Health Policy and Administration (HPAd 201

)
Implementation as a Management Function
July 28, Saturday, 3:00 – 5:00 PM Auditorium Francisco S. Cruz, MD., MPH.

Health Policy and Administration (HPAd 201) 7th Session
At the end of the session, the graduate students should be able to: 1. Discuss the concepts and guidelines in implementation phase of program management; 2. Discuss budgeting and resource mobilization; 3. Discuss supervision and competencies of successful supervisors/managers and 4. Define Murphy’s Law, Pareto’s principle and Peter principle; Session No. 7 Plan 3:00 Review of Planning as Management Function 3:20 Concepts and Guidelines in Implementation Phase of Program Management 3:50 Introduction to Budgeting and Resource Mobilization 4:10 Introduction to supervisory management skills 4:30 Murphy’s Law, Pareto’s principle and Peter principle 4:55 Preparing for the next (8th) session (Monitoring and Evaluation)

Health Policy and Administration (HPAd 201) Session: Review of 6th session
• Total Quality Management • Systems Approach: Inputs-->processes  outputs-- outcomes • Management Cycle: POSCORBE and PIE (PLAN) • A major part of the management cycle (commitment) • A logical sequencing of evidence-based, analytical thinking (process) • A road- map of priorities, strategies, activities, resources and commitments (document) • Elements: Objectives--->Strategies-->Targets-->Activities • Types: Strategic, directional, operational, long-term, medium term • Objectives Oriented Project Plan (ZOPP) and LFA • DOH KP (strategic medium term plan), PIPH (area-based operational plan) and LGU scorecard

Implementation Guidelines:
1.Activities in the work plan are directly related to the goals, objectives, or short-term targets defined by the annual work plan. 2.Activities are clearly presented. 3.Broken down into manageable tasks. 4.Activities are presented in chronological sequence.

Implementation Guidelines:
5.Work plan shows which activities will be completed, by whom, and over what period of time. 6.Activities have been assigned to the appropriate staff members. 7.Work plan indicates resource needs and resource allocations by activity. 8.Plan and scope of activities are reasonable considering time limitations, human resources, and financial resources.

Budget is the best manifestation of policy!

Budget
 A formal expression of plans, goals, and objectives of management that covers all aspects of operations for a designated time period.  The common art of allocating resources to various users/activities.  Provides control over the immediate environment, helps to master the financial aspects of the job and department, and solves problems before they occur.

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 A budget:  Predicts the contribution to income which will be expected to be generated by each department and each project.  Allocates to each department, project or activity an appropriate share of the of funding in order to enable that income to be generated.  It is also a management commitment  institution’s socioeconomic policy priorities by translating policies and commitments into expenditure and revenue.

GÖKBERK CAN. Budgeting, Financial Planning and Forecasting.
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Budget Process Cycle in NGAs and LGUs
Budget Preparation

Accountability and Audit

Budget Authorization

Budget Execution

Only in LGUs, Budget Review by DBM

Essential Elements of Budgeting
1.

Sources of Funds (Inflows)
• Government revenue collections (general – income taxes, etc.) • Fees for services rendered. • Specific taxes (products/services – liquor/cigarette taxes; flood tax from movie houses) • Solicitations from assisting agencies. • Donations (voluntarily from satisfied patients, philanthropists, professional groups, etc.) • Investments (marketable securities – bonds, time deposits, shares of stocks, etc.) • Sale of properties (land, old functional equipment, condemned items, scrap/waste materials, etc.)

2.

Estimate of future expenditures (Outflows)
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Cost-Based Budgeting versus Activity-Based Budgeting
Resources Resources

Cost-Based Budgeting
Activities

Activities

Activity-Based Budgeting
Cost objects: products and services produced, and customers served.
Forecast of products and services to be produced and customers served.
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Components of Line-Item Budget
1.

Current Operating Expenditures (Operational Expenditures or Recurrent Expenditures)
 Represent the amount of money needed for:
– personal services, – operation of equipment, – acquisition of supplies and materials, – maintenance of facilities, etc.,

in order to deliver the services for which the agency is responsible.  It is usually estimated for one-year period.
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Components of Line-Item Budget (2)

2.

Capital Outlay (Development Budget, Investment Budget, and Infrastructure Budget)
• Refers to appropriations “for the purchase of goods and services of a longer life expectancy extending beyond the calendar year and which add to the assets of the government (or organization)”

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Approaches to Budgeting
1. Top-down approach
– Upper management prepares budgets and passes them down to individual departments

2. Bottom-up approach
– Each department supplies the data and passes them up to the next level of management

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Approaches to Budgeting

Top Management

Middle Management

Middle Management

Supervisor

Supervisor

Supervisor

Supervisor

Top-down approach
McGraw-Hill/Irwin

Bottom-up approach

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Form #2: Work and Financial Plan
Work and Financial Plan

GOAL: Reduce EPI diseases in Municipality X by ___% Project Objective: –To strengthen the EPI coverage (UCI) particularly in hard to reach barangays of Municipality X. Component#1: Training of BHW Specific Objective#1: Recruit and train BHWs in conducting/assisting regular and special vaccinations in close coordination with RHU.
Project Activities 1. 2. 3. 4. Expected Output per activity Persons Responsible Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Budget Requirement 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 (PhP) Remarks

Component#2: Cold chain and Logistics Specific Objective#2: List and procure by RHU all cold chain and logistics requirements of far-flung barangays
Project Activities
1.

Expected Output per activity

Persons Responsible

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Budget Requirement 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 (PhP)

Remarks

2.
3. 4.

Component#3: Project Management Specific Objective#3: Develop and implement the RHU action plan for measles control including conduct of measles outbreak investigation, vaccine efficacy study and first special vaccination.
Project Activities 1. 2. 3. 4. Expected Output per activity Persons Responsible Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Budget Requirement 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 (PhP) Remarks

Supervisory Competencies
Events Manager
• Be involved in the conceptualization, preparation, conduct and assessment • Act as floor director with script with events management crew • Physical arrangement (stage, backdrop, sound, lights, AV systems, seating arrangement, exhibits, registration, secretariat, documentation), VIP list, emcee & performers • Dry run for big events; call time

Facilitator
• Emphasis on process and outputs • Encouraging and enabling • Always redirects and recaps • Good “people” skills • Ensuring active participation of all avoiding dominance of certain participants and unwarranted conflicts • Competence and expertise in topics to be discussed, IT knowledgeable

Supervisory Competencies
Mentor/Coach
• Counseling and group dynamics • Motivation and positive reinforcement • Similar to doctor-patient relationship • Focus on IP medium • Effective for underperformers and staff with low esteem
• Others: Convenor, Chair/CEO, Lead Investigator Familiar and in rapport with stakeholders Perceived and actual authority Consensus builder and conflict resolution manager Focused and evidencebased


The Supervisor as a Trainor
• Focus demands sacrifice!
• Training/information bull’s eye: MUST KNOW, NECESSARY TO KNOW AND NICE TO KNOW • Role of Interactive Media and the NET

• Learning objectives and behavioral change

The Supervisor as a Trainor
Major Tasks of a Trainor
• Development: TNA, course design and instructional materials development • Execution: Learning management, resources management and team management • Evaluation: Reaction, learning, behavior and results • Monitoring: Reports, observation and coaching Source: Center for Organization Development, DAP
Facilitating Skills 1. Listening and Observing 2. Questioning and Attending 3. Integrating The effective facilitator: • Guides discussion. • Provides the right questions. • Enhances two-way communication. • Coordinates learning activities. • Is learner centered. Source: Center for Organization Development, DAP

Conference Leadership and Supervision: Supervisory Management Skills
Effective Mid-Level Manager’s Skills
1. Planning: forecasting, objective setting, programming, scheduling and budgeting; 2. Leading: decision making, motivating, communicating, selecting people and developing people; 3. Organizing: establishing policies, establishing relationships, delegating and administering policies and 4. Controlling: Developing performance standards, evaluating results and taking corrective actions Source: Supervisory Development Program, DOH, 1997.

Inputs to Successful Supervisors
1. 2. 3. 4. 5. Good administrative skills Adaptability to the situation Stability of performance High standards of performance for subordinates Emotional support to subordinates Frequent feedback/forward Work resiliency T.E.A.M.

6. 7. 8.

Source: Supervisory Development Program, DOH, 1997

Conference Leadership and Supervision: Supervisory Management Skills
Performance Appraisal (PA)
• • Performance – assessment of the quantity and quality of job output against standards Effective performance appraisal – accurately measures current performance levels through observation and identification with mechanisms for reinforcements and feedback Effectiveness-based appraisal provides objective indicators (MBO/MBR) of employee’s contribution; what they produce and not what they do nor how they spend their time. Pitfalls of PA – human judgment, inadequate information of rater, ambiguous criteria & format and inflexibility & mismatch

1.
2. 3. 4. 5. 6. 7. 8. 9.

Tips in Giving Performance Feedbacks Have mutual trust: confidentiality, fairness and objective; Make discussions lead to solutions; Observe two-way listening Support and enable ratee to express freely; State feelings clearly then move on!; Be descriptive and not judgmental; Be specific about events and time; Give feedback as soon as appropriate; Share ideas and information rather than advice

Supervisory Management Skills
Control
• Alter ego to planning; regulatory in nature within the managerial system • Dependent on management style • Monitoring, feedback, feedforward, MIS • Impact on effectiveness and efficiency • Establishing standards, comparing performance & standards and correcting deviations • Accountability & Responsibility

Monitoring
• Process of routine periodic measurement of program & office inputs, processes and outputs • Focus on operations • Like evaluation, baselines and documentation needed • Performance monitoring assesses use of inputs as to approved budget and schedule • Process monitoring provides feedback to management operational perceptions of clientele and effectiveness of communication and linkages

Murphy’s Law
• Origin / History of the Phrase “what can go wrong will go wrong”
– 1877 (American Dialect Society) : Alfred Holt reported at a meeting of engineering society “…anything that can go wrong at sea generally does go wrong” – Author Arthur Block of “Murphys Law And Other Reasons Why Things go Wrong” (1977) attributes the Law’s namesake to a 1949 event at Edwards Airfore Base, Muroc CA. where Capt. Edward Murphy, a development engineer from an aircraft laboratory expressed his frustration at a technician who caused the errors in his project MX981 aircraft by saying “if there is any way of doing it wrong, he will”

Murphy’s Law
• The phrase “Murphy’s Law” was coined by Edward Murphy’s colleagues in adverse reaction to his excuse of blaming his technician when his devices failed to perform in his projects • The phrase received public attention when a colleague of Murphy (Dr. Strapp) was asked by journalists how it was that, in his watch, nobody had been severely injured during rocket tests, he replied: “because they always took Murphy’s Law under consideration”

Applications of Murphy’s Law
• From the initial public pronouncement in early 1950s “Murphys Law” quickly spread to various technical cultures connected to aerospace engineering • Pre-flight checks and counter checks are routine in aviations to ensure safety

• In hospitals, checklists are being advocated instead of reliance to memory, prior to any procedure to ensure patient safety
• Awareness that “anything that can go wrong will go wrong” will make us check and double check our equipments and ourselves and have a “plan B” or contingency for the things that that can go wrong

Pareto Principle
• Joseph M Juran
– Business management thinker

• Vilfredo Pareto
– Italian economist, who observed in 1906 that 80% of the land in Italy was owned by 20% of the population; – he developed the principle by observing that 20% of the pea pods in his garden contained 80% of the peas

Originally, the Pareto Principle referred to the observation that 80% of Italy’s wealth belonged to only 20% of the population.
• More generally, the Pareto Principle is the observation (not law) that most things in life are not distributed evenly. It can mean all of the following things: • 20% of the input creates 80% of the result • 20% of the workers produce 80% of the result • 20% of the customers create 80% of the revenue • 20% of the bugs cause 80% of the crashes • 20% of the features cause 80% of the usage And on and on…

• Also recognize that the numbers don’t have to be “20%” and “80%” exactly. The key point is that most things in life (effort, reward, output) are not distributed evenly – some contribute more than others. • “things aren’t distributed evenly”? The key point is that each unit of work (or time) doesn’t contribute the same amount.

So Why Is This Useful?
The Pareto Principle helps you realize that the majority of results come from a minority of inputs. Knowing this, if…

• 20% of workers contribute 80% of results: Focus on rewarding these employees. 20% of bugs contribute 80% of crashes: Focus on fixing these bugs first. 20% of customers contribute 80% of revenue: Focus on satisfying these customers. • The examples go on. The point is to realize that you can often focus your effort on the 20% that makes a difference, instead of the 80% that doesn’t add much.

Peter Principle
“In a hierarchy every employee tends to rise to their level of incompetence”

Peter Principle
• By Dr Laurence Peter and Raymond Hull in a 1969 book – The Peter Principle • In a hierarchy, workers are promoted so long as they work competently, sooner or later they are promoted to a position to which he is no longer competent and there they remain unable to get further promotion

• Work is accomplished by those employees who have not yet reached their level of incompetence • Everything that works will be used progressively in more challenging applications until it fails…

In an organization…
• Assessment of a potential of an employee for promotion is based on the performance of the current job…ie they are promoted to the highest levels of competence after which promotion raises them to incompetence… • Incompetence is not necessary as a result that the higher position is more difficult, simply that the job is different from what he previously excelled in…requiring different work skills that he may not possess

• Eg-chief resident as selected among the fourth year senior residents based on theoretical knowledge of cases, work habits and patient care but fails miserably once appointed as chief resident…

Supervisory Management Skills
• • Supervisory skills: planning, leading, organizing and controlling Inputs to Successful Supervisors: good administrative skills, adaptability to the situation, performance stability, high standards of performance for subordinates, emotional support to subordinates, frequent feedback/forward and work resiliency Effective performance appraisal accurately measures current performance levels through observation and identification with mechanisms for reinforcements and feedback Control: alter ego to planning; regulatory in nature within the managerial system; dependent on management style; accountability & responsibility Monitoring: process of routine periodic measurement of program & office inputs, processes and outputs; focus on operations

Summary of Supervisor as Trainor
• Focus demands sacrifice: “must know/learn” training/information bull’s eye • Major tasks of trainor: TNA, course design, conduct and evaluation • An effective manager is a competent trainor. • Tailor-fit the course (methods and materials) based on: traits of learners, tasks to be accomplished, context of training i.e. echo seminars, orientation, number of trainees and available resources i.e. IT.

Principle of Health Administration Preparing for the Next (8th) Session
Reading Materials for August 4, 2012 • • • • Any WHO or UNDP or UNFPA article on Monitoring & Evaluation Principles and Practices in Health Administration Volumes I and II DOH Formula1 Monitoring and Evaluation (will forward more reading materials on first week of August)

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