College of Health Sciences

Introduction to Health Service Management

For Public Health Students
Prepared by Ali Yimer
(MPH in Health Service Management )
Email: ali24yimer@gmail.com

June 2023
Woldia, Ethiopia
 Brain storming questions

1) Define management?
2) When was the issue of management started?
3) What do we manage?
4) Why do we need management?
5) Is it a Science or an Art ?

2
Objectives
 At the end of this session students will be able to:-
• Understand Rationale for the course
• Define health service management
• Understand Advantages of management
– Differentiate management and administration
– Differentiate efficiency and effectiveness
– Understand principles and concepts of management
– Describe management functions
• Explain Types, skills and roles of managers
• Describe impact of Management on environment

3
 Rationale for leaning management

• Management is universal and essential function in all

organizations.

• Proper health planning and health services management skill is an

important tool to bring about change in the health care system.

• Resources are scarce urging the need for proper skills in planning
and management for efficient utilization.

4
 Rationale …
• Difficulty to address all health problems at a time demands
prioritize problems.

• Increasing competition for health care provision and demand for

quality from users

• Management is a means for development & provides abundant job

opportunities

5
 Definitions of terms

Health
• Health is an elusive term because the state of being healthy can be
viewed from a multitude of perspectives.
• The absence of disease or infirmity
Traditional

• Health is a state of optimum capacity for the effective

performance of valued tasks.
Talcott Parson (1964)

• Health is a state of complete physical, mental, and social well-

being, not merely the absence of disease or infirmity
WHO 1948

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 Definitions …
• Health has 3 main features:
• A process of adaptation to a social environment
• Different things to different people and cultures
• A dynamic process with ever changing stimuli and
responses
Ivan Illich (1976).
• Health like happiness, is an elusive concept. Several definitions
exist, but none is entirely satisfactory
(Brearly et al. 1978).
7
 Definitions…
• Health care – is the total societal effort, undertaken in the private
and public sectors, focused on pursuing health

• Health services – are specific activities undertaken to maintain or

improve health.
• Can be preventive, Promotive, acute, chronic, restorative or
palliative in nature

• Health service organizations - Entities that provide organizational

structure within which the delivery of health services is realized.

• Health systems - are formally linked HSOs, possibly including

financial arrangements, joined together to provide more
coordinated & comprehensive health services.

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Definitions…
• Organization: a collection of two or more people who work
together in a structured way to achieve a specific goal or set of
goals.
• Collections of people who work together and coordinate their
actions to achieve a wide variety of goals.
 Believing there is a benefit working together to achieve a
common goal
 What does goal mean ?

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con….
• Goals :The purpose that organization strives to achieve.

• GOAL is the fundamental element of an organization.

 Organizational goals are important for at least four

reasons:

1. Goals Provide A Sense Of Direction.

2. Goals Focus Our Efforts.

3. Goals Guide Our Plans And Decisions.
4. Goals Help Us Evaluate Our Progress.
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Management

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 Management:

• Getting things done through people

• The process of reaching organizational goals by working with and

through people and other resources
• The process composed of interrelated social and technical functions &
activities, occurring in a formal organizational setting for accomplishing
predetermined objectives through the use of human and other resources.
• The process of planning, organizing, directing and controlling the
efforts of organizational members and using all available organizational
resources to reach predetermined objectives (commonly used definition)
• Health Management, therefore, is the application of management
principles for health care. 12
 What is manager?
• What is manager?
• A manager is a person who plans, organizes, leads
and controls human, financial, and other resources to
meet organizational goals.
• Are people formally appointed to positions of
authority in an organizations.

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Common points of management

• is a process – a set of interactive & interrelated ongoing functions

and activities

• involves accomplishing organizational objectives

• use of human & other resources

• occurs in a formal organizational setting

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 Characteristics of management

• Universal : It applies every where

• Continuous process: Carried out through out the budget year.

• Dynamic: Changes from one form to another

• Pervasive: practiced in every organization

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 Importance of Management

• Management is universal and necessary function

• It is essential for all kinds of organizations. This is because
every organization requires:
 the making of decisions,
 The coordinating of activities,
 The handling of people, and
 Evaluating the performance directed toward its objectives.

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 Administration vs. Management
Administration is an overall determination of policies,
programmes , guidelines & major objectives in organization.
Functionally:-
• Sets the general purpose of the organization.
• Frame outs major policies.
• Formulates the general plans and procedures.
• Approves major projects within the general programme.

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Management :-
 Is essentially an executive function and the active direction of
human effort to reach desired goals.
 Is the work that a manager seeks to get results through other
people.
 Administration sets policy ; Management executes policy.

• Though there is no universal agreement on the difference between

the two terms.
• But the same person may perform both functions.

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The Evolution of management

• The Practice of Management has existed ever since man has

been organised into communities.
• Reading Assignment: Theories of Management Thought

Management as an art, Science and a Profession

 Management is a social science and deals with the behavior of people in
the organization.
Management as an Art and Profession
 Engineer uses science of engineering while building a bridge.
 Manager uses the knowledge of management theory while performing
his/her managerial functions. 19
 Management as an art, a Science….

 Engineering is a science, and its application to the solution of

practical problem is an art.

 Similarly, Management as the body of knowledge and

discipline is a science.

 Its application to the solution of organizational problems is an

art.

Mgt is a science as well as an art and a profession.

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 Functions of Management
• The set of social and technical functions inherent
in the management process that include:
planning
organizing staffing
Decision making
and
Communication
Directing Controlling

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 Functions of management are:-
1. Planning……………………… Planning
2. Organizing
3. Staffing Implementation
4. Leading
5. Controlling …………………. Evaluation
In addition to these three broad sequential functions(PIE), Two
continuous functions of management are:-
• Communication
• Decision- Making
• Management is an integral process and it is difficult to put its
functions neatly in separate boxes.
July 11/2022 prepared by Ali Y. 22
 Functions of Management …
 Communication:- is necessary for sharing ideas between the:-
• Managers
• Staffs and
• The Communities == >> during the process of planning,
implementation and evaluation(PIE).
 Decision Making:- Is employed during
• Planning
• Implementation
• Evaluation
 Each one of them require decision making as a single task

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 Functions of Management …
1)Planning:- is the process of establishing goals and a suitable
course of action for achieving those designed horizons.

 A projected course of action for the future.

 It is a blueprint to take an action

 Deciding in advance on what, how, when and with whom to do.

July 11/2022 prepared by Ali Y. 24

 Functions of Management …
2. Organizing is the process of arranging and allocating works,
authorities and resources among an organizations members
to achieve organizational goals
• Organizing involves grouping employees into groups, teams,
or departments according to the kinds of tasks or jobs they
perform
– Grouping of activities into departments or some other
logical subdivision
– Assigning activities, dividing work into specific jobs and
tasks, and specifying who has the authority to accomplish
certain tasks
– Making sure the necessary human and physical resources
are available
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 Functions of Management …
3. Staffing
• It is the process of filling and keeping filled the
positions required by the organizational structure with
right people, at right places, and at the right time
• Acquiring and placing of qualified people
• It includes several sub-function like
– Recruitment
– Selection
– Hiring
– Transfer and promotions
– Training

26
 Functions of Management …
4. Leading/Directing
– Influencing others to achieve organizational objectives
– It involves energizing, directing, persuading others, and
creating a vision
– Involves interpersonal processes: motivating, communicating,
coaching, and showing group members how they can reach
their goals
– The leadership aspect of management focuses on inspiring
people and bringing about change, whereas the other three
functions focus more on maintaining a stable system

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 Functions of Management …
5. Controlling

• Controlling - a process of establishing performance standards, measuring and

reporting actual performance, comparing the two, and taking corrective actions.
• Is The process of ensuring that actual activities running in the planned manner.

• NB:- planning, organizing, leading and controlling are the simultaneous and
interconnected actions
– Controlling generally involves comparing actual performance to a
predetermined standard
– Any significant difference between actual and desired performance would
prompt a manager to take corrective action
– Determining whether the original plan needs revision, given the realities of
the day
– It causes a manager to return to the planning function temporarily to fine-
tune the original plan 28
 Concepts of Management
 Effectiveness
 Efficiency
 Economy of Scarce Resources

• Some and often many resources are scarce and costly

thus we have to economize.

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 Concepts of management…
 Work Relations

• Work activities should be designed and structured so as to support

each other towards the achievement of objectives
 Information

• Management needs information if it is to make the right decision.

Information should be:
 the right type/kind

 at the right time

 at the right place and

 in the right hands 30

 Brain Storming

• What is the difference between efficiency &

effectiveness?

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 Efficiency vs. Effectiveness
• Efficiency (“Doing things right”)
• The ability to minimize the use of resources in achieving
organizational objectives.
• Is about reaching ends by only the necessary means or by the
least wasteful use of resources
• Is input-output concept.
Efficiency…
• Basic concept of efficiency:

– do not waste resources;

– produce each output at least cost;
– produce the types and amounts of output which people value
most.
• Technical efficiency: use minimum resource to produce an
output
• Allocative efficiency: select intervention that people value most
 Effectiveness (“ Doing the right thing”).

• The degree to which a stated objective is being or has been

achieved.
• It is something that management tries to improve
• Doing the right things in the right way at the right times
• It is the key for organizational success.
Efficiency and Effectiveness in Management

35
 Principles of management
1) Management by objective
2) Learning from experience
3) Division of labor
4) Substitution of resources
5) Function determines structure
6) Convergence of work
7) Delegation
8) Management by exception
9) Shortest decision path
 Principles of management
1. Management by Objective
Management sees that objectives are specified then that they are
achieved.
The objectives should state:
 What is to be accomplished?
 How much of it?
 Where it is to be done?
 When it is to be completed?

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 Principles of management…

2. Learning from Experience

 Analysis of the results between the objectives and achievement
made.
 Is learning from success and failure for future.
 For better performance there should be feedback to learn from
experience.
3. Division of Labour
 Management attempts to bring about balance of work among the
different work and the different people concerned.
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Principles of management…
4. Substitution of Resources
 Often when the resources that are normally used to provide
service became scarce or too expensive, different resources
may be used to provide the intended results.

5. Convergence of Work
 Working relations should contribute to the success of each
activity and so to general effectiveness.

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 Principles of management…
 These working relations of activities are:
 The logical relations with each other
 Time relations or sequence
 Spatial relations between activities
 Functional and structural working relations between people.
Especial relations between activities
• functional and structural-working relations between people
 E.g. In EPI programme the general goal is to vaccinate/immunize
children and Mothers and require.
• Developmental activities (training of vaccinator) and
• Some continuous support activities (supplies)

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 Principles of management…

6. Functions Determine Structure

 When the work is defined i.e. the function and duties of

the individual members of the team are clearly defined

and known to all, the working relations (structure)

follow.

 The exact nature of authority will be clearly delineated

on the structure.
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Principles cont…
7. Delegation

 Delegation is the downward transfer of formal

authority from superior to subordinate.

 Factors to consider in delegation

 Experience, ability, urgency, availability, past

performance, motivation, risks/rewards

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Principles …
8. Management by exception

 Do not be overloaded with the routine and unnecessary

information, be selective and make big decision first.

 In short management by exception means:

 Selectivity in information and priority in decision

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 Principles cont…

9. Shortest Decision-path

This principle deals with issues like:

 Who should make which decision?

 When and where?

 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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Types of Managers

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 Types of Managers
1. By Levels of managers: by differences between levels by the
degree of authority and the scope of responsibility
• Top level (senior) managers
• Are Responsible for the overall management of an organization.
• They are responsible to set policies, strategies, Guidelines...

Example:- manager of both sales and product, president etc

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 Types of Managers…

• Middle-level managers
• Managers in the midrange of organizational hierarchy,
• They are responsible for the work of other lower level
mangers and also some operating employees Eg. Sales
manager, product, …
• First-level (front line) managers
• Are The lowest level in an organization at which individuals
are responsible for the work of others
• Example: OPD case team, MCH case team, unit leaders etc. 47
 Type of managers …
2. By the range of organizational activity they carry out.

3. Functional managers -These are responsible for a department

that is responsible for a single functional task and employees
with similar training and skill.
4. General managers -These are responsible for several
departments those perform different functions. Includes self-
contained units.

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 Common attributes to All managers

• All Managers are formally appointed to position.

• All Coordinate the works and efforts of others.

• All managers are responsible for utilization of resources.

• All are accountable for works and results.

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READING ASSIGNMENT
MICROMANAGEMENT & PICOMANAGEMENT?

50
Types of managers…
The difference is in the scope of activities they oversee.

 The primary differentiation between levels of managers

is the
 degree of authority,
 scope of responsibility and
 organizational activity.

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Managerial Skills

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 Management Skills
• There are three distinct types of skills

Conceptual skills
• reflect the mental abilities of managers to visualize the complex
interrelationships
• The ability to coordinate and integrate all of the organizational
interests and activities.
• Important for the top managers and less important for LLM.
• How changes in one part of the organization affects the rest of the
organization.

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Management Skills…
Human relations & communication skills
• The ability to work with, to understand and to motivate other
people as individuals or groups.
• The ability to motivate, facilitate, coordinate, lead,
communicate & resolve conflicts
Technical skills
• Is the ability to use the procedures, techniques and
knowledge of specialized field.
• Accountants, engineers, market researchers, and computer
scientists, as examples, possess technical skills
• Vital for the first line managers and less important for TLM.

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Management Skill Areas

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 Managerial Roles
• Management theorists assert that managers are meant to plan,
organize, coordinate, and control the work of an organization .

• It is important to clearly show how they translate their

responsibility into day-to-day activities.

• One research-based article on management by Henry Mintzberg

punctured the idea of how managers generally engage in systematic
planning.
56
 Management Roles …

1. Interpersonal roles
Role is a set of expectation for ones behavior.
• Figurehead Perform ceremonial and symbolic duties, such as
greeting visitors and signing legal documents.
• Leader Direct and motivate subordinates; counsel and
communicate with subordinates.
• Liaison Maintain information links both inside and outside
organization via mail, phone calls, and meetings.

57
 Management Roles…
2. Informational roles

Monitor
• Seek and receive information; scan periodicals and reports;
maintain personal contact with stakeholders.
• Disseminator Forward information to organization members via
memos, reports, and phone calls.
• Spokesperson Transmit information to outsiders via reports,
memos, and speeches.

58
 Management Roles…

3 . Decisional roles
• Entrepreneur Initiate improvement projects; identify new ideas
and delegate idea responsibility to others.
• Disturbance handler Take corrective action during disputes or
crises; resolve conflicts among subordinates; adapt to
environments.
• Resource allocator Decide who gets resources; prepare budgets;
set schedules and determine priorities.
• Negotiator Represent department during negotiations of union
contracts, sales, purchases, and budgets. 59
60
 ORGANIZATIONS AND
ENVIRONMENTS
• Organizations are neither self sufficient nor self
contained
• Dependent for input and out put
• Manager performs all the functions of management
in interaction with its environment
Management through its functions (planning,
implementation and evaluation) and in interaction
with the environment converts inputs (materials,
technology, information, finance, human resource,
time, etc) into outputs (products, services)
wubshet D. 61
ORGANIZATIONS AND ENVIRONMENTS…

External environment:
• All elements outside an organization that are
relevant to its operation
• It includes direct and indirect-action .

1) Direct-action elements:
• Directly influence an organization’s activities.

Examples: Individuals/groups, stakeholders.

wubshet D. 62
ORGANIZATIONS AND ENVIRONMENTS…

2- Indirect-action elements:
• Social variables: demographics, lifestyles
• Technological variables: new developments in
products, processes and materials.
• Economic variables: national income, per
capita income, employment, etc.
• Political variables: policies, laws and
regulations
wubshet D. 63
References
• Kreitner R. Management. 7th edition (1998), Arizona State University,
Houghton Mifflin Company, New York.
• Ellen A. Principles of Management. 2nd edition (2001) Hungry Minds
publisher.
• Rakich, J.S. Managing Health Services Organizations, 2nd edition, 1985.
• Stoner J.A.F, Freeman R.E., Gilbert Jr. D.R. Management. 6th edition, 1996.
• Kerzner H. Project Management: A Systems Approach to Planning, Scheduling
and Controlling, 2nd edition. 1984.
• Hersey P., Blanchard K.H. and Johnson D.E. Management of organizational
behavior: Utilizing human resources, 7th edition (1996), Prentice Hall.

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65
 QUIZZES
1. What is the difference between management
& administration?
2.list & describe the 3 managerial skills.
3.mention & describe at least 3 principles of
management
4.Write 3 interpersonal managerial roles &
explain each.
5.What are the two continuous functions of
management?
66