scientific management
 Develop a true science for each persons work
 Scientifically select employees and train them
 Supervise employees to ensure work is done
 Continue to plan the work but use workers to get work done

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 CLASSICAL THEORY

Administrative management
 Focuses on managing the total organization.
Henry Fayol
 He identified specific functions of a manger; planning,
organization, leading and controlling
Max Weber
 Developed the bureaucratic model. A model design based on
legitimate and formal system of authority.
 Characteristic of the model
 Division of labor
 Chain of command
 Protection from arbitrary dismissal
 Conducting business in an impersonal way and maintaining social
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 B. BEHAVIORAL/ HUMANISTIC/
MOTIVATION THEORY

Classical theory viewed organizations and jobs

from a mechanistic point of view.
This one emphasized on individual attitudes,
behavior and group process.
1.Abraham Maslow's Theory
 According to Maslow's theory, every human being has basic
needs.
 People are motivated by the desire to satisfy these needs.
Once a need is satisfied it ceases to be a motivator.
 As one need is satisfied, another appears and takes its
place, and the individual is then motivated to satisfy the new
need.

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 BEHAVIORAL/ HUMANISTIC THEORY

Abraham Maslow's Theory

 The various needs can be defined as follows:

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BEHAVIORAL/ HUMANISTIC THEORY

Abraham Maslow's Theory cont

 People at work experience a variety of needs.
 Managers should identify ways in which to meet
group or individual needs in order to motivate
them to work.
 It is the responsibility of the manager to enable
employees to fulfill their needs.

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 BEHAVIORAL/ HUMANISTIC THEORY

2. Douglas McGregor: Theory X and Theory Y

 These theories' are a set of management
assumptions about the behavior of subordinates.
 He noted that most managers make these
assumptions about their employees.
Theory 'X’ assumptions:
 An average human being has an inherent dislike for work
and will avoid it if possible.
 As a result of the assumption above, most people must be
coerced, controlled, directed and threatened with
punishment in order to produce.
 The average human being has to be closely directed, wishes
to avoid responsibility and only wants security. 11
BEHAVIORAL/ HUMANISTIC THEORY

Douglas McGregor: Theory X and Theory Y cont..

Theory 'Y’ assumptions:
 Employees like work, which is as natural as rest or play.
 Human beings do not have to be controlled or coerced
as long as commitment to the organization is present.
 Under proper conditions, they will not only accept but
also
seek responsibility.

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Theory X and Theory Y cont..
The manager holding Theory X assumptions
tends to be tough, authoritarian and supports
tight controls with punishments. As a result, they
tend to supervise workers
very closely.
 The manager using Theory Y believes in self
control, is democratic, and consults staff. They
encourage participation in decision making by
subordinates.
Generally a blend between ‘Theory X’ and
‘Theory Y’ is more likely to provide effective
management although this also depends on the
prevailing environmental conditions .
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 BEHAVIORAL/HUMANISTIC
THEORY
3. Victor Vroom expectancy theory
 This theory examines motivation from the
perspective of why people choose to follow a
particular course of action.
 Vroom introduces three variables. These are:
Valence
This is the importance that the individual places upon the expected
outcome of a situation.
Expectancy
This is the belief that output from the individual and the success of
the situation are linked, for example, if I work harder then the
outcome
will be better.
Instrumentality
This is the belief that the success of the situation is linked to the
expected outcome of the situation, for example, it's gone really14
well, so I'd expect praise
This theory would seem most applicable to a
traditional attitude work situation where the
level of motivation depends on whether the
employee wants the reward on offer for doing a
good job and whether they believe more effort
will lead to that reward.
However, it could equally apply to any situation
where someone does something because they
expect a certain outcome

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 BEHAVIORAL/HUMANISTIC THEORY

4. Fredrick Herzberg’s Two Factor Theory

 This theory of motivation is based on the idea that
some factors motivate and some demotivate. These
factors fall into two categories.
Hygiene Factors
 They are needed to ensure an employee does not
become dissatisfied. They do not lead to higher
levels of motivation, but without them there is
dissatisfaction. They are:
 Interpersonal relationships
 Work conditions
 Salary
 Status
 Security
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BEHAVIORAL/ HUMANISTIC THEORY

Motivation Factors
They are needed in order to motivate an
employee into higher performance. These
include:
 Achievement
 Growth
 Responsibility for task
 Interest in the job

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 TWO FACTOR-HERTZBERG

Employees Employees
not Employees
Hygiene factors

Motivation factors
Dissatisfied satisfied
and Dissatisfied
but And
unmotivated motivated
Unmotivated

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 Fredrick Herzberg’s Two Factor Theory cont…
 According to Herzberg, merging the hygiene and
motivation factors results in four scenarios :

HIGH HYGIENE +LOW HIGH HYGIENE + HIGH MOTIVATION=

MOTIVATION= • High motivation
• Low motivation • Few complains
• Few complains • High productivity
• Low productivity • Ideal situation

LOW HYGIENE LOW MOTIVATION HIGH MOTIVATION+ LOW HYGIENE=

• Low motivation • Highly motivated staff
• Many complains • Many complains
• Low productivity • Job is exciting & challenging
• Worst situation • Salaries & work conditions are poor

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 C. SYSTEMS THEORY

This theory places an emphasis on organizations as

cooperative systems.
A system is defined as ‘a set of arrangements of
things so related or connected as to form a unit or
organic whole’. The organization is, therefore, defined
as ‘a system of consciously coordinated personal
activities or forces’
 The systems theory explains that organizations come
into existence when there are persons able to
communicate with each other who will each contribute
an action to accomplish a purpose.

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 SYSTEMS THEORY CONT..

For cooperation to be effective the

following must be present:
 Place where work is done
 Time when work is done
 Person with whom work is done
 Things upon which work is done
 Method or process by which work is done

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 CONTINGENCY THEORY

The contingency theory asserts that when

managers make a decision, they must take into
account all aspects of the current situation and
act on those aspects that are key to the situation
at hand.
The continuing effort to identify the best
leadership or management style might now
conclude that the best style depends on the
situation.

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 LEADERSHIP

Definitions
Difference between manager and
leadership
Types of leadership
Theories of leadership
Leadership styles
Qualities of good leadership

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 DEFINITIONS

A leader is anyone who uses interpersonal skills to

influence others to accomplish a specific goal.
A leader can also be defined as a person who exerts
influence by using certain personal behaviors and
strategies or a person given authority by the statutes
of an organization to lead a group of people.
Leadership can be defined as ‘the use of one's skills to
influence others to perform to the best of their ability
towards the achievement of goals’.
 It is the art of getting others to want to do what one
deems as important.
Leadership is not a fixed position. It is a process which
changes on situational basis. 24
DIFFERENCE BETWEEN A MANGER
AND A LEADER

Managers think incrementally while

leaders think radically
Managers do things right while leaders do
the right things
Leaders stand out by being different
Leaders question assumptions and are
suspicious of tradition

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 TYPES OF LEADERSHIP

There are two types of leadership. These are:

Formal
 This is when an appointed leader is chosen by the
administration and given official or legitimate authority.
 This form of leadership has the greatest impact when
followers accept the leader.
Informal
 An informal leader does not have official authority to
direct activities of others.
 They are usually chosen from within a specific group, for
example, social group, church organization or work
group. An individual may become an informal leader as a
result of a variety of factors including age, seniority, 26
special competencies or personality.
 THEORIES OF LEADERSHIP

They include:
 Trait Theory of Leadership
 Situational or Contingency Theory of Leadership
 Great man theory
 Behavior theory
 Participative theory
 Relationship theory

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 TRAIT THEORY OF LEADERSHIP

The leader is seen as gifted or develops

certain characteristics including:
 Physique, that is, weight, height.
 Intellect, that is, knowledge, judgment.
 Personality, that is, aggressiveness, dominance and
authoritarianism.
According to this theory, the leader behaves
according to the role expectations of the
group.
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 TRAIT THEORY OF
LEADERSHIP CONT..
This theory states that leaders possess a
set of physical and emotional
characteristics that are important for
inspiring others towards a common goal.
Some theorists who subscribe to this
theory believe that leaders are born with
certain qualities that determine leadership
ability and success .

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 SITUATIONAL OR CONTINGENCY
THEORY OF LEADERSHIP
This theory states that the effectiveness of
leadership depends on the relationship among
the leaders and the task at hand, interpersonal
skills and the favorability of the work situation.
There are critical factors that must be considered
in the above relationships, these include:
 The degree of trust and respect between the leader and
follower
 The clarity of goals to be accomplished
 The ability of the leader to reward followers and exert
influence

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SITUATIONAL OR CONTINGENCY
THEORY OF LEADERSHIP CONT..

In this theory leaders were viewed as able

to adapt their style according to the
situation.
The implication here is that, as a nurse
manager, must assess each situation and
determine appropriate action, based on
the people involved.

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 LEADERSHIP STYLE

There are three main styles of leadership,

namely:
 Authoritarian or Autocratic
 Democratic or Participative
 Laissez faire or Permissive

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 AUTHORITARIAN OR AUTOCRATIC

The leader assumes full responsibility for all

decisions and actions.
The characteristics of an autocratic leader
include:
 Loss of interest and initiative by employees
 Loss of motivation and dismal performance
 Less than optimal goals are achieved because the
resources utilized are the manager only.
Ideal in:
 Crisis situations
 Leading inexperienced staff
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 DEMOCRATIC OR PARTICIPATIVE
LEADERSHIP

In this leadership style, people are free to

express themselves.
The manager here is ‘people oriented’ and
focuses attention on human aspects as well
as on building effective work groups.
A collaborative spirit or joint effort exists
which allows for group participation in
decision making
It encourages enthusiasm, high morale and
increased satisfaction.
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 DEMOCRATIC OR PARTICIPATIVE
LEADERSHIP CONT..

Ideal in:
 A wide variety of work situation

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 LAISSEZ –FAIRE OR PERMISSIVE
LEADERSHIP

In this style, the leader lets people do what they

want.
The leader plays down their role in the group's
activity and exercises minimum direction or
control
The leader wants everyone to feel good about
what they are doing and often avoids
responsibility by relinquishing power to followers
and permitting them to engage in managerial
activities such as decision making, planning.

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 LAISSEZ –FAIRE OR
PERMISSIVE LEADERSHIP
Ideal in:
 Motivated professional groups, for example, in
research projects in which independent thinking is
rewarded.

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 QUALITIES OF GOOD LEADERSHIP

An effective leader should posses the

following qualities
 Empathy: Ability to look at things from another
person's point of view.
 Respect: An effective leader should respect others
as unique individuals.
 Objectivity: No bias or prejudice.
 Self awareness: Knowledge, being aware of the
impact you have on others and being aware of your
ability to make decisions or involve yourself with
specific problems
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MANAGEMENT SKILLS

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 THEY ARE:

Technical skills
Interpersonal skills
Conceptual skills

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 MANAGEMENT SKILLS

1.Technical skills
Those that require to perform specialized
tasks i.e......... use of
tools,procedures,equipment and techniques
These skills are gained through formal
training

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 2.INTERPERSONAL

• Also called life skills

• Enable us to understand and work well with other
people
• Enables us to take other peoples perspective
• Allows one to be reasonable, likable and
amicable
• The better one has human skills, the better likely
to be a manager
• Enable us to work through other people
• Used to communicate, motivate, mentor and
delegate
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 3. CONCEPTUAL SKILLS

Used to analyze complex situations

Those that make one understand things from
a global perspective
Enables one to judge and come up with ideas
Enables one to coordinate and integrate
things together with positive outcome

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 4. DIAGNOSTIC SKILLS

These are problem solving skills

Enables one define a situation, separate them
and come up with a solution
Takes a step by step outlook of the problem

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 LEVELS OF LEADERSHIP

1. Position
This is the lowest level of leadership and is based solely
on title and position.
2. Permission
As relationships are developed with others, they give
permission to the leader to lead beyond the limits of their
job description.
3. Production
As the group becomes more productive together,
leadership
is advanced.
4. People Development
This level of leadership involves developing people and
assisting them to reach their potential.
5. Personhood
This level of leadership involves a lifetime of developing
others to their highest potential
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 LEVELS OF MANAGEMENT

Top level managers

Middle level managers
Low level managers

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 LEVELS OF MANAGEMENT CONT...

 Top level managers

 It consists of board of directors, chief executive or
managing director. The top management is the ultimate
source of authority and it manages goals and policies .
 It devotes more time on planning and coordinating
functions.
 Middle level managers
 Include; branch managers and departmental managers.
 They are responsible to the top management for the
functioning of their department.
 They devote more time to organizational and directional
functions.
 Low level managers
 Lower level is also known as supervisory / operative level
of management. 47
48
 PRINCIPLES OF
MANAGMENT

Management principles are the statements of

fundamental truth based on logic which
provides guidelines for managerial decision
making and actions.
Henry Fayol described 14 principles of
management
They are derived through observation and
analysis of events which managers have to
face in actual practice.
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 1. DIVISION OF LABOUR

In order to achieve organizational goals, people

must be assigned tasks according to their skills,
no single person can do everything.
Work should be divided among individuals and
groups to ensure that effort and attention are
focused on special portions of the task. Fayol
presented work specialization as the best way to
use the human resources of the organization.

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2. Authority and responsibility
 The concepts of Authority and responsibility
are closely related.
 Authority is the right to give orders and the
power to exact obedience.
 Responsibility involves being accountable,
and is therefore naturally associated with
authority.
 Whoever assumes authority also assumes
responsibility.
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3. Unity Of Command:
 Workers should receive orders from only one
manager.
 This makes the manager-employee relationship as
simple as possible and puts a limit to confusion,
mistakes, excuses and delays in the daily
performance of duties.
 For example, in a hospital, the nurses in various
wards are responsible to those in charge of the
departments or wards, who in turn, are responsible
to the chief nurse.
 All problems are channeled through this unity of
command. 52
4. Unity of Direction
 All those working in the same line of activity
must understand and pursue the same
objectives.
 All related activities should be put under one
group, there should be one plan of action for
them, and they should be under the control of
one manager.
 It seeks to ensure unity of action, focusing of
efforts and coordination of strength.
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5. Subordination of individual interests to the
general interests:
 The interests of one person should not take
priority over the interests of the
organization as a whole.

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6. Remuneration
Many variables, such as cost of living, supply of
qualified personnel, general business
conditions and success of the business should
be considered in determining a worker's rate of
pay

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7. Centralization
 Centralization implies the concentration of
decision making authority at the top management.
Sharing of authority with lower levels is called
decentralization.
 Centralisation refers to the degree to which
subordinates are involved in decision making.
Whether decision making is centralized (to
management) or decentralized (to subordinates) is
a question of proper proportion
 The amount of power wielded with the central
management depends on company size
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8. Order
This means People and materials should be in
the right place at the right time
This ensures safety and efficiency in the
workplace

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9. Scalar chain
 Managers in hierarchies are part of a chain like
authority scale.
 Each manger, from the first line supervisor to the
president possess certain amount of authority.
 The President possesses the most authority; the first
line supervisor the least.
 Lower level managers should always keep upper level
managers informed of their work activities.
 The existence of a scalar chain and adherence to it are
necessary if the organization is to be successful.

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10.Equity
Employees must be treated kindly, and
justice must be enacted to ensure a just
workplace. Managers should be fair and
impartial when dealing with employees

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11.Stability of tenure of personnel:
Retaining productive employees should always
be a high priority of management.
Recruitment and Selection Costs, as well as
increased product-reject rates are usually
associated with hiring new workers

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 12. Initiative:
 Management should take steps to
encourage worker initiative, which is
defined as new or additional work activity
undertaken through self direction.

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13. Espirit de corps:
 Management should encourage harmony
and general good feelings among
employees.

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14.Discipline
 It is the respect for agreements which are
directed at achieving obedience, application,
energy and the outward marks of respect.
 The primary emphasis in discipline is in
assisting employees to behave in a manner that
allows them to be self directed in meeting
organizational goals.
 Punishment may be applied for improper
behavior in constructive discipline. This should
be carried out in a supportive, corrective 63
manner.
 DISCIPLINARY PROCESS

The following is a guideline on the steps in the

disciplinary process that can be applied to an
employee who has violated rules or regulations.
1. Preliminary investigation and caution to the employee
about the problem
2. A cordial discussion with the offender and a brief warning
as to why further violations will not be tolerated
3. A stronger verbal warning after a further violation of
regulation
4. A formal written warning
5. A written warning accompanied by suspension from the
job for a prescribed number of days
6. Suspension from the job for a longer period of time
7. Discharge with opportunity to appeal
This process provides an opportunity to make
amends for violations of the rules and regulations
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 FUNCTIONS OF MANAGEMENT

A function is a broad area or responsibility

with many activities aimed at achieving a
predetermined objective.
They include:
 Planning
 Staffing
 Organizing
 Delegating or Directing
 Controlling
 Budgeting
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 1. PLANNING

Planning is simply defined as deciding in

advance what will and will not be done in
the next minute, hour, day, month or year.
Planning is advance thinking as a basis
for action. It involves what needs to be
done, how it will be done and mechanisms
of evaluating work done.

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 W H AT I S P L A N N I N G ?

• This is deciding in advance what will be done in the next

minute, hours, days, months or years.
• Planning is advance thinking as a basis for doing.
• It involves what needs to be done, how it will be done and
whether it was done.
• Planning therefore is having a specific objective or
purpose and mapping out a method before hand.
• Plans affect how people will work and for how long.
• When planning we should consider the seen and unseen
and consider that all factors influence one another.
• We live in an era of change and therefore we need to plan
our activities.
• Planning is a continuous process 67
Importance of planning
 Gives focus and thus facilitates the accomplishment of
company objectives
 Gives direction to activities in an organization. Without
planning, people will not know what is expected of them.
 Facilitates control
 Helps detect problems within the organization
 Serves as a framework for all other managerial functions
 Helps in use and applications of resources.
 Forces managers think ahead
 Forces managers to appraise/study the environment
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Activities involved in planning include
 Gathering information
 Setting goals and objectives
 Policy formulation, that is guiding statements in
decision making
 Developing tactical plans
 Developing procedures
 Budgeting or resource allocation

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 TYPES OF PLANS
Plan Type Key features

Long Term(Policy) -Period > 10 years

-Driven by politics and desire for a common good
-Defines policy imperatives
-Desired results defined by impact indicators
-Resources/budget not defined

Medium Term(Strategic) -Period between 3 – 5 years

-Driven by policy, international and regional declarations
-Defines Strategies for implementing the policy imperatives
-The desired results are either impact or outcome indicators
-Implementation work plan based on strategies
-Required resources and gap identified

Short Term(Operational) Period 1 year

-Driven by Medium Term Plans (MTP), implementation guidelines
-Defines interventions/activities for the medium term strategies
-Desired results defined by output/process indicators
-Has implementation based on activities
-Usually based on available resources

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PLANNING CYCLE

71
 PLANNING PROCESS
• The planning process includes a series of activities
which the nurse manager sets out to do.
• The process is subject to change as new facts are
known.
• If plans are fixed and unchangeable, then they may fail.
• The nurse plans and develops specific goals and
objectives for his/her area of responsibility.
• The process of planning is comprised of four stages.
These are :-
• Assessment
• Setting goals
• Implementation
• Evaluation 72
 ASSESSMENT

This is the first stage in the process. It involves

identifying and clarifying or diagnosing
the problem.
A good diagnosis pinpoints what is wrong. It may
identify a particular situation that needs improvement,
for example, the standards of nursing care.
The main questions you should ask are:
 Where is the problem? For this one can come up a problem tree.
 What are the obstacles that are
preventing achievement?

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EXAMPLE OF PROBLEM TREE

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 SETTING GOALS

Goals determine the direction of activities and

serve as a guide for action.
 This stage involves developing a set of actions
for achieving the objectives and selecting
promising solutions from the alternatives
Goals set should be:
 Specific
 Measurable
 Achievable
 Realistic
 Time bound

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 2. SETTING GOALS:

• This is the stage of establishing goals to be achieved.

• These determine the direction of activities and serve
as guides for action.
• It is important to determine the goals in terms of short
term, medium or long term.
• Developing a set of actions for achieving objectives
and selecting promising solutions from alternatives.
• One should be concerned with what could be done to
overcome problems identified.
• This requires imagination and originality.
• Alternatives must be analyzed and compared.
• The alternatives can range from doing nothing or
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finding a means around the problem.
 IMPLEMENTATION

This is the actual execution of the plan.

Implementation involves decision making, which is
the core of planning. These decisions deal with the
following issues:
 Activities, that is, noting whether they are carried out as
planned and whether services are delivered as intended.
 Manpower should be adequate, at the right place and right
time to perform the activities.
 Resources, that is, the physical, financial and information
resources needed to perform the activities.

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 EVALUATION

 It involves determining the extent to which objectives have

been achieved.
 The main concern for the nurse is to find out the ef fectiveness
of the results, as well as the efficiency in the per formance of
activities and the economic use of resources.
 The following questions should be asked:
 Are the results as intended?
 Are the results of value?
 If the answers to these questions are yes, then carr y on as
planned. If the answer is negative, the objectives are re-
examined and the plan is readjusted.

78
 PLANNI NG PERI OD

• A manager usually makes a distinction between long-range

and short range planning.
• The definitions of these depend on manager’s level in the
organizational hierarchy & the type of organization.
• Most managers define short term planning as that which
covers a period of up to one year.
• Long term involves a time interval of three, five or ten years
or more.
• A nurse supervisor’s planning period is usually within the
short range.
• For many activities planning will be for a week, a day or a
shift
• e.g scheduling of nurses to work in a ward or department. 79
 DIFFICULTIES ENCOUNTERED
IN PLANNING

• The manager needs to anticipate and recognize difficulties that

may arise during planning
• e.g planning for a nurse to go on night duty then the nurse calls that s/he
is sick.
• Problems come up continuously, usually without any sequence of
priority and importance.
• The manager needs to consider how to overcome the difficulties.
• One method used is to “sort and grade” which involves:
• Deciding which matters the supervisor /manager should handle
personally & those which should be delegated to someone else.
• Classifying problems according to priority – most urgent to be
attended first.
• Flexibility in time schedules is important when emergencies
arise.
• This allows to take care of these situations without significantly
80
 EXAMPLES OF DIFFICULTIES

• Plans tend to be slow when joint efforts of

several individuals are needed.
• There is friction as people bring together their
ideas to make a decision.
• Differences in perception of objectives.
• Communication problems.
• Persuasive ability of the impressive individual.

81
 OVERCOMING DIFFICULTIES

• Many techniques have been used to help managers

control their time schedules.
• Time management is of essence here.
• The manager can do the following:
• Use desk calendars – This is one of the simplest
methods.
• Note those items which need major attention e.g.
meetings, appointments, reports, discussions.
• Schedule events as far in advance as practicable.
• Keep a planning sheet for each week – prepare at
the end of one week for the week to follow.
82
 2. STAFFING

Staffing involves hiring and retaining staff in an

organization.
The staffing process involves a situation analysis,
looking into what you want and whom you can get.
It includes:
 Recruitment
 Selection
 Induction
 Scheduling

83
 RECRUITMENT

It involves filling a vacancy.

It includes the examination of the vacancy
and consideration of sources of suitable
candidates either internally or externally.
Advertising the vacant position attracts
candidates who have the skill and abilities
needed for the job. It can be done internally
or externally.

84
 SELECTION

Once candidates have responded to the

advertisement, short listing is done.
Shot listing Involves picking those who meet the
requirements for further interview.
The candidates are the assessed through
interviews and at least three best candidates
are chosen . In case the best candidate is not in
a position to take the job offer, the second best
is approached till the vacancy is filled.

85
 ORIENTATION/INDUCTION

• Also called induction

• 2 parts:
Geographical-Familiarization with the geographical
parts of the organization
General-Acquainting the new employee with the
mission, goals, policies and objectives of the
organization and getting them to understand the
expectations on their part e.g..... the nursing in-charge
should conduct an orientation forum for the new staff.

86
 SCHEDULING ( DUTY ROTA)

 This is assigning tasks to the new employee.

 Work schedules and time off should meet organizational
goals with fairness and equity among personnel.
 A schedule should adhere to the following:
 Policies, standards and practices of the organization on the hours
worked by professional and support staff.
 Appropriate ratio or balance between professional and support staff.
 Continuity of nursing services and twenty four hour coverage.
 Approved budget.
 Consideration of vacations.
 Allowance of adjustment in case of illness, emergencies or changes
in patient care needs.
 Individual needs of staff.

87
 FACTORS AFFECTING
STAFFING

Staff numbers and placement maybe affected

by the following variables:
 Staff factors: job descriptions, education level of staff,
experience and expectations from the organization.
 Patient factors: including variety of patient conditions,
length of stay, the patient population, care needs and
fluctuation in numbers.
 Health care organization factors: including policies and
procedures, financial resources available, number of
beds per unit, staffing norms, issues of professional
coverage and nursing assignment systems.

88
 3.ORGANIZING

Organizing is the process of grouping the necessary

responsibilities and activities into workable units,
determining the lines of authority, communication,
developing patterns of coordination and giving
feedback
Organization refers to the structure that is designed
to support organizational processes.
The key factors influencing organizations are the:
 Vision
 Mission
 Philosophy

89
 VISION, MISSION, PHILOSOPHY

Vision
• A vision statements is future oriented, purposeful and
designed to identify the desired future of the organization
• e.g. The hospital intends to be the best in terms of quality services
delivered.
Mission
• This is the statement that communicates the reason for the
organization’s existence .
• It identifies the organization’s customers & types of services
offered.
• It enacts the vision statement.
Philosophy
• It states what values, beliefs held about the nature of work it
is required to accomplish, the mission and the nature and 90
 OBJECTIVES OR GOALS:

• These are the ends that an organization must achieve in

order to carry out its mission.
• Objectives are considered as translation of the mission
into specific, concrete terms against which actual result
can be measured more easily.
• Strategic planning should address the following questions:
• What is our core business?
• Where do we want to be in 5, 10, 20 years time?
• And what do we have to do in order to get there?
• What resources are we likely to acquire?
• What change are we likely to have and how can we cope with our
operating environment?
• How can we gain and retain competitive advantage over others? 91
 In devising strategic plans, the organization should analyze itself and
plan activities according to the needs.
 One of the common approaches used is SWOT analysis.
 (Strengths, weaknesses, opportunities and threats)
 The strengths & weaknesses are assessed in relation to availability of
e.g;
 existing staf f & skill levels; resources like supplies, materials; ser vices
available in terms of quality and deliver y.
 Oppor tunities and threats are usually in the external environment.
 Oppor tunities are e.g. prospects of new products or ser vices like a new
x-ray machine or new outpatient ser vices.
 The threats come from e.g competitors, change in public taste or
economic depression.
 The manager should tr y to seize the oppor tunities & remove the threats.
 Top management is challenged to ensure it has a healthy & prosperous
future for the continuous growth & development of the organization.92
 TYPES OF ORGANIZATIONS

An organization is made up of a group of

people who have united together to pursue and
accomplish a common purpose as one team.
This collective effort & the pooling of
resources to achieve a common aim is what is
termed as organization
 e.g business firms, hospitals, clubs, churches.
 There are two different types of organizations;
 formal
 informal.
93
 FORMAL ORGANIZATIONS
membership & activities are governed by certain
specified rules and procedures
These rules & procedures determine the degree of
authority & behavior of each participating member
 e.g government ministries, non-profit making organization,
business companies.
When designing the departmental organizational
structure, the manager should plan for an ideal
organization
The ideal organization is defined as that structure
which the manager believes is most desirable for
the achievement of the Departmental objectives.
94
 INFORMAL ORGANIZATIONS

These are social groups or “cliques” which

develop within formal organizations in order to
fulfill individual social needs
 e.g according to social interests like welfare society.
There is no formal organization that operates
efficiently without an accompanying informal
organization.

95
 O R G A N I Z AT I O N A L S T R U C T U R E

 Organizational structure refer s to how work is organized , where decisions are

made & the authority & responsibility of worker s .
 A structure is a map of communication & decision making paths.
 Organization structure is an impor tant tool through which manager s can
increase organization ef ficiency.
 It depicts the expression of responsibility relationships among people and
jobs.
 The organizational structure is graphically por trayed by the organizational
char t.
 This is a pattern to show how par ts are put together to accomplish a
par ticular purpose.
 Individual positions are shown as rectangular boxes each representing a job.
 The char t shows:
 Areas of responsibility.
 To whom and for whom each person is accountable.
 Major channels of formal communication.
 Interdepartmental relationships. 96
 SA M PL E - O R G A N IZ AT IO N A L C H A R T

Chief Nursing Officer

Deputy chief nurse Deputy chief nurse Deputy chief nurse

Adm , Ed & Standards Medicine Surgical

ACN A.CN ACN ACNsp. CAN

Nurse-Ed standards paeds med General ACN ortho
surg

SNO SNO SNO

Med Med Med
Wd 1 WD 2 Wd 3

97
 ORGANISATION OF HEALTH
SERVICES IN KENYA

Tiers or Levels (4):

– Tier 1: Community level;
– Tier 2: Primary Care level
– Tier 3: County level
– Tier 4: National level

98
 ORGANISATION OF HEALTH
SERVICES IN KENYA (CONT’D
 DESCRIPT
 LEVELS  FOCUS
 A l l P G H I’sO, Na n d
National Referrals • Highly specialised health care, for area / region
 N AT I O N A L
 Are general, of specialisation
REFERRAL regional, or • Tr a i n i n g a n d r e s e a r c h s e r v i c e s o n i s s u e s o f
FA C I L I T I E S discipline national importance
specialists  Referral
 All district, sub- • C o m p r e h e n s i v e i n - p a t i e n t d i a g n o s t i c , m e ds iecravli,c e s
surgical and rehabilitative care, including
district hospitals,
 COUNTY including NGO /
reproductive health services
• Specialised outpatient services
REFERRAL private, form • Facilitate, and manage referrals from lower levels,
FA C I L I T I E S network of County and other referrals
Referral Services in • Wi t h o t h e r C o u n t y R e f e r r a l F a c i l i t i e s , f o r m t h e
a county  Referral
• C
D oi suenatsye Rper feevrerna tl i oS ny sat ne dm h e a l t h p r o m o t i o n s e r v i c e s
 All dispensaries, • B a s i c o u t p a t i e n t d i a g n o s t i c , m e d i c a l s u r gsi ec ra vl i& ces
 P R I M A RY health centres, rehabilitative services
clinics, maternity • Inpatient services for emergency clients awaiting
CARE
homes referral, clients for observation, and normal delivery
FA C I L I T I E S  Catchment area: services
• F a c i l i t a t e r e f e r r a l o f c l i e n t s f r o m c o m muR n iet fi ee sr ,r aa ln d t o
30,000 persons
• rFeafceirl ri at al t fea icni ldiitvi ei ds u a l s , h o u s e h o l d s a n d c o smemr vuinciet si e s
adopt appropriate healthy behaviours
 COMMUNITY • Provide agreed health services
 No physical
• Recognise signs and symptoms of conditions
UNITS facilities requiring referral,
• Facilitate community diagnosis, management
&referral.
99
Organisational Structure of National Health Services
CABINET
SECRETARY
FOR HEALTH
TOP MANAGEMENT

PRINCIPAL
SECRETARY
FOR HEALTH
Semi Autonomous Government
Agencies
DIRECTOR
GENERAL FOR
HEALTH

Resource Centre Disaster Management

SENIOR MANAGEMENT

Directorate for
Directorate for Health Directorate for Sector
Health Promotion Directorate for
Curative and Planning and
and Disease Administration
Rehabilitation Governance
Prevention

National Hospitals Child Health Referral Services Health Planning Financial Mgt.

Sector
KEMSA Disease Control Pharmaceutical Supply Chain Mgt.
Coordination

KEMRI Animal Health Laboratory Health Information Logistics Mgt.

Reference Labs Nutrition Clinical Services Sector Governance Internal Audit

NHIF Health Promotion Nursing Services HR Management HR Administration

& Community Care

PPS Quality Assurance Infrastructure Mgt. Accounts

Environment and
Hygiene Control Reproductive
NBTS Procurement
Health

NCD & Injury 100

NACC Control
 Organizational Structure of County Health Services

Resource Centre

COUNTY DIRECTOR FOR HEALTH

Disaster
Sub County Health Management Teams
Management

Directorate for Health

Promotion and Disease Directorate for Curative and Directorate for Planning and Directorate for
Prevention Rehabilitation Governance Administration

Child Health Referral Services Health Planning Financial Mgt.

Disease Control Pharmaceutical Sector Coordination Supply Chain Mgt.

Animal Health Laboratory Health Information Logistics Mgt.

Nutrition Clinical Services Sector Governance Internal Audit

Health Promotion &

Nursing Services HR Management HR Administration
Community Care

Quality Assurance Infrastructure Mgt. Accounts

Environment and Hygiene
Control Reproductive Health Procurement

NCD & Injury Control

101
 P U R P O S E S O F O R G A N I Z AT I O N A L S T R U C T U R E

The main purposes of organizational structure

are to:
have the right people taking right decisions at
the right time.
establish who is accountable for what & who
reports to who.
facilitate easy flow of information
 channels of communication.
depict inter-departmental relationships.
integrate and coordinate activities.
102
 TOOLS USED BY A MANAGER

Organizational manuals
They provide in comprehensive written form, the
decisions which have been made concerning the
organizational structure.
The manual should clearly specify the responsibilities
of each supervisory position & how they are related to
other positions.
They should state the objectives of the organization
and each department.
Manuals should have major policies of the
organization particularly relating to personnel
 e.g Human resource issues, disciplinary policy, terms and
conditions of service, leave, training & development. 103
 POLICY

A policy is a guide which clearly spells out

responsibilities and prescribes actions to be
taken under a given set of circumstances.
It provides general direction for decision
making so that action can be taken within
the framework of organizations beliefs and
principles.

104
Procedure
This prescribes steps that should be followed
in order to conform or carry out a policy.

Standards
 These coordinate and articulate the
operations of organizations.

E.g standard Operating procedures (SOPs)

105
EXERCISE

Read and write short

notes on :
• Vision
• Mission
• Philosophy and
• Organization structures

106
 4. DELEGATION

Delegation is the process through which responsibility

and authority for performing a task, function, activity
or decision is transferred to another individual who
accepts that authority and responsibility.
Factors involved in the delegation process include:
 Responsibility for work delegated, that is,
willingness to do the assigned work or an obligation
to accomplish a task.
 Accountability or the obligation to carry out the
responsibility or authority or act of accepting
ownership for the results or lack thereof.
 Authority, that is, the right to act or empower.
107
 DELEGATION CONT..

Steps involved in delegation

 Defining the task
 Evaluating the task
 Determining who should perform the task
 Providing clear communication about expectations
regarding the task
 Reaching agreement with the delegate on accepting
responsibility and accountability
 Monitoring performance and providing feedback

108
 5. CONTROLLING

It is the measuring and correcting

performance of employees to ensure that the
planned objectives of an organization are
achieved.
involves the regulation of activities so that
some targeted element of performance
remains within acceptable limits.

109
 CONTROLLING CONT

Importance of controlling.
 It ensures work is done according to the objectives set and
activities are carried out as planned, within the allocated
time and with the resources provided.
 It enables supervisors recognize gaps in the knowledge and
understanding of the staff, and arrange for appropriate
training.
 It enables management to ensure that the resources
provided for work are adequate and are being properly used.
 It enables management to identify the cause of work
deficiencies.
 It facilitate the recognition and reward for good work done
and recognize suitable staff.
 It identifies mistakes before they become critical, bearing
in mind that prevention is better than cure. 110
FUNCTIONS OF MANAGEMENT

Budgeting

111
 6. BUDGETING

 It is the process of costing inputs and activities in

monetary terms. It is the act of quantifying objectives
in financial terms
 Budgeting is made of estimated costs of inputs and
activities that will be required to implement the plan.
Reasons for budgeting include :
 To avoid spending more than an organization can afford
 To aid in planning and controlling
 To assist in assessing the financial requirements of
the institution
 To indicate the areas in which money raised or received will
be spent
 To facilitate comparison of actual performance with
budgeted targets
112
 MANAGING RESOURCES

Nursing management often takes place in

situations of scarce resources. The manager
must therefore achieve the greatest results
with the resources available.
The main resources include:
 Materials
 Time
 Human resource
 Finances

113
 MANAGING MATERIALS

Materials refer to drugs, supplies and

equipment needed by the nurses and other
health personnel to deliver services.
These materials are essential for a health
care institution to achieve its objectives
For quality and efficient services, the
materials must be provided at the right
place, at the right time and in the right
quantity

114
 MANAGING MATERIALS CONT..

The nurse manager should know the

policies and procedures that relate to
material management and should therefore
be familiar with the following activities.
 Demand and estimation. That is identifying what is required before
hand
 Procurement guidelines
 Receipt and inspection. This is to ensure that material received is
the right quantity and quality
 Inventory control. Close supervision of movement of materials or
consumption rate is a good tool for proper control
 Storage. It should be of adequate size to accommodate all the
different materials required

115
 MANAGING TIME

Time is an important resource and is referred

to as one of the M’s of management and
stands for moments. The others are money,
material and man power

116
 MANAGING TIME CONT…

Principles of time management

The following techniques can be used to deal
with time management constrains
 Goal setting
 The manager sets both organizational and personal goals which are either
short or long term and provide direction and vision for actions as we;; as
time frames for accomplishing activities
 Time analysis
 The manager should conduct a survey of how they spend a day. Reviewing
the daily schedule and keeping it accurate may demonstrate how time is
used.

117
Techniques cont….
 Priority setting
 The nurse manager should identify time frames for achieving goals
 The ’to do’ list should be prioritized by classifying activities as ’one’
for urgent, ’two’ for not urgent but important and ’three’ for less
important.
 Delegation
 The nurse manager can delegate those activities that can be
effectively handled by juniors
 Controlling interruptions
 The nurse manager should identify causes of interruption and plan to
reduce them. One way of doing this is incorporating some of these
interruptions into planned and scheduled activities

118
 MANAGING NURSING
SERVICES

This refers to the coordinating responsibility of

the nurse, who, in addition to giving care, also
works with members of the health care team in
providing a comprehensive programme of
nursing care.
The nurse’s main task is to link the team or a
nursing department to the larger organization
and to the resources necessary to achieve the
objectives.

119
 MANAGING NURSING SERVICES
CONT..

The following are the main responsibilities as regards to

managing nursing services:
 The nursing service must be operational twenty four hours a day,
seven days a week all year round.
 High quality nursing care must be provided to patients taking into
consideration their physical, social, psychological and spiritual
needs.
 Resolution of health care delivery problems.
 Policy development.
 Planning, organizing, directing and controlling materials and human
resources in order to provide effective care. This was covered in
sections two and three.
 Utilizing the appropriate methods of patient assignment in order to
deliver care
to patients.
 Research for knowledge generation, better understanding of issues 120
and engineering new methods of management, that is, innovation.
 NURSING CARE DELIVERY
SERVICES

The practice of nursing has an aggregate of

complicated duties and responsibilities.
Delivery system or modalities ensure delivery
of quality care.
There are four methods of nursing modalities
 Case method nursing/total patient care
 Functional nursing
 Team nursing
 Primary nursing

121
 CASE ASSIGNMENT

This was the first method to be identified in

nursing care delivery.
Each patient is assigned to a nurse for total
patient care while the nurse is on duty.
 If they go off duty, the work is handed over
promptly to another nurse.
Patient receives holistic and unfragmented
care during the nurse's time on duty.

122
 CASE METHOD CONT…

Merits
Nurse attends clients total need due to time
and proximity
Continuity of care is facilitated
There is client-nurse interaction
Client feels secure knowing that one person is
familiar with his/her needs
Workload for the unit can be equally divided
among staff
123
 CASE METHOD CONT…

Demerits
many clients don’t require the intensity of
care inherent in this type
This method must be modified if non-
professional health workers are to be used
effectively
There are no enough nurses and cost
effectiveness must be considered

124
 FUNCTIONAL NURSING

This method emphasizes the division of labour

according to specific tasks.
It is ‘task or thing oriented’ and is determined
by the technical aspects of the job to be done.
Each nurse has a clearly defined set of tasks
determined by complexity, including skills,
knowledge and experience in certain nursing
techniques, for example,
 drug administration,
 wound dressing,
 bed baths and so on
125
 FUNCTIONAL NURSING CONT..

Merits
It is economical
It is time saving
Easy to organize
There is specialization

126
 FUNCTIONAL NURSING CONT..

Demerits
It can be monotonous hence boredom
Client may become impersonal
Risk for diminishing continuity of care
Staff members are accountable for the task
rather than the client
Care is fragmented
There is little avenue for development.

127
 TEAM NURSING

Personnel collaborate in providing care to a group

of patients under the direction of a team leader.
Patient care is divided among the team members.
Team nursing can be organized in the following
manner:
 A group or team of nurses with different levels of skills are
assigned to a group
of patients. The size and composition of the team is
dependent upon the setting.
 The team works together to accomplish a goal.
 They focus on patient centered as opposed to task oriented
assignments. These are based on patient needs and the
knowledge, skills and experiences of
team members. 128
 TEAM NURSING CONT..

Organization cont….
 A member of the work group is assigned as a leader. In the original
concept, the team was led by a registered nurse.
 The leadership role may be permanent or rotated.
 The team works together with each member performing the tasks for
which they are
best prepared.
 Team members report to the team leader who reports to the head nurse.
 Success is dependent upon effective communication.

129
 TEAM NURSING CONT..

Merits
It allows individual members to make personal and
useful suggestions.
It combines the best thinking of all team members
about patients' problems and improves the quality of
decision making.
It cultivates team spirit, which affects the climate and
continuity of care.
There is fragmentation of care and better utilization of
personnel in the performance of quality care.
There is also the potential for leadership development
and it encourages greater staff satisfaction due to
increased guidance and better matching of
assignments to skills. 130
 TEAM NURSING CONT..

Demerits
Establishing the team concept takes time
and a lot of effort
There is less individual responsibility and
independence regarding nursing actions
All personnel must be client centered
The time spent in coordinating delegated
work and supervision can prove expensive.

131
 PRIMARY NURSING

It involves total nursing care directed by a

nurse on a 24 hour basis as long as the client
is under care.
The basis of assignment is as follows:
 A professional nurse, usually a registered nurse, is assigned to a patient
for their total hospital stay or to a small group of patients, not more
than four or five.
 This nurse assumes responsibility for twenty four hours a day for the
duration of the patient’s stay in hospital.
 The primary nurse assesses plans and executes the plan or may delegate
to a secondary or associate nurse to execute the plan during her
absence.
 The primary nurse communicates with the physician and coordinates
care with other health workers.
 The chief nurse functions as a coordinator of the unit and is a resource
person for the primary nurses. 132
 PRIMARY NURSING CONT…

Merits
It encourages a one to one relationship and in so
doing promotes total patient care by virtue of the
quality of interaction.
The nurse coordinates all aspects of care, including
the physical, social and psychological, which ensures
the continuity of care.
This method promotes increased autonomy and
responsibility leading to job satisfaction due
to involvement.
Clients are satisfied as a result of their increased
interaction with one nurse who
is knowledgeable 133
 PRIMARY NURSING CONT…

Demerits
The nurse may be isolated from colleagues
If the nurse is not competent the patient will
be disadvantaged
There is little avenue for group planning of
client care.

134
 PROGRESSIVE/CLIENT
CARE NURSING

Patient care is provided in accordance to the

unit for example:
 ICU for the critically ill
 Post intensive care unit
 Regular care units
The client is evaluated with respect to
intensity of care needed.

135
 PROGRESSIVE/CLIENT CARE
NURSING CONT..

Merits
Efficient use is made of personnel and
equipment
Client are in the best place to receive the care
they require
Clients are moved towards self-care
independence is fostered where indicated

136
 PROGRESSIVE/CLIENT CARE
NURSING CONT..

Demerits
There may be discomfort to clients who
are moved often
Continuity care is difficult even though
possible
Long-term nurse-client relationships are
difficult to arrange

137
CHANGE

138
 CHANGE MANAGEMENT

Change is the process of making something

different from what it was.
Change is inevitable and nurse managers
should understand and anticipate the
reactions to change

139
 CHANGE MANAGEMENT CONT..

Once the organization identifies the need for

change, it should assess the possible
implications of this change. This may require:
 Definition of alterations in operational methods,
staffing levels and the employee's attitudes and
perspectives necessary to
implement alterations.
 New equipment and systems.
 Redesigning of jobs.
 Restructuring of jobs.

140
 RESISTANCE TO CHANGE

Employees may fear change because of its

potential for the disruption of the existing
status quo in the organization. The following
are some of the reasons why people resist
change:
 Insecurity, fear of unforeseen consequences and
threats to individual status.
 Skills and experience acquired may have no further
value.
 Possible collapse of work groups and interpersonal
relationships.
141
 WHAT IS PLANNED CHANGE?

Planned change is a set of activities in an

organization that are intentional and goal-
oriented.

142
 WHAT ARE THE GOALS OF PLANNED
CHANGE ?

Essentially there are two goals:

It seeks to improve the ability of organization
to adapt to changes in its environment.
It seeks to change employee behavior since
an organization’s success or failure is
essentially due to the things its employees do
or fail to do, planned change is concerned
with changing the behavior of individuals and
groups within the organization.

143
 WHY ORGANIZATIONS CHANGE?

Organizations change because of several reasons some of

which are external to the company & others are internal
to it. The External causes can be some of the following:

1. Government policies
2. Changes in the economy
3. Competition
4. Cost of raw materials
5. Pressure groups
6. Technology push
7. Scarcity of labor
8. Social pressures
9. Legal requirements, etc

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 OVERCOMING RESISTANCE

Kurt Lewis suggested three steps to

overcome resistance:
 Unfreeze, that is, getting rid of existing practices and
ideas that stand in the way of change. This requires
a high level of communication with employees to
convince them that change
is necessary.
 Change, that is, teaching employees to think and
perform differently.
 Refreeze, that is, establishing new norms and
standard practices.
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