Introduction to Health

Services Management

Ayinengida Adamu (BSc , MPH)

Department of Health Economics,
Management and Policy
Jimma University

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 Presentation Outline

• Session Objectives
• Definitions
• What to manage?
• Management Functions/practices
• Principles of Management
• Managerial Levels, Skills and Roles

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 Session Objectives
At the end of this session students are
expected to be able to
– Define the Management and related terms
– Describe the functions of Management
– Explain the principles of management
– Differentiate the attributes of levels of
management
– Identify the roles and skills of management

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 Terms to discuss
• Health
• Health care Vs Health services
• HSOs/HS
• Management

• What meaning would these terms give for

you???
• Do you think that they are important to deal
with???
• How do we use the terms in our day to day
conversations?
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 Definitions of terms
Health
• Non health professionals
– The absence of disease.
• narrow definition
• WHO, (1975) defined:
• A state of complete physical, mental, and
social well-being, not merely the absence
of disease.
• Western societies:
• The maximization of the biological &
clinical indicators of organ function and the
maximization of physical, mental & role
functioning in everyday life. 5
 Definitions of terms

Negative terms and narrow definitions

 Interventions- only in case of life
threatening traumas & illnesses
Positive terms & broad definitions
 A variety of significant interventions to enhance
organ functioning.

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 Definitions of terms
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 or to prevent decrements of
health.
• Can be preventive, promotive, curative or
rehabilitative in nature.

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 Definitions of terms
Health service organizations (HSOs)
• Organizational structure within which the delivery
of health services is directed to consumers.
Health systems
• Are formally linked HSOs, possibly including
financial arrangements, joined together to provide
more coordinated & comprehensive health services

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The six Building blocks of Health
systems

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 Definitions of terms

Management

• Old & universal practice.

– Chinese great wall, Egyptian pyramid, Axum

• However, no universal definition

• Strong underlying similarities among
definitions.

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 Definitions …..
 Getting things done – Shortest
definition
The underling principle of this definition is
'commitment to achievement',
• i.e. commitment to purposeful action, not to
action for its own sake
• “management is saying what one wants to be
done, and then getting it done “
So management ensures that objectives are
specified (i.e. states specifically what is to be
achieved) and then that they are achieved.
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 Definitions …..

 The process composed of interrelated

social and technical functions &
activities, occurring in a formal
organizational setting for the purpose
of accomplishing predetermined
objectives through the use of human
and other resources.

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 Definitions …..
 Peter F. Drucker, "management is an organ;
organs can be described and defined only
through their functions".
 Wagner and Hollenbeck defined management
as
“a process of planning, organizing,
directing, and controlling organizational
behaviors to accomplish a mission through the
division of labor”
• Good management is to organization what
health is to the body
– the smooth functioning of all its parts.
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 Common points
Is a process – a set of interactive &
interrelated ongoing functions and activities

Involves accomplishing organizational

objectives

Use of people human & other resources

But people are the most important
resource

Occurs in a formal organizational setting

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 Definitions …
 In conclusion, Management work
involves establishing organizational
objectives and creating organizational
environment in which the direct work,
aided by support work, can lead to the
accomplishment of predetermined
objectives.

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 What to manage?
• When managing health systems and
services, there is always a question. What
has to be managed?
• Three things to manage are:
A.Volume and coverage of services
(planning, implementation and evaluation)
B.Resources (e.g. staff, budgets, drugs,
equipment, buildings, information)
C.External relations and partners - including
users of services
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 Management
Functions/Practices
 They are group of activities with
common purpose
 The set of social and technical functions
inherent in the management process
includes:
o Planning
o Organizing
o Staffing
o Directing (motivating, leading & communicating)
o Controlling 17
Management Functions

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 Management functions
Planning
Is the function that determines in
advance what should be done.

It is looking ahead and preparing for

the future. It is the process of deciding
the organizational objectives and
charting out ways of attaining those
objectives.
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 Organizing
• It is the process of developing
intentional pattern of relationship
among people and other resources.
• The manager differentiates and
integrates the activities.
• By differentiation is the process of
departmentalization or segmentation of
activities.
• Integration is the process of achieving
unity of effort among various
departments.
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 Staffing
• It is the process of filling and keeping
filled all the organizational positions,
with right people at right places at the
right time.
• It includes several sub function like;
– Recruitment
– Selection
– Transfer and promotions
– Training

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 Leading
According to Keith Davis leadership is the
ability to persuade others to seek defined
objectives enthusiastically.

 It is the human factor which binds a group

together and motivates it towards goals.

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 Controlling
Is a process of,
Establishing performance standards based on
the HSO's objectives,
Measuring actual performance,
Comparing it with the intended result ,
And taking corrective action as necessary.

In other words, it is regulating activities

in accordance with the plan

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 Management functions Vs Levels of managers

• Planning is the most important function of top managers.

• Middle managers fulfill all four management functions
about equally.
• Directing is the most important function of supervisory
managers. 24
 Principles of management
1. Management by objectives(MBO)
 A process in which specific performance
objectives are jointly set by subordinates and
their superiors.
 Progress towards objectives is periodically
reviewed and rewards are allocated on the
basis of progress.
 Each person’s major area of responsibilities is
clearly defined in terms of measurable
outcome

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 Principles of management by
objective (MBO)
 Cascading of organizational goals and
objectives
 Specific objectives for each member
 Participative decision making
 Explicit time period
 Performance evaluation and feedback

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 Principles of management
2. Learning from experience
 Any gap between objectives and obtained
results (achievements) →analysis → discover
causes of the gap
3. Division of labor
 Management attempts to bring about balance
of work among different people concerned.
 Assign the right proportion of each kind of
staff to the task at hand

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 Principles of management
4. Substitution of Resources
 when the resources normally used to provide
service become scarce or too expensive,
different resources may be used to deliver the
same service.
5. Convergence of work
 Working relations should contribute to the
success of each activity and so to the general
goal of the organization

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 Principles of management
6. Functions determine structure
 Determining the function & duties of individual
member is followed by working relations
(structure).
7. Delegation
 Assigning job activities and corresponding
authority to specific individuals within the
organization.

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 Principles of management

8. Management by exception
 Selectivity in handling information &
prioritized decision making
 ‘Don’t postpone decisions until they become
unnecessary.’

9. Short Decision path

 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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Levels , Skills & Roles of Managers

Managers
• Are people formally appointed to
positions of authority in organizations or
systems who:
• enable others to do their direct or support work
effectively
• have responsibility for resource utilization
• are accountable for work results

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 Levels
Levels
– Three levels
– The primary difference between
levels of managers are the
 degree of authority and the
scope of responsibility .

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Levels of management

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 Levels
Top level (senior) managers
 Have authority over and are responsible for
the entire organization
i.e. all staff, resources and
organizational results
 Are accountable to the governing body
 Establish operating policies and guide the
organization with its environment
 Include individuals with the title of
chairperson, president, chief executive
officer, executive vice president, vice
president, or chief operating officer. 34
 Levels
Middle-level managers
• reporting to senior managers
• there are numerous middle level
managers than top managers
• have authority over & responsibility for
a specific segments of the
organization
• Terms such as director or manager
usually used for middle manager—
• e.g director of human resources or
western regional manager. 35
 Levels
First-level (front line) managers
 Oversee the nonsupervisory employees.
 Spend the greatest amount of time actually
directing employees.
 Except for making small, on-the-job
adjustments, they seldom perform planning and
organizing activities.
 Instead, supervisory managers initiate the
upward flow of information that middle and top
managers use to control organizational
behavior.
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 Skills
 There are three distinct types of skills:
1. Conceptual skill
2. Human relation skill
3. Technical skills

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 Conceptual skills
• Reflect the mental abilities of managers to
visualize the complex interrelationships in a
work place .

• Permits managers to understand how the

various factors in particular situations fit
together & interact one another

• Cognitive ability to see the organization as a

whole and relationship among its parts

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Human relations & communication
skills

• Are the abilities of managers to get along well

with other people, to understand them, & to
motivate & lead them in the work place
• The ability to motivate, facilitate, coordinate,
lead, communicate & resolve conflicts.

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 Technical skills

 Are abilities to use the methods,

processes, and techniques of
managing
 It includes:
• Methods & techniques
• Specialized knowledge
• Competent use of tools
• techniques to solve problems in that
specific discipline
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Essential Managerial Skills

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 Managerial Roles

• Managerial role is the behavioral pattern

expected of someone within a functional
unit.
• All mangers have formal authority over
their organizational units & derive status
out of that position.
• The work of managers is viewed as a
series of three broad categories of roles,
(Henry Mintzberg).

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 cont…
1. Interpersonal roles
Figurehead
 Performs ceremonial & symbolic duties
such as greeting visitors, making
speeches at organizational events,
signing legal documents etc.
Leader (influencer)
 direct & motivate subordinates
 seek to motivate, inspire & set
examples through their own behavior
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 cont…
Liaison
 Allows managers in formal & informal
contacts both inside & outside their
organization to establish relationships
that will help them achieve organizational
objectives.
 Interpersonal roles provide managers with
opportunities to gather information.

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 cont…
2. Informational roles
Monitor role
 Managers gather information from
their network of contacts, including
those established in their liaison roles
.
 Filter the information, evaluate it and
decide whether to act as a result of
the information
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 cont…

Disseminator
 This role grows out of the managers’
access to information and his ability
to choose what to do with that
information
 Distributes information to those who
should receive it, both outside and
inside the organization

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 Cont…
Spokesperson
 Is related to the figurehead role
 Communicating the position of their
organizations to internal and external
stakeholders who affect their areas of
responsibilities
 transmit information to people outside
the work unit, keep supervisors informed
or representing the organization in
dealing with the external environment

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 cont…

3 . Decisional roles
 The authority granted by their
organization supported by their
interpersonal and informational roles
permits managers to play decisional
role.

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 Cont..
Entrepreneur
 are initiators and designers of changes
intended to improve performances in
their organizational domains
 act as change agents → initiate
improvement projects, identify new
ideas, delegate idea responsibilities to
others.

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 cont…

Disturbance handler
 detect wide variety of problems &
decides on and implements solutions
 takes corrective action during disputes
or crises and resolves conflicts among
subordinates
 the ability to make good decisions
about handling disturbances is and
important determinant of managerial
success.

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 cont…
Resource allocator
• Prioritize tasks and make decisions
regarding the use of limited resources
to meet conflicting needs to achieve
goals

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 cont…
Negotiator
 Interact and bargain employees, suppliers,
regulators, customers, clients and others.
 Represent departmental interests during
negotiations
 Negotiating includes deciding what
objectives to seek through negotiations
and how to conduct the negotiations.

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Mintzberg’s 10 managerial roles.

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 Managers’ Jobs and the Roles They Fill

When top, middle, and supervisory managers were asked

about the importance of the roles they perform, their
answers provided the data illustrated graphically here.
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• “What we think, know, or believe in is,
in the end, of little consequence. The
only consequence . . . is what we do.”
(Haines, 1995)

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 References
1. WHO, On Being In charge - A Guide for Middle
Level Management in PHC. Geneva
2. Nick Goodwin, Reinhold Gruen and Valerie
Iles, Managing Health services.

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