UNIT 1: INTRODUCTION TO HEALTH SYSTEM MANAGEMENT

Unit Outcomes
By the end of this unit the learner should be able to;
1. Define concepts in Health System Management
2. Explain theories of Health System Management
3. Describe the styles of Health System Management
4. Describe Practices and Principles of Health System Management

CONCEPTS OF MANAGEMENT
Introduction
The word management has been in existence for many years and it has evolved over time.
It has gained cognisance over time because it is a crucial element in the co-ordination of individuals
and group efforts.
The role of managers is to guide organizations towards goal accomplishment. All organizations exist
for some purpose or goal, and managers have the responsibility of combining and using organizational
resources to ensure that the organization achieves its purpose through the members (staff).
All organizations exist for some purpose or goal, and managers have the responsibility of combining
and using organizational resources to ensure that the organization achieves its purpose through the
members (staff).
In management, a manager should be pro-active (take measures to anticipate changes) and not be
reactive (not seeing what can happen tomorrow). Organizations therefore have
Organizations therefore have certain things in common. These include:
 A goal or a purpose
 A program/method of achieving goal or purpose
 Plans to ensure effectiveness of the goals.
 Leaders/managers who are responsible for helping organizations achieve its goals

Definition of terms
There is no universally accepted definition of management. Various scholars have defined management
in different ways.
Management is the process of forecasting and planning, organizing, leading, coordinating and
controlling the resources of a health system in the efficient and effective pursuit of a specified goal.
Management is working with and through individuals and groups and other resources to accomplish
organizational goals (Hersey & Blanchard).
Management is the process of planning, organising, leading and controlling the work of organization
members and of using all available resources to attain the organizational goals (Stone & Freeman)
Management is working with human, financial and physical resources to determine, interpret and
achieve organizational objectives by performing the functions of planning, organizing, staffing, leading
and controlling ( Megginson & Pietri).
Management is the process of designing and maintaining an environment in which individuals working
together in groups efficiently accomplish selected aims (Koontz & Weihrich).
Management is the art and science that guides the use/utility of human efforts and other resources
efficiently to effectively achieve both individual and group goals for the accomplishment of the
organizational objectives (Eric Mathuva).
It is essential for organized life and necessary to run all types of management. Good management is the
backbone of successful organizations. Managing life means getting things done to achieve life’s
objectives and managing an organization means getting things done with and through other people to
achieve its objectives.
 Management in all business and human organization activity is simply the act of getting people together
to accomplish desired goals and objectives. It comprises planning, organizing, staffing, leading,
directing, facilitating and controllingor manipulating an organization for the purpose of accomplishing
a goal. Resources encompass the deployment and manipulation of human resources, financial
resources, technological resources, and natural resources.

Managers are persons who are formally appointed to positions of authority in an organization.
They enable others to do their work and are accountable to a higher authority for work results.
A system is defined as “a regularly interacting or interdependent group of items forming a unified
whole” and as “a group of devices or artificial objects or an organization forming a network especially
for distributing something or serving a common purpose.
Health system: all the insitutions, people and actions whose primary purpose is to improve health.
Information: Meaningful collection of facts or data.
Information System: Systems that provide specific information support to the decision-making process
at each level of an organization.
Health Information System: A set of components and procedures organized with the objective of
generating information which will improve health care management decisions at all levels of the health
system.

CONCEPTS IN THE HEALTH SYSTEM MANAGEMENT

Three of the most important concepts in the health system management are effectiveness, efficiency
and equity
Effectiveness
Effectiveness is the measure of how well an organization is meeting their organization Or a person in
an organization is meeting their goals. For example if the goal is to provide high quality health care and
the organization or person succeeds in doing so the n they are working effectively. If the health care is
poor and people are not satisfied the n the organization or person is not effective.
Efficiency
It is the measure of how well the health sector is using its resources to achieve its goal. Health system
management involves getting things done using human financial and material resources so that the goal
of improving the health of the community can be achieved
If money and material is being used well and there is little or no wastage the you are working efficiently.
If costs are too high and materials are being wasted then your activity is inefficient. Efficiency involves
doing thing right, using resources wisely and with a minimum of waste.in a situation where a health
facility receives CSB that expires in 2 weeks’ time after serving only a few people, we term this as
inefficiency.
Equity
Access to health care is a basic right of all people. However this does not always happen in real life for
many reasons. Health inequalities are a result of unfair distribution of resources and many be associated
with low income levels,housing,education, gender, geographically inaccessible areas and sometimes
with ethnicity

PRINCIPLES OF MANAGEMENT
In health system management the following are the most important principles to apply.
 Team spirit
 Division of labour
 Focus on results not activities
Team spirit
This principle advocates the benefits of working as a team and building good morale among everyone
you work with.it helps to promote an atmosphere of mutual trust and understanding.
Division of labour
It advocates that work must be shared or divided fairly among the team. Normally in a team there needs
to be division of labour where each category of staff exercises their particular skills towards achieving
specific objectives. The role of management is to assign a balanced proportion of each type of worker
to the work to be done.

Focus on results not activities

One of the principles of management is to make sure that everybody within the organization has a clear
understanding of the goals and objectives and make each person aware of their own roles and
responsibilities in achieving those objectives
Management or managing has four main elements. It is
 A process comprised of interrelated social and technical functions and activities.
 That accomplishes organizational objectives
 Achieves these objectives through use of people and other resources
 Does so in formal organizational setting
Functions of management
 Planning
 Organizing
 Controlling
 Directing
 Staffing
 Decision making
Importance of management to organizations

 It improves and sustains personnel performance in various endeavours

 It effects good performance in places of work in any organization

 It puts disorganized resources into useful and effective ends

 Brings order within an organization

 Produce managers who will effect the establishment and accomplishment of economic,
political and social goals of a country

MANAGEMENT AS ART AND SCIENCE

Is it a science or an art?

As a Science:

 It is a body of knowledge which can be learnt by an individual and become a manager.

 This knowledge is what constitutes the science

  It is the know-how – it is doing things in the light of the realities of a situation

As an Art:

 Managing as practice is an art, just like all other practices like engineering, accountancy – is an
art

 The effectiveness of managing can be improved through practices and experience.

The concept of managerial effectiveness and efficiency

Effectiveness

 Is solution oriented? Organizations function within the larger society and the performance of
organizations.

 In totality effectiveness is a key factor to the performance of a society/nation.

 An efficient manager is one who achieves outputs that measure to inputs.

Effectiveness – the achievement of objectives (Doing the right things)

Efficiency – the achievement of the ends with the least/minimum amount of resources (Doing things
right)

Theories of health system and management

The theoretical component of systems is that they are either “closed” or “open.”
a) Closed systems are completely self-contained, are not influenced by external events and
eventually must die.
b) Open systems, on the other hand, interact with their external environment by exchanging
materials, energies, or information, and are influenced by or can influence this environment;
they must adjust to the environment to survive over time.
The environment can be generally classified as political, economic, social, and technological, as well
as physical, the space available and the way system components relate physically to each other.
Health systems are open and must be approached from this perspective.
They are open to their local and national environments, and now, ever increasingly, to international and
global influences.
All the world’s national health ministries are members of the World Health Organization, are often
accountable to more local government, and usually to the people they serve.

Health systems are one of several determinants of health, and high-performing health systems can
improve the health of populations.
While there is no perfect health system, an understanding of the system in its current form allows us to
gain a comprehensive picture of how it contributes to maintaining health, and thereby also start to
understand the various interac-tions required of its various components.
Theoretically, components within a system can be deterministic, i.e., the components function
according to a completely predictable or definable relationship, as in most mechanical systems; or they
can be probabilistic, where the relationships cannot be perfectly predicted, as in most human or human-
machine sys-tems, like health care. WHO suggests that health sys-tem boundaries should encompass
all whose primary intent is to improve and protect health, and to make it fair and responsive to all,
especially those who are worst of?
 1. Hersey’s and blanchards theory of readiness
Developed by Paul Hersey and Kenneth Blanchard

 Is based on the ’readiness’ level of the people the leader is attempting to influence.
 Readiness is the extent to which followers have the ability and willingness to accomplish a specific
task.
 Ability is the knowledge, experience, and skill that an individual possesses to do the job and is
called job readiness
 Willingness is the motivation and commitment required to accomplish a given task.
 The style of leadership depends on the level of readiness of the followers.
This theory is ideal for:
 Appropriate for diagnosing the work environment
 It has two major components
o Ability
o Willingness
 AbilityOnes ability to solve a problem, including knowledge and experience
 WillingnessOnes willingness to carry out a task with self-confidence, commitment and self –
respect

Four benchmarks in readiness levels

• Individuals
• R1 = Unable and unwilling (UU)? Sack
• R2 = Unable and willing (UW) Need training
• R3 = Able and unwilling (AU) Need motivation
• R4 = Able and willing (AW)? Promote

Four benchmarks explained

• R1, R2, R3 and R4 - Translates the level of readiness which managers can use to
gauge the readiness levels of their staff. Organizations can therefore be diagnosed using the
four variables
• Ability
• Willingness
• Confidence
• Motivation
• Remember when applying this theory a person is willing or unwilling, able or unable

2. Contingency Theory
 This theory asserts that managers make decisions based on the situation at hand rather than a
"one size fits all" (suitable for or used in all circumstances) method.
 A manager takes appropriate action based on aspects most important to the current situation.
Managers in a university may want to utilize a leadership approach that includes participation
from workers, while a leader in the army may want to use an autocratic approach.

3. Systems Theory
 Managers who understand systems theory recognize how different systems affect a worker and
how a worker affects the systems around them.
  A system is made up of a variety of parts that work together to achieve a goal.
 Systems theory is a broad perspective that allows managers to examine patterns and events in
the workplace.
 This helps managers to coordinate programs to work as a collective whole for the overall goal
or mission of the organization rather than for isolated departments.

4. Chaos Theory
 Change is constant.
 Although certain events and circumstances in an organization can be controlled, others can't.
 Chaos theory recognizes that change is inevitable and is rarely controlled. While organizations
grow, complexity and the possibility for susceptible events increase.
 Organizations increase energy to maintain the new level of complexity, and as organizations
spend more energy, more structure is needed for stability.
 The system continues to evolve and change.

5. Theory X and Theory Y

 The management theory an individual chooses to utilize is strongly influenced by beliefs about
worker attitudes.
 Managers who believe workers naturally lack ambition and need incentives to increase
productivity lean toward the Theory X management style.
 Theory Y believes that workers are naturally driven and take responsibility.
 While managers who believe in Theory X values often use an authoritarian style of leadership,
Theory Y leaders encourage participation from workers

LEADERSHIP STYLES IN HEALTHCARE SYSTEM

1. Transactional Leadership
 Transactional leadership highlights the importance of organization, supervision, and
group performance.
 As the name suggests, it views the relationship between healthcare executives and staff
as transactional.
 By accepting their positions, staff members implicitly agree to obey leadership.
 Staff members accept and complete the orders given to them, and in turn healthcare
leaders pay them salaries.
In this type of leadership style, rewards and punishments serve as motivational tools healthcare
executives use to encourage compliance with their directives. For example, when staff members
follow specific procedures, they may earn recognition, but when they fail to follow them, they
can face reprimand.
Transactional leaders emphasize:
 Respect for rules, standards, and procedures
 Clearly defined roles
 Close supervision
 2. Innovative Leadership
 Innovative leadership focuses on how to succeed in unpredictable circumstances and
how to foster an environment conducive to innovation in a healthcare organization.
 Innovative thinking lies at the heart of innovative leadership.
 Innovative thinking, in the context of healthcare leadership, centers on how to contend
with unknown factors and unpredictability. Innovative thinking doesn’t rely on past
experiences, nor does it try to sort out right from wrong. Instead, it envisions ambitious
goals and strategizes how to achieve them through multiple possibilities.
Innovative leaders embrace “what if?” questions and encourage their teams to extend themselves
beyond familiar solution patterns. This approach requires a willingness to stretch conventional
boundaries.
Innovative leaders work to create an organizational culture in which everyone solves problems
using innovative thinking. This involves developing methods that encourage staff members to
think differently about how they face challenges, as well as helping them invent ways to handle
limited or stressed resources.
Beyond establishing an environment that invites innovation from staff members, healthcare
executives using this leadership style seek out ways to conduct their own work and management
of people with more innovation. They begin by evaluating their own roles and functions. They
also examine old, perhaps entrenched problems with new eyes. That may mean reconsidering a
problem’s source or choosing unexpected methods to address a problem.
Innovative leadership offers healthcare executives noted benefits. Because this style of
leadership invites staff members to explore their own ideas, people tend to feel more
intrinsically motivated under innovative leaders. Intrinsic motivation often produces people’s
best work. It can also result in high job satisfaction and reduced turnover.

3. Charismatic Leadership
 Charismatic leaders depend on their ability to communicate in a moving, emotionally
charged way.
 By expressing their visions with power and inspiring trust, they influence those they lead
and persuade them into action.
Qualities characteristic of charismatic leaders include the following:
 Emotional expressiveness involves genuine expressions of feelings that affect how others feel. These
feelings are typically positive but also cross the emotional spectrum.
 Emotional sensitivity involves tapping into how others feel to connect emotionally.
 Emotional control involves regulating emotional displays and not losing composure unless doing so
makes a desired point.
 Social expressiveness involves engaging others to interact socially and having excellent skills as a
public speaker.
 Social sensitivity involves reading social cues and interpreting social situations, and demonstrating
tact and sensitivity as a result.
 Social control involves the ability to connect with all types of people socially and emotionally.
These traits can help unite people around a common goal. They also allow charismatic leaders to
motivate their staff members and get them invested in the visions they set forth. Because
charismatic leaders are mission-driven they often succeed at instituting needed changes in their
healthcare organizations.
Charismatic leadership can have many benefits, such as:
 The ability of charismatic leaders to inspire can strengthen the loyalty and commitment of those they
lead. The social skills of charismatic leaders can create a work environment in which staff members
feel appreciated. This can lower turnover rate and improve engagement.
 Greater innovation. Charismatic leadership focuses on growth and innovation and treats mistakes as
opportunities to learn and develop. In such an environment, staff members are less risk averse and
more likely to find creative solutions to problems.
 Increased productivity. Because charismatic leaders achieve high levels of trust and respect, those
they lead often feel highly motivated to achieve and exceed expectations. This bolstered motivation
often leads to higher-quality work and productivity.
Charismatic leadership relies on best practices. These best practices help healthcare executives
strengthen the charismatic qualities that best serve them.

4. Situational Leadership
 Healthcare leaders who use a situational leadership approach embrace the idea that
different situations call for different leadership styles.
 Situational leaders examine the tasks before them and determine which leadership
approach makes the most sense.
 For instance, when staff members are learning a new task for which they have limited
skills, situational leaders may give many orders but also offer a lot of support. However,
when staff members need to handle tasks for which they are highly skilled, a situational
leader may delegate responsibilities and offer minimal guidance and support.
Situational leadership encompasses four general leadership approaches:
 Telling. Leaders give directives about what to do and how to do it.
 Selling. Leaders convince people to buy into their visions by interacting with them and selling their
ideas.
 Participating. Leaders encourage individuals to get involved by sharing their ideas and engaging in
the decision-making process.
 Delegating. Leaders delegate responsibilities for completing a task and offer only limited input.

5. Transformational Leadership
Transformational leadership focuses on empowering staff members to participate in initiating
changes that can transform a healthcare organization for the better.
Transformational leaders seek ways to share the leadership process with employees across all
positions. The philosophy behind this leadership style is that anyone, regardless of job
description, can exhibit leadership.
Transformational leaders motivate and inspire staff members to work toward the betterment of a
healthcare organization. They engender loyalty by building confidence and a shared vision
among staff.
They also earn respect by developing relationships with and between staff members. While
transformational leaders care about achieving goals, they also focus on the individuals they lead
— committed to their growth, development, and success as well.
Transformational leaders can energize a group, project a clear vision for a team’s goals and
objectives, and provide direction that boosts action. As a result, they tend to succeed in
increasing productivity and improving performance. They also bolster morale and positively
affect job satisfaction.
 Change management is the methods and manners in which a company describes and
implements change within both its internal and external processes.

PRACTICES OF CHANGE MANAGEMENT

 Define clear goals.

 Be honest and transparent.
 Train and reassure your teams.
 Encourage conversations and communicate regularly.
 Listen to your employees.
 Bring your leaders on board.
 Choose the right communication tool.
 Empower your employees.
 Encourage knowledge sharing
 Document and make information easily accessible
 Recognize and reward
 Make it social

PRINCIPLES
PRINCIPLES OF CHANGE

By definition, change management is a structured approach to transitioning individuals, teams, and

organizations from a current state to a desired future state.

Six Principles of Change

1. The belief that you can change is the key to change. This is not the powerlessness message of
the 12 steps but rather the message of self-efficacy. Addictions are really no different from
other behaviors—believing you can change encourages commitment to the process and
enhances the likelihood of success.
2. The type of treatment is less critical than the individual's commitment to change. People can
select how they want to pursue change in line with their own values and preferences. They don't
need to be told how to change.
3. Brief treatments can change longstanding habits. It is not the duration of the treatment that
allows people to change but rather its ability to inspire continued efforts in that direction.
4. Life skills can be the key to licking addiction. All addictions may not be equal; the community-
reinforcement approach, with its emphasis on developing life skills, might be needed for those
more severely debilitated by drugs and alcohol.
 5. Repeated efforts are critical to changing. People do not often get better instantly—it usually
takes multiple efforts. Providing follow-up care allows people to maintain focus on their change
goals. Eventually, they stand a good chance of achieving them.
6. Improvement, without abstinence, counts. People do not usually succeed all at once. But they
can show significant improvements; and all improvement should be accepted and rewarded. It
is counterproductive to kick people out of therapy for failing to abstain. The therapeutic
approach of recognizing improvement in the absence of abstinence is called harm reduction.

PRINCIPLES OF CHANGE MANAGEMENT

Change management is a systematic approach to dealing with the transition or transformation of an

organization's goals, processes or technologies. The purpose of change management is to implement
strategies for effecting change, controlling change and helping people to adapt to change.

TEN PRINCIPLES OF CHANGE MANAGEMENT

1. Address the “human side” systematically. “Transformation causes “people issues”. A formal
approach for managing change — beginning with the leadership team and then engaging key
stakeholders and leaders — should be developed early, and adapted often as change moves through the
organization. This demands as much data collection and analysis, planning, and implementation
discipline as does a redesign of strategy, systems, or processes.”
2. Start at the top. “Leaders themselves must embrace the new approaches first, both to challenge and
to motivate the rest of the institution. They must speak with one voice and model the desired behaviors.
The executive team also needs to understand that, although its public face may be one of unity, it, too,
is composed of individuals who are going through stressful times and need to be supported.”
3. Involve every layer. “As transformation programs progress from defining strategy and setting targets
to design and implementation, they affect different levels of the organization.”
4. Make the case. “confront reality and articulate a convincing need for change…. demonstrate faith
that the company has a viable future and the leadership to get there. Finally, provide a road map to guide
behavior and decision making”
5. Create ownership. “Ownership is often best created by involving people in identifying problems
and crafting solutions. It is reinforced by incentives and rewards.”
6. Communicate the message. “The best change programs reinforce core messages through regular,
timely advice that is both inspirational and practicable. Communications flow in from the bottom and
out from the top, and are targeted to provide employees the right information at the right time and to
solicit their input and feedback. Often this will require over communication through multiple, redundant
channels.”
7. Assess the cultural landscape. “Thorough cultural diagnostics can assess organizational readiness
to change, bring major problems to the surface, identify conflicts, and define factors that can recognize
and influence sources of leadership and resistance. These diagnostics identify the core values, beliefs,
behaviors, and perceptions that must be taken into account for successful change to occur. They serve
as the common baseline for designing essential change elements, such as the new corporate vision, and
building the infrastructure and programs needed to drive change.”
8. Address culture explicitly. “Company culture is an amalgam of shared history, explicit values and
beliefs, and common attitudes and behaviors. Change programs can involve creating a culture (in new
companies or those built through multiple acquisitions), combining cultures (in mergers or acquisitions
of large companies), or reinforcing cultures (in, say, long-established consumer goods or manufacturing
companies)”
9. Prepare for the unexpected. “Effectively managing change requires continual reassessment of its
impact and the organization’s willingness and ability to adopt the next wave of transformation.”
10. Speak to the individual. “Individuals (or teams of individuals) need to know how their work will
change, what is expected of them during and after the change program, how they will be measured,
and what success or failure will mean for them and those around them.”

Change and change management

How Leadership in Health Care is changing
As mobile technology and big data continue placing more strain on health care leadership and
management, patients are expecting more control over their treatment and a quicker response time from
their care providers.
How Changes in Health Care Are Impacting Leadership
The health care environment is becoming more complex, causing health care leaders to struggle as they
try to keep up with new technologies.
Mobile technology is improving patient-doctor connectivity, and patients are demanding timely
responses from a plethora of platforms, including patient networks, telemedicine and social media.

Big data is causing an increased demand for specialized tech roles to ensure compliance with HIPAA
regulations, which is placing a strain on human resources and organizational structure.

According to a report published by the Health Research & Educational Trust (HRET) titled “Building
a Leadership Team for the Health Care Organization of the Future,” 60 percent of health care leadership
teams are larger than they were three years ago.

Mission and vision statements

Vision

A strongly felt aim, ambition, or calling.

Vision statement
A vision statement is a declaration of an organization's objectives, intended to guide its internal
decision-making. A vision statement is not limited to business organizations and may also be used by
non-profit or governmental entities.