HEALTH SERVICE MANAGEMENT (II)_090729.ppt

This is all about how the environment affects one's health

1. HEALTH SERVICE
MANAGEMENT (II)
By
Dr Ifeoma Njelita
Dept of Community Medicine
COOU

2. Health Plan Implementation
•Many well planned health programmes fail to
meet expectations due to failures in
implementation.
•Executing a plan successfully through
implementation is a very delicate process that
demands meticulous attention to the
implementation functions viz; organising,
staffing, leading and controlling the activities of
the health team.
•Successful implementation is also dependent on
adequate budgeting & funding of the programme

3. Organising the Team’s activities
•A well-formulated health plan usually specifies
the detailed resource requirements for
implementation of the programme.
•The first step in implementation is to mobilise
and deploy all these resources effectively.
•The organising function is concerned with the
development of a formal structure of relating
people & other resources in such a way that they
all contribute maximally & cohesively to
organisational effectiveness.

4. Organising the Team’s activities
•When more than one person is involved in
achieving a common objective, their grp effort
must be organised or pre-arranged if it is to be
maximally successful.
•To ensure an equitable division of labour & co-
ordination of the efforts of all members of the
team for maximum effect, order is absolutely
essential in the assembly of personnel.
•This order, the result of the process of organising
human resources is the ORGANISATIONAL
STRUCTURE or ORGANOGRAM.

5. Organising the Team’s activities
•The Organogram is a diagram indicating the
various departments & how they relate to each
other.
•The purpose of organising is to arrange or place
resources in the best possible position to obtain
maximum corporate benefit from individual
efforts.
•Good organisation reduces friction, promotes
harmony, avoids duplication & conflict, optimises
the utilisation of talents & facilitates the cost-
efficient realisation of the organisational goals.

6. The Organising function involves the;
•Delineation of authority or power;
•Delegation, the process of entrusting sub-
ordinates with tasks to be carried out on behalf
of their superiors, assignment or distribution of
responsibility for carrying out specified tasks;
•Deployment of the resources required for
achieving the assigned responsibilities;
•Development of formal mechanisms for co-
ordination of the various activities;
•Setting up of communication channels
(organogram).

7. The Principles of Organisation
•The Classical approach.
Fayol’s Principles of Organisation.
•The Newer approaches;
The behavioural approach.
The decision-making approach.
The mathematical or biological approach.

8. Fayol’s Principles of Organisation
•Objectives.
•Authority.
•Responsibility.
•Discipline.
•Unity of direction.
•Unity of command.
•Subordination of personal/individual interest to
cooperate interest.
•Span of control.
•Division of works/Specialization.

9. Fayol’s Principles of Organisation
•Order.
•Short chain of command/hierarchy.
•Equity.
•Coordination – voluntary & directed.
•Remuneration.
•Stability of tenure.
•Centralization/Decentralization.
•Initiative.
•“Espirit de corps” – Team spirit.

10. Obstacles to effective Organisation
•Failure to plan programmes and specify
objectives & strategies.
•Failure to clarify organisational relationships &
roles so as to avoid conflicts & inefficiencies. To
avoid this, it should be ensured that the
organisational chart/organogram is well
understood by all personnel & use of clearly
written job descriptions.
•Failure to delegate authority.
•Granting of responsibility without commensurate
authority.

11. Obstacles to effective Organisation
•Over-organisation resulting in bureaucratic
“red-tapism”.
•Organisational rigidity even in the presence of
a realistic need for adaptation to a changing
environment and situations.
•Failure to design formal mechanisms for co-
ordination of activities.

12. Staffing
•The importance of human element in mgt cannot be
overemphasized. People are an essential resource.
•Though essential to have an appropriate organisational
structure for effective mgt, it is much more crucial to
fill the positions on the organogram with the right
people & to create a work environment which will
ensure that people work in harmony as a team
towards organisational goals while also accomplishing
their own personal goals.
•The quality of a health programme is greatly
dependent on available resources.

13. Staffing
•While money & materials may be available,
even in scarce supply, neither money nor
materials alone can provide health care.
•Only people can utilise the available material
& financial resources and set action in motion
to provide health care.
•The largest proportion of most health
programme budget is usually spent on salaries
and personnel emoluments.

14. Staffing
•This strongly indicates the impt of acquiring
the skills that will ensure cost-efficiency &
cost-effectiveness in the use of this most impt
& expensive resource – health personnel.
•Managing people is much more complex than
managing financial and material resources.
•It is an understatement to say that getting the
best out of people demands much patience,
understanding and great skill.

15. The components of the Staffing
function
•Procurement of staff through;
Recruitment
Selection
Placement
Orientation
Transfers and Promotion
•Preparation through;
Appraisal
Training and development
•Maintenance through;
Leadership and Control

16. Maintenance thru effective Leadership
and Control
•The maintenance component of human resource
mgt is concerned with creating and maintaining a
work environment that will stimulate individuals
working together in groups to perform maximally
on the job & to remain highly motivated &
committed to attaining the objectives of the
organisation.
•The process required to achieve this sustained
commitment involves the leading and controlling
functions of mgt,

17. Leading the health care team
•A health care team consists of individuals working
together as a group to achieve a common goal –
provision of health care to individuals, families &
the community.
•The team is heterogeneous being made up of
different cadres of health workers – professionals,
auxiliaries & ancillary staff who have no direct
health care functions.
•It is not a small task to create a harmonious,
willing and purposeful work team out of such a
heterogeneous group. It requires leadership skills.

18. Leading the health care team
•Leading is concerned with developing good
interpersonal relations b/w health team
managers & other members of the team.
•Health managers require a deep understanding
of human behaviour patterns.
•Each health worker is a unique complex
individual with his/her own personality, needs,
ambitions, attitudes, potentials, aspirations.
•People value their dignity & like to feel important
& such must be treated with respect no matter
their job description/position.

19. Leading the health care team
•Each person has his own contribution to make
and each is indeed important.
•Furthermore, people most times expect or desire
more than money from a job, preferring to
develop their capabilities & potential in addition
to other rewards.
•Effective leading requires managers to design or
create a work environment which will encourage
the harmonisation of the needs of individual
health workers with the demands of the health
organisation.

20. Motivation
•This is the inner impulse that drives or moves a
person to act in a particular manner.
•A health manager needs to know what motivates
people so as to develop the ability to build
motivating factors into organisational roles.
•Human motives are based on needs whether
consciously or sub-consciously felt.
•In its simplest terms, motivation involves a chain
reaction.

21. The Need-Want-Satisfaction chain

22. Motivation
•In reality, the chain is not as simple as the
diagram portrays.
•Management researchers have suggested that
motivation is a series of internal impulses
which respond to a hierarchy of needs
(Maslow & others 1954).

23. Maslow’s hierarchy of Needs

24. Motivation
•It has been postulated that once a lower need is
satisfied it ceases to be a motivator & the person can
only be motivated only by a desire to satisfy the next
higher need.
•Potent motivators include self improvement,
recognition, achievement, responsibility, advancement.
•Dissatisfiers include poor interpersonal relations,
inefficient administrations, poor leadership qualities,
inadequate pay, poor working conditions
•Motivation will not be effective in the presence of
dissatisfiers yet removing them will not provide positive
motivation.

25. Motivation
•“Carrot and Stick” approach to motivation.
•Management scientists have described 3 basic
approaches to motivation;
Paternalistic – if people are happy with work
conditions they will respond by performing well
at work.
Classical – ties rewards to performance.
Participative management – people are more
highly motivated & committed to organisational
goals if they are involved in decision-making.

26. Motivation
•Motivation is complex and requires a situation
approach.
•What a health manager does to induce
motivation should depend on the prevailing
situation as determined by the xtics of the
individuals and grps concerned and the
organisational climate.

27. Leadership
•This is the ability of a manager to influence
people to work with a sustained zeal towards the
achievement of organisational goals.
•Leaders place themselves in front of the grp so as
to facilitate and inspire the progress of the grp
towards its objectives.
•They do not stand behind to push forward.
•Very few employees work with sustained zeal in
the absence of leadership.
•Effective leaders seem to have the ability to
inspire and motivate their followers.

28. Leadership
•Some studies have indicated a significant
correlation b/w effective leadership and the
following traits;
 Intelligence.
 Self confidence.
 Initiative.

29. Leadership styles classified on the
basis of Authority utilisation
•Autocratic (Exploitative/Benevolent Authoritative) –
leaders have very little trust in the subordinates, limit
decision-making to the top and engage in downward
communication only. Tends to discourage initiative.
•Democratic (Participative/Consultative) – leaders have
substantial trust & confidence in subordinates, seek
their opinion & use their ideas, communicate in all
directions & encourage decision-making throughout
the organisation. Preferred by majority of people.
•Anarchic (Laissez-faire) – leaders have complete trust
in the subordinates who have complete freedom of
choice and can do as they like.

30. Leadership styles
•Situational factors determine which type of
leadership is most appropriate.
•The work to be done & personnel expected to do
it decide which style is suited.
•Highly technical tasks, emergency situations,
unskilled & unreliable personnel require
Autocratic style.
•Anarchic style may be deployed when leading a
highly competent, reliable & dependable team.
•The skilled leader varies his style to adapt to the
prevailing circumstance.

31. Enhancing Leadership
Effectiveness
•An awareness of the factors which make for
leadership effectiveness and the ability to put
this knowledge to practice.
•(Empathy) The ability to place oneself in the
position of one’s subordinates so as to better
understand their feelings, attitudes and
perceptions.
•Objectivity in their dealings with subordinates, an
unemotional analysis of facts, restraint even
under provocation.

32. Attributes of a good Leader
•A good leader must be able to influence or
inspire others to follow.
•Must be able to motivate to work with a
sustained zeal to attain grp goals.
•Must be able to combine all the three
leadership styles.
•Should carry other personnel along in
decision-making.

33. Summary of Skills of the
Effective Manager
• Human skills : the ability to work effectively with people, to
build cooperative effort & stimulate team work. Requires a deep
perception of self, peers, subordinates & superiors, emotional
intelligence, critical thinking as well as sociological, psychological
& anthropological knowledge & intelligence.
•Technical skills : knowledge, understanding & practical proficiency
in the technical aspects of management.
•Conceptual skills : ability to visualise the organisation as a whole,
the interaction between it’s constituent parts as well as the impact & the
relationship of the organisation with it’s external environment against the
background of the organisation’s mission & vision.

34. Team Building
•The word “team” paints a picture of energy & skill, a
flowing energy of the skills of individuals working in
synergy to achieve goals which ordinarily would be
beyond them as individuals.
•Team work is extremely important in health care as it
is most unlikely that one person can acquire all the
necessary skills & have enough time to do all that has
to be done to provide healthcare even at the primary
level.
•Effective teams have defined goals, competent &
committed members who collaborate to improve their
performance in attaining organisational goals.

35. Team Building
•The team building process is a conscious effort
of managers to harness this potential of
people to work cooperatively together.
•This can be achieved by managers who take
into consideration human behaviour patterns,
motivation, effective leadership etc.

36. Controlling Human Resources
•Control is very important in any system b/c of the
fundamental role it plays in the effective &
efficient attainment of organisational goals.
•Control is any process that guides activity
towards some predetermined goal.
•The plan of work to be done on a health
programme provides an invaluable framework
for controlling the activities of the health team.
•Control cannot be achieved without
comprehensive plans.

37. Controlling Human Resources
•Control is undertaken in order to:
Ensure that work is done in line with set
objectives, activities planned within the allotted
time & with resources provided.
Ensure that resources provided are adequate and
are properly utilised (no wastage).
Identify causes of work deficiencies & take
immediate remedial action.
Recognize the gaps in knowledge.
Recognize and reward good performance.

38. The Control process
•Establish standards.
•Measure performance against standards.
•Feedback of information on deviations found.
•Correcting the deviations.

39. Supportive Supervision
•Supervision is the process of keeping
surveillance over the performance of assigned
tasks.
•The effective supervisor supports his/her
subordinates, facilitates and helps them by
providing a supportive climate i.e. a helpful
work environment.

40. •Supportive supervision is a process of helping
staff to improve their own work performance
continuously.
•It is carried out in a respectful and non-
authoritarian way.
•It focuses on using supervisory visits as an
opportunity to guide, monitor, coach and
improve knowledge and skills of health
workers to promote compliance with
standards of practice and assure the delivery
of quality health care service.

41. Reasons for Supportive supervision
•To help staff identify and solve problem.
•To motivate and enhance productivity of staff.
•To improve the capacity of staff.
•To identify weaknesses/challenges and provide
support.
•To assess and work performance of staff.
•To ensure that staff work within the context of their
scope of work.
•To work with staff to set goals, monitor performance
and proactively improve quality of service.

42. Benefits of Supportive supervision
•It involves on the job transfer of knowledge,
attitude and skills between supervisor and
supervisee.
•It strengthens internal relationship and builds
partnership between supervisor & supervisee.
•It promotes identification of problems and
their collective solutions.
•It optimizes the use of resources.

43. Benefits of Supportive supervision
•It increases accountability and helps
supervisees to know progress in their work.
•It promotes two-way communication, and
feedback mechanism between the supervisor
and supervisee.
•It identifies areas for improvement and
capacity gaps.

44. Supportive Supervision
The content of supervision should include
deliberate and specific efforts to:
1.Listen attentively, share experience, offer
advice and new ideas
2.Train on the job, teach, explain, suggest ways
to improve
3.Analyse & interpret, resolve problems
4.Confront and discipline only when absolutely
necessary

45. Traditional managerial tools for the
control process
•Work plan.
•Written instructions.
•Work schedules.
•Job descriptions.
•Staff lists.
•Check lists.
•Records of usage and activity.
•Reports of progress and activity.
•Supervisory visits - personal observations & consultations.
•Budgets & Expenditure.
•Operational (Internal) audit.

46. Modern tools
•Operational Research.
•Time – Event Network Analyses e.g. PERT
(Programme Evaluation and Review
Technique).
•Standing orders.

47. Causes of poor work performance
•Insufficient training.
•Insufficient resources.
•No clear job descriptions.
•Unclear instructions.
•Lack of reward for good work.
•Non-supportive supervision.
•Inter-personal problems and conflicts.
•Personal problems of the worker.