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  1. 1. 04/02/2023 HSM 1 by Dr Mesfin Addisse 1 INTRODUCTION TO MANAGEMENT OF HEALTH SERVICES Graduate training: Master of Public Health Department of Community Health Instructor(s): Dr.Mesfin Addisse, Dr.Getnet Meteke, Dr.Damene H/Mariam, and honorary staff MANAGEMENT OF HEALTH SERVICES- I
  2. 2. 04/02/2023 HSM 1 by Dr Mesfin Addisse 2 ………  MHS is a two-part course (COMH 608 and COMH 609), designed  to help MPH students have a firm foundation in the principles and tools of management as applied to health.  Thus Emphasis is placed on  on guiding students to acquire the skills to identify and address management problems.
  3. 3. 04/02/2023 HSM 1 by Dr Mesfin Addisse 3 Objectives of the course  Recognize a variety of leadership and management styles and to classify one’s own style of leadership and management.  To understand the importance of and be able to critically appraise an organization’s mission and goals.  To be able to conduct a strategic analysis and elaborate a health plan, including its objectives, strategic and operational plans and a plan for strategic control of progress.
  4. 4. 04/02/2023 HSM 1 by Dr Mesfin Addisse 4 Objectives of the course………..  To understand key models and be able to use basic tools for management decision-making.  To understand the concept of social responsibility and social responsiveness and to develop a sense of professional ethics in management.  To understand the key elements of organizational structure in order to select or modify organizational design to make it effective and appropriate to function.  To be able to conduct an environmental analysis and prepare a plan for managing the organizational environment.
  5. 5. 04/02/2023 HSM 1 by Dr Mesfin Addisse 5 Objectives of the course………..  To develop and understand organizational processes subsystems including  coordination, authority, delegation, decentralization, organizational change, innovation, and organizational development.  To be able to manage human resources, including through  development of skills in human resource planning,  recruitment and selection,  human resource development,  supervision and performance appraisal, and  other aspects of personnel management.
  6. 6. 04/02/2023 HSM 1 by Dr Mesfin Addisse 6 Course outline  Introduction to HSM  Planning  Planning and strategic management  Decision making  Organization  Communication  Management Information System  Motivation and performances  Leadership  Student evaluations: Students will be graded on four criteria: 1) Class attendance & participation 2) Presentation 3) Take-home paper (Assignments) 4) Final examination
  7. 7. 04/02/2023 HSM 1 by Dr Mesfin Addisse 7 References  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.  Rakich, J.S. Managing Health Services Organizations, 2nd edition, 1985.  Rao V.S.P and Narayana P.S. Principles and Practices of management, 1st edition (1987), Konark Publishers.  Hersey P., Blanchard K.H. and Johnson D.E. Management of organizational behavior: Utilizing human resources, 7th edition (1996), Prentice Hall.  Kreitner R. Management. 7th edition (1998), Arizona State University, Houghton Mifflin Company, New York.  Shortell S. M. and Kaluzny A.D. (1997). Essentials of Health Care Management, Delmar Publishers
  8. 8. 04/02/2023 HSM 1 by Dr Mesfin Addisse 8 MODULE 1 INTRODUCTION TO HEALTH SERVICES MANAGEMENT- I
  9. 9. 04/02/2023 HSM 1 by Dr Mesfin Addisse 9 Key Definitions  Health:- is the maximization of the biological & clinical indicators of organ function & the maximization of physical, mental, & role functioning in every day life.  Health care:- is the total societal effort, undertaken in the private & public sectors, focused on pursuing health.  Health services:- are specific activities within the larger domain of health care undertaken to maintain or improve health or to prevent decrements of health.  Health service organizations:- are entities that provide the organizational structure within which the delivery of health services is made directly to consumers, whether the purpose of the services is preventive, acute chronic, restorative or palliative.
  10. 10. 04/02/2023 HSM 1 by Dr Mesfin Addisse 10 UNIT 1:  ORGANIZATIONS AND THE NEED FOR MANAGEMENT  Objectives: Define relationships between management and organization Identify and discuss the management process Discuss on the managerial roles, types of managers and skills required
  11. 11. 04/02/2023 HSM 1 by Dr Mesfin Addisse 11 Definitions and concepts  What is the experience of this class?  Are /were you a member of any organization?  Organization  Two or more people who work together in a structured way to achieve a specific goal or set of goals.  formal and informal  In both people are kept together  believing there is a benefit working together to achieve a common goal  What does goal mean ?
  12. 12. 04/02/2023 HSM 1 by Dr Mesfin Addisse 12 Defn……  Goal : The purpose that organization strives to achieve.  GOALS are the fundamental elements of an organization. Why?  Goal is the reason to exist and an organization can not exist without a goal  An organization can have more than one goal  What do all organizations need to achieve goals? To achieve goals all organizations should  Have a method and  Have to acquire and allocate resources Thus the need for management. What is management?
  13. 13. 04/02/2023 HSM 1 by Dr Mesfin Addisse 13  The process of planning, organizing, staffing, leading, and controlling the work of organization members and of using all available organizational resources to reach stated organizational goals.  It is a process of reaching (predetermined) organizational goals by working with and through people and other organizational resources (finance, equipment, information, and information).  It is a process of utilizing efficiently the available resource to achieve organizational goals.  It is the practice of consciously and continually shaping organizations.  Planning:-managers think through their goals and actions in advance.  Organizing:-managers coordinate the human and material resource of the organization.  Leading:- how managers direct and influence subordinates, getting others to perform essential tasks.  Controlling:-managers attempt to assure that the organization is moving toward its goals. Management
  14. 14. 04/02/2023 HSM 1 by Dr Mesfin Addisse 14 Manag…..  Whether formal or informal organizations managers are BASIC. (???? Management process occurs in a formal organizational setting)  Who are the managers?  Why are they basic?  In all organizations managers are essential. Because managers are:  People responsible for directing the effort’s aimed at helping organizations achieve their goals  People responsible for helping organization members set and reach goals. Definition: HSO/HS managers are people formally appointed to positions of authority in organizations or systems who enable others to do their direct or support work effectively, who have responsibility for resource utilization, & who are accountable for work results.
  15. 15. 04/02/2023 HSM 1 by Dr Mesfin Addisse 15 Exercise  Discuss on the goals of the organization that you have worked for.  What are the reasons for the existence of the organization?  Why do we study organizations and management?
  16. 16. 04/02/2023 HSM 1 by Dr Mesfin Addisse 16 Reasons For Studying Organization & Management  1. Living in the Present :  organizations have role on the standard of living  We relay on organizations daily for food, clothing, medical care, etc. 2. Building the Future:  Organizations work or move to the desirable future;  new treatment for diseases, new practices, new products, new management, etc.  Positive/Negative impact
  17. 17. 04/02/2023 HSM 1 by Dr Mesfin Addisse 17 Reasons For Studying Organization & Management……. 3. Remembering the Past :  Connections to the past history.  Patterns of human relationship  People define themselves in terms of the organization they have been a part of.  Keeping record and value own history and keeping traditions alive.  How would history be important? Give some examples of organizations and their history.
  18. 18. 04/02/2023 HSM 1 by Dr Mesfin Addisse 18 Management as a specialty in time and human relationships  Management deals with time  Time Management is to create a desirable future.  Management is either practiced or is a reflection of a particular historical era.  Management produces effects that emerge over time.  Organizations, managers and other individuals deals with time  Management deals with human relationships  Managers act in relationships : two-way streets. Influence on both sides  Managers act in relationships that have spillover effects for other people. Better or worse  Managers juggle multiple simultaneous relationships.  Organizations, managers and other individuals think about future human relationships and  About new relationship and modify existing ones.
  19. 19. 04/02/2023 HSM 1 by Dr Mesfin Addisse 19 Managing and managers  Managers and organizational performance
  20. 20. 04/02/2023 HSM 1 by Dr Mesfin Addisse 20 Managing and managers  Managers and organizational performance  Management is a major and PRINCIPAL activity that is responsible to make a difference how the organization  is doing, affecting and affected by people.  Thus there is a need for measuring Managers and organizational performance.  Managerial performance measures  How efficient and effective a manager is.  How well a manager determines and achieves organizational objectives.  Organizational performance: measures  How efficient & effective an organization is.  How well it achieves it’s objectives.
  21. 21. 04/02/2023 HSM 1 by Dr Mesfin Addisse 21 Managing and managers……..  Which one is the best for managers / organizations, efficiency or effectiveness?  Effective management is the main resource of developed countries  Effective management is the most needed resource of developing countries  Efficiency: the ability to minimize the use of resources in achieving organizational objectives. “Doing things right.”  Effectiveness: the ability to determine appropriate objective. “Doing the right thing.”
  22. 22. 04/02/2023 HSM 1 by Dr Mesfin Addisse 22 The Management process  Management: different definitions but common elements:  Management is a process : a set of interrelated and interactive on-going activities and functions.  Process: a systematic method of handling activities.  Involves achieving goals  Involves achieving goals through people and utilization of other resources  Occurs in formal organization setting  Management is a process: a set of interrelated and interactive on-going activities and functions. What does this definition imply ?
  23. 23. 04/02/2023 HSM 1 by Dr Mesfin Addisse 23 Functions : Management functions  describes how managers do what they do.  Basic management functions or activities that make up the management process are: i) Planning  It is the process of establishing goals and a suitable course of action to achieve the goals.  Helps to deal with the present and anticipate the future. Planning:-managers think through their goals and actions in advance.  It involves what to do, how to do and when to do  Planning is a primary management function. Why?  Through planning managers clearly put and outline exactly what organizations must do to be successful.
  24. 24. 04/02/2023 HSM 1 by Dr Mesfin Addisse 24 The Management functions …………. ii) Organizing  Organizing:-managers coordinate the human and material resource of the organization.  Organizing creates a mechanism to put plans into action. How?  Through Assigning the tasks developed during planning to individuals/groups within the organization.  It is the process of arranging and allocating work, authority and resources among organization members to achieve goals.  It involves establishing authority & responsibility relationships; division of work, job design, coordination, information and feedback systems in the organization.
  25. 25. 04/02/2023 HSM 1 by Dr Mesfin Addisse 25 The Management functions ………….  Do we need different structures for different goals.  Do we need different structures depending on the available resources?  Organizational design: The process of matching an organizational structure to goals and resources. How do you address relationships and time in this process? New people to join the structure of relationship: staffing (is both technical and social)
  26. 26. 04/02/2023 HSM 1 by Dr Mesfin Addisse 26 The Management functions …………. iii) Leading (directing, motivating, and communicating)  Primarily concerned with people in the organization.  It is the process of directing and influencing the task-related activities of group members or an entire organization.  The process of guiding the activities of organization members in appropriate direction.  Influencing ,directing , actuate (activate ,motivate)  Time and relationships.
  27. 27. 04/02/2023 HSM 1 by Dr Mesfin Addisse 27 The Management functions …………. iv) Controlling  The process of ensuring/ conforming the actual activities in relation to planned activities.  A function for which managers:  Establish standards of performance  Gather information and Measure current performance  Compare performance with standard  Taking corrective action  Rewarding
  28. 28. 04/02/2023 HSM 1 by Dr Mesfin Addisse 28 The Management functions …………. v) Decision Making  Choosing between or among alternatives.  a function made at all levels from planning up to controlling.  Senior managers make policy decissions and resource allocation decisions that affect the entire and various parts of the organizations.  Middle- and first-level managers make decisions about allocating and utilizing resources provided by senior management within their areas of authority and responsibility.
  29. 29. 04/02/2023 HSM 1 by Dr Mesfin Addisse 29 The Management functions ………….  . PLANNING (deciding in advance what is to be done) ORGANIZING (developing international patterns of relationships among people and other resources) DECISION MAKING (Choosing between or among alternatives) STAFFING (Acquiring, maintaining, and retaining human resources) DIRECTING (Initiating work in the organization) CONTROLING (Regulating activities in accordance with plans)
  30. 30. 04/02/2023 HSM 1 by Dr Mesfin Addisse 30 The Management functions ………….  Time and relationships?  Through time do all the established relations work.  To be successful which function must be performed well by managers?
  31. 31. 04/02/2023 HSM 1 by Dr Mesfin Addisse 31 Types of managers and managerial roles A. Classification by management level  Traditional by level in the hierarchy First-line (or first/ low level) ,Supervisory mangers: Middle managers: Middle level Top/ senior managers : high level  Other classification Policy level Administrative or coordinating level Operations level
  32. 32. 04/02/2023 HSM 1 by Dr Mesfin Addisse 32 1. First-line (or first/ low level) ,Supervisory mangers:  Responsible for the work of operating and do not supervise other managers  Direct non management employees and have authority and responsibility for overseeing a specific type of work and a particular group of workers.  First or lowest level of managers in the organizational hierarchy.
  33. 33. 04/02/2023 HSM 1 by Dr Mesfin Addisse 33 2. Middle managers  Managers in the midrange of the organizational hierarchy  They are responsible for other managers and sometimes for some operating employees  They report to more senior managers 3.Top managers / senior  Mangers responsible for the overall management of the organization  They establish operating policies and guide the organization’s interaction with its environment.  Small in number
  34. 34. 04/02/2023 HSM 1 by Dr Mesfin Addisse 34  List types of managers for the three levels by choosing one organization. 1. First-line mangers: Supervisors, School directors, Coaches, Technical supervisor 2.Middle director Department heads, Heads of services 3. Top managers: executive officer, president vice president
  35. 35. 04/02/2023 HSM 1 by Dr Mesfin Addisse 35  Are there different names for a manager? Different names of manager include executive administrator, leader, boss, principal, chief, supervisor, senior manager, superintendent, commissioner, overseer, officer, Coach ,President, Executive, Prime minister etc. Attributes common to all regardless of title or level  formally appointed to positions of authority by the organization  directing work efforts of others subordinates and non subordinates  responsible utilization of organizational resources  accountable to superiors for work results
  36. 36. 04/02/2023 HSM 1 by Dr Mesfin Addisse 36 Are non-managers  responsible for utilization of organizational resources?  accountable to superiors for work results?  Senior, middle, and first level managers are responsible for very different types of activities. But all of these activities are important and no organization can be successful unless the management work at each level is done well and unless the work at each level is carefully integrated with that done at the other levels.  If both are responsible,  What is the difference between managers and non managers?  The non managers are not formally appointed to positions of authority by the organization for directing work efforts of others.
  37. 37. 04/02/2023 HSM 1 by Dr Mesfin Addisse 37 B. Functional and general manager Classification based on scope of activities  Functions: Refers to a group of similar activities in an organization, such as marketing, production, finance.  Functional Manager: Responsible for one organizational functional area/activity e.g. finance, human resource management  General Manager: Responsible for all functional activities e.g. a company’s functional activities such as production, sales, marketing, and finance.
  38. 38. 04/02/2023 HSM 1 by Dr Mesfin Addisse 38  Is it possible to have more than one general manager in an organization?  Do both functional and general managers perform the four management functions?  Yes, the difference is in the scope of activities they oversee.  The primary differentiation between levels of managers is the degree of authority and scope of responsibility and organizational activity.
  39. 39. 04/02/2023 HSM 1 by Dr Mesfin Addisse 39 c) Management level and skills  major resource  primary determinant for a manager to be effective and efficient  performance and personality traits  Three basic types of skills are needed for successful management 1.Technical skill:  the ability to use procedures, techniques and knowledge of a specialized field  using specialized knowledge and expertise in executing work related techniques and procedures.  Related to things :process or physical objects
  40. 40. 04/02/2023 HSM 1 by Dr Mesfin Addisse 40 Management level and skills…… 2.Human (interpersonal) skill : the ability to work /get along with, understand, motivate, and lead other people as individuals. builds cooperation among the team. Working with people : Attitude, communication. 3.Conceptual skill: Ability to see the organization as a whole (the mental abilities of managers to visualize the complex relationships in a workplace-among people, among departments, among various organizations…).  A manager with this skill has the ability or better understand how various functions of the organization complement one another  The relationship of the organization to its environment  How changes in one part of the organization affect the rest of the organization
  41. 41. 04/02/2023 HSM 1 by Dr Mesfin Addisse 41 Management level and skills……  All managers use all these three types of skills in performing management work but in different mix (degree).  The senior manager is vitally concerned with how the service in general fits into the organization.  In contrast the low level manager, whose primary function is to troubleshoot an entire operating staff, may be constantly required to make decisions on the basis of technical knowledge of procedures while rarely having time to think about the relationship of the specific service to other departments of the organization. Which skill is needed by all managers?  Because the common denominator are people at all levels, an inability to work with people, not a lack of technical skills, is the main reason some managers fail to reach their full potential.  A manager with Human skill  Knows weaknesses and strengths,  Knows how feelings hurt others. Choose  Either people have to be controlled Vs self discipline  Do not make wrong judgments about people without studying contents of information.
  42. 42. 04/02/2023 HSM 1 by Dr Mesfin Addisse 42 Managerial Roles In addition to engaging in the function of management managers also perform other activities associated with certain management positions. Two ways to answer the question, "What do managers do?" are  the functional approach (traditional) and  the role approach ( depicted by Henry Mintzberg)  Managerial functions relate to the desired outcomes of managerial action,  Managerial roles categorize managers' actual behavior.
  43. 43. 04/02/2023 HSM 1 by Dr Mesfin Addisse 43 The Managerial Roles…… Henry Mintzberg  concluded from his observation of managers that management is best explained in terms of roles.  criticized the functional approach:  for making management appear to be simple, more orderly /Methodical /neat than it really is.  Managers practically adopt certain patterns of behavior (roles) when feeling managerial positions.  The ten facts of managerial life, derived from direct observation, characterize managers as hard- working and busy people who engage in many and varied, primarily oral, interactions with others.  Three managerial role categories (of a formal authority and status), according to Mintzberg, are interpersonal, informational, and decisional.
  44. 44. 04/02/2023 HSM 1 by Dr Mesfin Addisse 44 The Managerial Roles…… 1)Interpersonal Roles-  The tree interpersonal roles managers play are as:- a) figurehead - they engage in activities that are ceremonial and symbolic in nature; as a symbol of legal authority, attending ceremonies, signing documents, etc. b) liaison - role involves formal and informal contacts beyond the vertical chain of command (both inside and with external stakeholders), to establish relationships that will help them achieve organizational objectives. i.e. links in horizontal as well as vertical chain of communications c) influencer - role includes motivating & leadership when they seek to inspire, and set examples through their own behavior. i.e. managers are accountable, responsible, & motivator.
  45. 45. 04/02/2023 HSM 1 by Dr Mesfin Addisse 45 The Managerial Roles…… 2) Informational Roles – The three informational roles are: a) Monitor - filter, evaluate and choose to act or react to that information. b) Disseminator - role involves choosing to disseminate the information. communicating selected information to subordinates c) Spokesperson - represent and speak on behalf of the organization. communicating selected information to outsiders
  46. 46. 04/02/2023 HSM 1 by Dr Mesfin Addisse 46 The Managerial Roles…… 3) Decision-Maker Roles- The authority granted by their organization & supported by their interpersonal & informational roles; permits managers to play decisional roles. There are four decision maker roles: a) Entrepreneur /Change agent: designing and initiating changes within the organization .organizations are internally dynamic and continuously affected by the environment. Unless managers act ? b) Disturbance Handler-They handle both internal and external disturbances and take corrective action. They anticipate disturbances and resolve conflicts. c) Resource allocator - managers decide who gets what based on priority setting. d) Negotiator - managers choose how to interact with their superiors, peers, and subordinates. i.e. Negotiating with other parties representing organizational interests.
  47. 47. 04/02/2023 HSM 1 by Dr Mesfin Addisse 47 The Managerial Roles…… Roles are interrelated: Liaison ,information, decision making…  A key message on role of managers is they have to be very versatile when it comes to dealing with human relationship.  When the interconnected roles are each played well, the result is synergistic.  Being a good negotiator makes a manager a better disturbance handler.  Playing the information roles effectively improves performance in the decisional roles because managers have information with which to make decisions.
  48. 48. 04/02/2023 HSM 1 by Dr Mesfin Addisse 48 The Managerial Roles: Roles are interrelated ……  Different levels of these roles is used at different levels of managers & by different individuals.  Senior managers engage in figure head, entrepreneur, and spokesperson roles more frequently than do other managers.  Middle level managers often are heavily involved in disturbance handler and resource allocator roles, and many of them rely on their abilities to successfully play their informational roles as a key ingredient in their work.  First level managers may play leader , disturbance handler, and negotiator roles extensively in their daily work. Exercise  Provide prominent examples of interpersonal roles that you had as a manager or have observed from a manager.  Provide prominent examples of informational roles that you had as a manager or have observed from a manager.  Provide prominent examples of decision-making roles that you had as a manager or have observed from a manager.