HEALTH SERVICE MANAGEMENT

T(MPH))
Girmay T(MPH

College of Medicine and Health

Sciences
DMU
December , 2014

03/07/20
Course Objectives
2

At the end of the lesson/course students will able to:

 Define management and explain the managerial
functions, roles and skills needed to manage
effectively
 Identify how management has gone and reached to the
modern era.
 Discuss the impact of external environment on
management.
 Define planning , identify the types and design proper
health plans.

03/07/20
Course Objectives
3

 Develop the skill of decision making.

 Identify the key elements of organizing and
organizational structure
 Manage human resource properly;
 Explain what human resources involve and how to
manage others resources.
 Explain the theories and styles of leadership
 Discuss the theories of motivation

03/07/20
Course Objectives
4

 Discuss the significance of working in group and

appreciate team effectiveness.
 Describe organizational control from a strategic
perspective ; identify the types of control and
component of common to all control system
 Discuss the components and principles of PHC
 Discuss the management of health system

03/07/20
Introduction
5

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

03/07/20
Introduction…..
6

Organization
 collections of people who work together and coordinate
their actions to achieve a wide variety of goals
 Two or more people who work together in a structured
way to achieve a specific goal or set of goals.
 believing there is a benefit working together to achieve
a common goal
 What does goal mean ?

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Organization
7

 Goals :The purpose that organization strives to achieve.

 GOAL is the fundamental element of an organization.

 Organizational goals are important for at least four

reasons:
[Link] Provide A Sense Of Direction.

 Without a goal, individual and their organizations tend to

muddle along, reacting to environmental changes without a
clear sense of what they really want to achieve.
By setting goals, people and their organizations bolster
their motivation and gain a source of inspiration that helps
them overcome the inevitable obstacles they encounter.

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Organization…
8

2. Goals Focus Our Efforts.

 Every person and every organization has
limited resources and a wide range of possible
ways to use them.
 In selecting a single goal or set of related goals,
we establish priorities and make a commitment
about the way we will use our scarce
environment.
 This is especially important at an organization,
where managers must coordinate the actions of
many individuals.
03/07/20
Organization…
9

3. Goals Guide Our Plans And Decisions.

People at organizations face similar decisions,
which are clarified by asking, What is our goal?
Will this action moves us toward or away from our
organizational goal?
4. Goals Help Us Evaluate Our Progress.
A clearly stated, measurable goal with a specific
deadline becomes a standard of performance that
lets individuals and managers alike evaluate their
progress. Thus, goals are an essential part of
controlling.

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Organization…
10

What do all organizations need to achieve goals?

To achieve goals all organizations should
 Have a method and

 have to acquire and

 allocate resources

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What is Management?
11

- Getting things done through people.

- The efficient use of resources.
- Getting people to work harmoniously
together and to make efficient use of
resources in order to achieve objectives.

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Management
12

 Samuel C. Certo: “Modern Management”

- It is the process of reaching organizational
goals by working with and through people
and other organizational resources.

 Central to this process is the

effective and efficient use of limited
resources.

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Management
13

 Is a process of utilizing efficiently the available

resource to achieve organizational goals.
 The practice of consciously and continually shaping
organizations.

 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.

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Management
14

 What is manager?
 A manager is a person who plans, organizes, leads
and controls human, financial, and other resources
to meet organizational goals.

03/07/20
Importance of Management
15

 Management is universal and necessary

function.
 It is essential for all kinds of organizations.
This is because every organization requires:
 making of decisions,
 coordinating of activities,
 handling of people, and
Evaluating the performance directed
toward its objectives
03/07/20
Managerial and Organizational Performance
16

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 objectives.

What do efficiency and effectiveness refer to?

03/07/20
Managerial Concerns…
17

Efficiency: The ability to minimize the use of

resources in achieving organizational objectives.
 Doing things right.

Effectiveness: The ability to meet organizational

objectives; the ability to determine appropriate
objectives.
 Doing the right thing.

03/07/20
Efficiency and Effectiveness in Management
18

Efficiency (Means) Effectiveness (Ends)

Resource Goal
Usage Attainment

Low Waste High Attainment

Management Strives for:

Low Resource Waste (high efficiency)
High Goal Attainment (high effectiveness)

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19

03/07/20
Types, Skills and Roles of Managers
20 Classification by management level
Traditional by level in the hierarchy
 First
First--line (or first/ low level) ,Supervisory mangers:
 Middle managers:
managers Middle level
 Top/ senior managers : high level

Top
Managers
Middle Managers
First-Line Managers
Nonmanagerial Employees
03/07/20
Types of Managers
21

1. First
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/lowest level of managers in the organizational
hierarchy.
03/07/20
Types of Managers…
22

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

03/07/20
Types of Managers…
23

[Link] 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
Exercise
 List types of managers for the three levels by choosing
one organization.
 Are there different names for a manager? List.

03/07/20
Types of Managers…
1. First-line mangers: Supervisors, School directors,
24

Coaches, Technical supervisor

[Link] managers: Department heads, Heads of
services
3. Top managers: Executive officer, president vice
president
Different names of manager include
executive administrator ,leader, boss, principal, chief,
supervisor, senior manager, superintendent,
commissioner, overseer, officer, Coach ,President,
Executive, Prime minister etc.

03/07/20
Types of Managers…
25

What are the Attributes common to all managers

regardless of title or level?
 formally appointed to positions of authority by the
organization
 directing work efforts of others subordinates and
non subordinates
 responsible for utilization of organizational
resources
 accountable to superiors for work results

03/07/20
Types of managers…
26 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.
Are non-managers,
 responsible for utilization of organizational
resources?
 accountable to superiors for work results?
If both are responsible,
 What is the difference between managers and
non managers?
03/07/20
Types of managers…
27

 The non managers are not formally appointed to

positions of authority by the organization for
directing work efforts of others.
Classification based on scope of activities: Functional
and general manager
 Functions: Refers to a group of similar activities in an
organization, such as marketing, production, finance.
 Functional Manager:
Manager Responsible for one
organizational functional area/activity e.g. finance
 General Manager:
Manager Responsible for all functional
activities e.g. a company
03/07/20
Managerial Skills and Management Level
28  Three basic types of skills for successful management
[Link] Skill
2. Human Relation Skill
3. Conceptual Skill

03/07/20
Managerial Skills…
29

[Link] 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
03/07/20
Managerial Skills…
30
[Link] skill
 the ability to work with, understand and motivate other
people as individuals.
 The ability to understand, alter, lead, and control the
behavior of other individuals and groups.
 builds cooperation among the team.

3. Conceptual skill
 Ability to see the organization as a whole.
 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 affects

the rest of the organization
03/07/20
Managerial Skills…
31
Which skill is equally 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.

03/07/20
Management level and skills
32

03/07/20
What do managers do?

33 Functional Approach
 Planning
 Defininggoals, establishing strategies to
achieve goals, developing plans to integrate and
coordinate activities.
 Organizing
 Arranging and structuring work to accomplish
organizational goals.
 Leading
 Working with and through people to accomplish
goals.
 Controlling
 Monitoring, comparing, and correcting work.
03/07/20
Roles of Managers(Mintzberg )
34

Interpersonal
Decisional role
Entrepreneur
roles
Disturbance Figurehead
handler Leader
Resource Liaison
allocator
Negotiation

Informational
role
Monitor
Disseminator
Spokesperson
03/07/20
Roles of Managers
35

Three managerial role categories, according to

Mintzberg, are interpersonal, informational, and
decisional.
1. Interpersonal Roles
The three 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

03/07/20
Roles of Managers
36

B. Liaison - role involves formal and informal

contacts beyond the vertical chain of command
(inside and outside).
 links in horizontal as well as vertical chain of
communications
C. Influencer - role includes motivating and
leadership. accountable, responsible, and motivator

03/07/20
Roles of Managers
37

2. Informational Roles-The three informational roles

are:
A. Monitor - filter, evaluate and choose to act or
react to that information.

B. Disseminator - 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

03/07/20
Roles of Managers
38
3. Decision-Maker Roles- There are four decision
maker roles:
A. Change agent: organizations are internally
dynamic and continuously affected by the
environment.
Entrepreneur: designing and initiating changes
within the organization
B. Disturbance Handler - They handle both internal
and external disturbances. They anticipate
disturbances and resolve conflicts.

03/07/20
Roles of Managers
39

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.
 negotiating with other parties representing
organizational interests

03/07/20
ORGANIZATIONS AND ENVIRONMENTS

40 Organizations are neither self sufficient or self

contained
 Dependent for input and out put

 Management performs all the functions of

management in interaction with its environment

Management through its functions (planning,
implementation and evaluation) and in interaction
with the environment converts inputs (materials,
technology, information, finance, human resource,
time, etc) into outputs (products, services)

03/07/20
ORGANIZATIONS AND ENVIRONMENTS
41

External environment:

 All elements outside an organization that are relevant to

its operation

 It includes the direct-action and the indirect.

 1) Direct-action elements: directly influence an

organization’s activities.

 Individuals/groups

 Examples: stakeholders.
03/07/20
Cont….
42

Indirect-action elements:
 Social variables: demographics, lifestyles
 Technological variables: new developments in
products, processes and materials.
 Economic variables: national income, per
capita income, employment, etc.
 Political variables: policies, laws and
regulations

03/07/20
Components of external Env’t
43 Political
 Policy

 Political institution/organization

 Government officials/institutions

Economic and Business Communities

 Suppliers

 Clients

 Farmers

 Merchants

 Other stakeholders

03/07/20
Components of external Env’t…
44
Social
 Community

 Leaders

 Man in the street

 Others

Technological
 Medical equipment

 Strategies

National and International Issues

 Change in national and international situations

03/07/20
Concepts of Management
45 Philosophical mindset ideas.
Effectiveness
 It is the degree to which stated objective is being
achieved.
Efficiency
 It is concerned with the balanced use of resources in
relation to outcome.
Economy of Scarce Resources
 Some and often many resources are scarce and costly
thus we have to economize.

03/07/20
Concepts of management…
46
Work Relations
 Work activities should be designed and structured so as

to support each other towards the achievement of

objectives
Information
 Management needs information if it is to make the right

decision. Information should be:

 the right type/kind
 at the right time

 at the right place and

 in the right hands

03/07/20
Principles of management
47 Management by Objective
Management sees that objectives are specified then that
they are achieved.
The objectives should state:
 What is to be accomplished?
 How much of it?

 Where it is to be done.

 When it is be completed.

03/07/20
Principles of management
48
Learning from Experience
 Analysis of the results between the objectives and
achievement made.
 For better performance there should be feedback to
learn from experience.
Division of Labour
 Management attempts to bring about balance of

work among the different work and among the

different people concerned

03/07/20
Principles of management

49 Substitution of Resources
 Often when the resources that are normally used to

provide service became scarce or too expensive,

different resources may be used to provide the
intended results.
Convergence of Work
 Working relations should contribute to the success of
each activity and so to general effectiveness

03/07/20
Principles of management
50
 These working relations of activities are:
 The logical relations with each other
 Time relations or sequence
 Spatial relations between activities
 Functional and structural working relations between
people.
Functions Determine Structure
 When the work is defined i.e. the function and duties of
the individual members of the team are clearly defined
and known to all, the working relations (structure) follow.
 The exact nature of authority will be clearly delineate
on the structure.
03/07/20
Principles cont…
51 Delegation
 Delegation takes place when somebody’s authority is
lent so as to enable that person to take responsibility
when the occasion arises.
Management by Exception
In effect this means two things:
 Do not be overloaded with the routine and
unnecessary information, be selective.
 Make BIG decision first.

In short management by exception means:

 Selectivity in information and priority in decision
03/07/20
Principles cont…
52

Shortest Decision-path
This principle deals with issues like:
 Who should make which decision?
 When and where?
 Decision must be made as closely as possible
in time and place to the object of decision
and to those affected by it.

03/07/20
History of Management Thought
53

 Learning Objectives :
 Understand the historical context how the different
management theories developed.
 Distinguish the different approaches of
management theory.

03/07/20
Management Thoughts/Schools
54

 They are theoretical frameworks for the study of

management.
 Each of the schools of management thought are
based on somewhat different assumptions about
human beings and the organizations for which they
work.
 Different writers have identified as few as three and
as many as twelve.

03/07/20
The Evolution of Management Thoughts/Schools
55  Formal organizations existed for many centuries. such as:
 The Greek and Roman armies,
 The Roman Catholic Church,
 Period of industrial revolution,
 Early 1900’s
Did we have similar management experience in Ethiopia and
Africa?
 The pyramid
 The Axum monument
 The Lalibela churches
 The Adwa war
 To do great pyramids the Egyptians
 mobilized human and material resources
 have to plan, implement ,coordinate , control and report.
03/07/20
Management Thoughts/Schools
56

Why Do We Study Management Theory?

 A theory is a coherent group of assumptions put
forth to explain the relationship between two or
more observable facts.
 Theories are perspective with which people make

sense of their world experiences

03/07/20
Management Thoughts/Schools
57

Thus theories
 provide a stable focus for understanding what we
experience.
 provide criteria for determining what is relevant.
 enable us to communicate efficiently and thus move into more
complex relationships with other people.
 Theories make it possible and challenge us to keep
learning about our world.
Because
 theories have boundaries and everything cannot be covered
by any one theory.

03/07/20
Management Thoughts/Schools
58

 There is no universally accepted theory of

management.
 Knowing the evolution help us to know how it
was , how it is now and where it is heading

03/07/20
1. Classical organization theory
59

 Emerged in early part of the twentieth century.

 Features
 Strict
CONTROL of workers
 Absolute CHAINS of COMMAND
 PREDICTABILITY of behavior
 UNIDIRECTIONAL downward influence

03/07/20
Classical organization theory…
60

 PROBLEMS
 Creativityand intelligence are underutilized
 Increased dissatisfaction
 Decreased motivation and commitment to task and
organization
 Decreased communication effectiveness and satisfaction

03/07/20
Classical organization…
61

Scientific Management Theory

 Production-oriented field of management dedicated to
improving efficiency and minimizing waste.
 focuses on ways to improve the performance of
individual workers.
 Father of The scientific management school

 Frederick [Link] (1856-1915)

03/07/20
Scientific Management Theory
62

Major premises
 there is always one best way and has to be discovered and put in

action
 Managers are intelligent; workers are and should be ignorant

 Provide opportunities for workers to achieve greater financial

rewards
 Workers are motivated almost solely by wages

 Maximum effort = Higher wages

 differential rate system.

Frederick W. Taylor saw workers soldiering or deliberately working

beneath their potential and designed a 4-step method to
overcome this problem 03/07/20
Scientific Management Theory…
63

1. breaking the job into its smallest pieces.

2. to select the most qualified employees to
perform the job and train them to do it.
3. supervisors are used to monitor the
employees to be sure they are following the
methods prescribed.
4. continue in this fashion, but only use
employees who are getting the work done.

03/07/20
Scientific Management Theory…
64

In summary : the four principles are:

 Development of a true science management.

 Scientific selection of workers.

 Scientific education and development of workers.

 Intimate, friendly cooperation between manager

and labor.

03/07/20
Scientific Management Theory…
65

HENRY L. GANTT (1861-1919)

 worked with Taylor

 Gantt reconsidered Taylor's incentive system.

 Unlike the differential rate system as having too little

motivational impact, Gantt idea.
 Every worker who finished a day's assigned work
load would win a 50-cent bonus.
 Supervisor would earn a bonus for each worker
who reached the daily standard, plus an extra
bonus if all the workers reached it.
03/07/20
Scientific Management Theory…
66

Frank B. and Lillian M. Gilbreths (1868-1924 and

1878-1972)
 a husband and wife team

 helped to find more efficient ways for workers to

produce output.
 Work on fatigue and motion studies

 focused on ways of promoting the individual

worker's welfare.

03/07/20
67

 Scientific management was concerned with

increasing the productivity of the shop and the
individual worker
While
 Administrative mgt theory grew out of the need to
find guidelines for managing such complex
organizations as factories.

03/07/20
Administrative management Theory
68

HENRI FAYOL (1841-1925)

 founder of the classical management school

 organizational functions versus the total organization
 Taylor was basically concerned with organizational functions
 Fayol was interested in the total organization.
 Henry Fayol's universal approach assumes that all
organizations, regardless of purpose or size, require
the same management process; and this rational
process can be reduced to separate functions and
principles of management.
03/07/20
Cont’d…
69

 General and Industrial Management

 Principles and Elements of Management - how managers
should accomplish their managerial duties
 Primary focus: Management
(Functions of Administration)
 More Respect for Worker than Taylor
 Workers are motivated by more than money
 Equity in worker treatment

03/07/20
Administrative mgt…
70

Fayol’s 14 Principles of management

1. Division of Labor: The more people specialize, the
more efficiently they can perform their work.
 Effort and attention are focused on special portion
of the task.
 Work specialization is the best way to use human
resource.

2. Authority: Managers must give orders so that they

can get things done.
 Authority and responsibility should be closely
related.
03/07/20
Administrative mgt…
71

3. Discipline: Members in an organization need to

respect the rules and agreements that govern the
organization.
 discipline results from good leadership at all
levels of the organization, judiciously enforced
penalties for the sake of promoting common
efforts.

4. Unity of Command: Each employee must receive

instructions from only one person.
 reporting to more than one manager conflicts in
instructions and confusion of authority

03/07/20
Administrative mgt…
72

5. Unity of Direction: The entire organization should be moving

toward a common objective ,in a common direction.

6. Subordination of Individual Interest to the Common Good: In any

undertaking, the interests of employees should not take
precedence over the interests of the organization as a whole.

7. Remuneration: Consideration of variables such as cost of living

,success of the organization etc. to determine rate of payment. to
both employees and employers.

8. Centralization: Decreasing the role of subordinates in decision

making is centralization;
 increasing their role in decentralization, Fayol believed that
managers should retain final responsibility,
03/07/20
Unity of Command
73

 It implies that a sub-ordinate should receive orders &

instructions from only one boss.
 Nature - It is related to the functioning of personnel’s.
 Necessity- It is necessary for fixing responsibility of
each subordinates.
 Advantage- It avoids conflicts, confusion & chaos.
 Result- It leads to better superior sub-ordinate
relationship

03/07/20
Unity of Direction
74

 It means one head, one plan for a group of

activities having similar objectives.
 It is related to the functioning of departments, or
organization as a whole.
 It is necessary for sound organization.
 It avoids duplication of efforts and wastage of
resources.
 It leads to smooth running of the enterprise.

03/07/20
Administrative mgt…
75

9. The Hierarchy: Lower line managers should always

inform upper level managers.

10. Order: To increase efficiency and coordination

,materials and people should be in the right place at
the right time.
 People, in particular, should be in the jobs or positions
they are most suited to.
11. Equity: All employees should be treated equally.
12. Stability of Staff: Retaining productive employees
should always be a high priority of management.

03/07/20
Administrative mgt…
76

13. Initiative: Subordinates should be given the freedom

to conceive and carry out their plans, even though
some mistakes may result.
Encourage employees to do through self direction.
14. Espirit de Corps: Promoting harmony and team spirit
among members to give the organization a sense of
unity. Small factors should help to develop the spirit .
Are managers born or made ?
 Before Fayol, it was generally believed that "managers are born, not
made."
 Fayol insisted that management was a skill like any other--one that
could be taught once its underlying principles were understood.

03/07/20
Cont’d…
77

 Application in the Modern Workplace

 Fayol’selements of management are recognized as the
main objectives of modern managers
 Planning - more participatory
 Organizing - human relationships and communication
 Especially applicable for large organizations (military)

03/07/20
Weber’s Theory of Bureaucracy
78

MAX WEBER (1864-1920

Max Weber named the management system that contains
these components to be a bureaucracy.
Weber believed that in its pure form bureaucracy
represented an ideal or completely rational form of
organization .
 Primary Focus: Organizational Structure
 Worker should respect the “right” of managers to direct
activities dictated by organizational rules and procedures
 More descriptive

03/07/20
Tenets of Bureaucracy
79

 detailed rules and regulations :

 Positions arranged in a hierarchy
 Specialization and division of labor
 Impersonal relationships.
 Technical competence
 Everything written down
 Maintenance of “ideal type” - bureaucracy

 Cornerstone: existence of written rules

 Application: Large organizations guided by countless rules
are bureaucracies 03/07/20
2. The Behavioral School
80

 Understanding human b/r in the Organization

 Successful management depends largely on managers’
ability to understand and work with people who have a
variety of backgrounds ,needs, perceptions and
aspirations .
 The behavioral school emerged from the human
relations movement which is an effort to make managers
more sensitive to their employees’ needs
 And the classical approach:
 did not achieve the needed efficiency and workplace harmony
 people did not always follow predicted or expected patterns
of behavior
03/07/20
The Behavioral School…
81

 Thus, the behavioral approach to management

emphasizes increasing productivity through
understanding of people and adapt the
organization to them.
The Human Relation Movement
 describes the ways in which managers interact with
their employees.
The human relations movement arose due to historical
influences:
 Threat of unionization
 Philosophy of industrial Humanism

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3. The Management Science School
82

Management science focuses specifically on using

scientific methods and mathematical techniques to
the development of mathematical models.
 These models help organizations to try out various

activities with the use of a computer.

 Modeling can help managers locate the best way to

do things
 Increasing the Quality of Decision making
through the application of mathematical and
statistical methods.
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The Management Science School
83

Limitations:
 Mathematical modeling tends to ignore relationships

 Emphasis on only the aspects of the organization

that can be captured in numbers, missing the

importance of people and relationships.

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4. The System Approach
84

 A system is a number of interdependent parts

functioning as a whole for some purpose.

The main premise /assertion/idea/basis of system

theory :
 the activity/modification of any segment of an
organization affects, in varying degrees, the activity of
every other segment.
 i.e. interrelatedness
 each part has a role that helps the whole to function

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Systems approach…
85

Systems approach to management views:

 the organization as a unified, purposeful system
composed of interrelated parts. Thus,
 Systems oriented managers make decisions only after
they have identified the impact of these decisions on
other departments and on the entire organization.
Subsystems: are the parts that make up the whole of a
system
 Interdependent subsystems such as production, finance,
and human resources etc.

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Systems approach…
86
 each system in turn may be a subsystem of a still larger
whole.
 Thus a department is a subsystem of a plant, which may
be a subsystem of a company,
 which may be a subsystem of a conglomerate or an
industry, which is a subsystem of the national economy,
 which is a subsystem of the world system

 Interdependent subsystems such as production, finance,

and human resources work toward synergy
 Synergy: as separate departments within an
organization cooperate and interact, they become more
productive than if each were to act in isolation.
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Systems approach…
87

Types of systems
[Link] SYSTEM: constantly interacting with the
environment.
2. Closed system not influenced and not interact with
the environment.
 All organizations interact with their environment, but

the extent to which they do so varies.

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Systems approach…
88

System Boundary: Each system has a boundary that

separates it from its environment.
 In a closed system, the system boundary is rigid;

 in an open system, the boundary is more flexible.

System theory:
 emphasizes the dynamic and interrelated nature of
organizations and the management task.

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6. The Contingency Approach
89
 The answer to any really engrossing question in
economics is: It depends.
 Why do methods highly effective in one situation failed
to work in other situations?
 Results differ because situations differ; a technique that
works in one case will not necessarily work in all cases
The contingency approach emphasized that:
 what managers do in practice depends or contingent
upon a given set of circumstances situation.
 ’’if-then’’ relationship.
 if this situational variable exist this is what the manager
will do.
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The Contingency Approach…
90

 What are the challenges / problems in

implementing the contingency approach?
perceiving organizational situation as they exist
 to Identify which technique will,
 under particular circumstances,
 at particular time,
best contribute to the attainment of management goals

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2. Functions of Management
91

 Communication

P I

E
 Decision Making
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Planning
92

What is planning?
Basic planning questions
1. Where are we now?
2. Where are we going?
3. How do we reach there?
[Link] do we know whether we reach or not?

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PLANNING…
93

Planning
 Is the process of establishing goals and suitable
course of action for achieving these goals
 is the action you take today to prepare for tomorrow.
It is a roadmap to where you intend to go.
 There may of course be detour, slow-downs, or
problems along the way, but generally planning
defines the direction you intend to go.

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PLANNING…
94
Attributes of planning
 Futuristic
 anticipate the future
 what is required and
 how it will be accomplished
 Decision making
 determines what is to be done: when, where, how, and for what
purpose.
 choosing among the alternatives. Resource allocation.
 Continuous and dynamic Why?
 because planned activities are affected by internal and external
factors. And
 need for environment scanning and adaptive changes .
 Taproot for the other elements of management process
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PLANNING…
95

Purpose of planning
 Provides direction
 Reduces uncertainty

 Minimizes waste and redundancy

 Sets the standards for controlling

 Decision coordination (consider tomorrow)

 Emphasis on organizational objective

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PLANNING…
96

Types of Plans
Plans can be classified on different bases or
dimensions. The important ones are:
 Repetitiveness/frequency of use
 Time dimension, and
 Scope/breadth dimension
Classification of Plans Based on
Repetitiveness
1. Standing Plans
2. Single-use Plans
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PLANNING…
Standing Plans
97

 Ongoing plans that provide guidance for activities performed

repeatedly.
 That are followed each time a given situation encountered
 Include mission or purpose, goal or objective, strategy, policy,
procedure, method, and rule
Purpose or Mission
 The terms can be used interchangeably

 Identify the basic function of organization

Objectives or goals
 The terms can be used interchangeably

 The ends toward which activity is aimed

 The end point of planning

 The end point of organizing, staffing, leading, and controlling are aimed

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PLANNING…
98

Strategies
 Ways and means to achieve objectives

 Major course of action

 Every objective should have at least one strategy

Policies
 General statements or understandings that guide or
channel thinking in decision making
 Define an area within which a decision is to be made

 Help decide issues before they become problems

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PLANNING…
99

Procedures
 Show the sequence of activities

 Guides to action

 Help in the implementation of policies

Methods
 More detailed

 Only concerned with the single operation

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PLANNING…
100

2. Single-use Plans
 A one-time plan specifically designed to meet the need

of a unique situation
 Are those plans that are not used up once the objective
is accomplished
 Used only once

 Include programs, projects and budgets

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PLANNING…
101

Classification of Plans Based on Time

Long-range planning
 The time may range usually from 5-10 years
 Distant future
 The development of a plan for accomplishing a goal
over a period of several years.
Assumption: current knowledge about future conditions
is sufficiently reliable to ensure the plan's reliability
over the duration of its implementation.

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Planning…
102
2. Short-range planning
 Complementary of long- range plans
 Constitutes the steps towards the
implementation of long-range plans
 Generally 1 year, sometimes up to 2 years
3. Intermediate-range planning
 Ranges between long and short- range plans

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Planning…
103

Classification of Plans Based on Scope/Breadth

1. Strategic Planning
2. Tactical Planning
3. Operational Planning

Strategic Planning: is process of analyzing and deciding on

the organization's mission, objectives, major strategies,
major resource allocation
 Strategic planning is:
 performed by top level mangers, mostly long range in its time
frame, expressed in relatively non-specific terms
 type of planning that provide general direction

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Planning…
104

 Apply to the entire organization.

 designed to meet an organization’s broad
goals
 focus on environmental assessment and
addresses objective and strategy.
 That an organization must be responsive to a dynamic,
changing environment.

Assumption: the environment is indeed changeable,

often in unpredictable ways.
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Planning…
105

Tactical Planning
 Refers to the process of developing action plans through
which strategies are executed
 Departmental managers in organizations are often

involved in tactical planning. Examples are:

 Developing annual budget
 Choosing specific means of implementing strategic plans
 Deciding on course of action
 Midlevel managers: design and implement programs and
policies in their area of responsibility.
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Planning…
106

Operational Planning
 Most specific and detailed

 Concerned with day-to-day activities

 Short-range and more specific and more detailed.

 Contains details for carrying out or implementing

those plans in day-to-day activities,
 First line managers: plan in relation to specific

operations or activities e.g. scheduling work activity

and allocating resource.
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Planning…
107

Strategic Plan versus Operational Plan

[Link] horizon: long time versus short time
[Link]: wide range of goals versus narrow range
operations.
[Link] of detail: simplistic and general versus
detail and specific activities.
[Link] plans?

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Planning…
108

THE PLANNING PROCESS

Step 1: goal formulation (what do we want?)
 Review/understand organization’s mission
 Translate mission into concrete terms
Step 2: identification of current objectives and strategy
Step 3: environmental analysis (what is out there that needs doing?)
 Assess the direct-action and indirect-action elements of the
environment.
Step 4: Resource analysis (what are we able to do better or worse than
anyone else?)

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109

Step 5: Identification of strategic opportunities and

threats (what can we do that needs doing?)
 Situations that are favoring and problems existing or
predicted
 Analysis of the environment and resources
Step 6: Determination of the extent of required strategic
change
 Performance gaps (objectives established in the goal
formation versus the results likely to be achieved)
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Cont….
110

Step 7: Strategic decision-making- Identify, select and

evaluate alternatives

Step 8: Strategy implementation- Incorporate into daily

operations of the organization

Step 9: Measurement and control progress

 Check progress at periodic intervals
 Measure success

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Cont…
111

BASIC QUESTIONS IN PLANNING

A. Where are we now?
Assessment: Background information Statistical
data, etc.
B. Where do we want to go?
- Problem definitions/identification
- Defining/establishing goals
- Programming activities, strategies, etc.

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Cont…
112

C. How will we get there?

- Identify four key factors:
Who? Where? When? and How?
- Management and resources
D. How do we know when we arrive?
- Monitoring and evaluation.

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Cont…
113

The steps of health planning

 Situational analysis
 Priority setting

 Setting objectives and targets

 Identifying potential obstacles and limitations

 Designing the strategies

 Writing the plan

 Evaluation

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Cont…
114

 SWOT ANALYSIS: A FRAME WORK FOR SELECTING

STRATEGIES
 SWOT MATRIX

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Planning out comes
115

Items that traditionally are considered to be

outcomes of planning are Organizational Vision,
Mission, Objectives, and Strategies, and unit
Operational Policies, and Procedures.
VISION
 It usually accompanies the statement of mission.

 It is “a strategic view of the future direction and a

guiding concept of what the organization is
trying to do and to become”.

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Cont…
116

Benefits of Visioning
 Breaks the manager out of boundary thinking.

 Provides continuity of actions.

 Identifies direction and purpose.

 Alerts stakeholders to needed change.

 Promotes interest and commitment.

 Encourages openness to unique and creative solutions.

 Encourages and builds confidence.

 Builds loyalty through involvement (ownership).

 Results in efficiency and productivity.

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Planning out comes
117

 E.g.
We aspire to see healthy and productive inhabitants
in the city administration
MISSION
 A mission statement identifies/states the purposes
and reasons for which the organization exists.
 It specifies the unique aim of the organization.
 The elements of mission are:
Who are you? What are we? Why do we exist? What
is our constituency?

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Planning out comes
118

 E.g.
To reduce morbidity and mortality through
provision of quality and equitable,
promotive, preventive and curative health
services to the inhabitants in the city
administration.

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Planning out comes
119

 The mission, strategic plan, and vision

reflect a philosophy about the organization
and its roles.

 They are “the foundation on which the

rest of the strategic planning process is
built”, are the basis for other
organizational planning.

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Planning out comes
120

OBJECTIVES

 are statements of the results that the HSO/HS

seeks to accomplish.

 are HSO/HS outputs. They are the ends, targets

and desired results toward which all
organizational activities are directed.
 are specific, measurable, attainable, realistic, and
have time bound, SMART.

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Planning out comes…
121

E.g.
 To reduce the number of new HIV infection
by 25% in 2015.
 To reduce mortality attributed to TB by 50% in
2015.
 To reduce IMR from 81/1000 Live Births to
71/1000 LB by 2015.

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Planning out comes…
122
Organizational STRATEGIES
 is the term that is traditionally reserved to describe the
means/ways of accomplishing organizational objectives.
 are broad, general programs that are selected and designed
by the HSOs/HSs to accomplish their objectives.

 Strategies:
 Expansion and rehabilitation of H/facilities.
 Adopt and develop standardized operational guidelines.
 Establish strong public-private partnership.
 Continuous improvement of the existing H/S, etc.

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Limitations of planning
123

 Lack of accurate information

 Problems of change
 Failure of people
 Internal inflexibilities
 External inflexibilities
 Rigidity in planning
 Time and cost factors

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Planning
124

Plan your work.

Work your plan!

If you fail to plan

You plan to fail!

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125

Health Planning
 Objective: To acquire planning skills so as to plan and
prepare health action plan for HSO
Definition
Planning
 is the process of determining exactly what the
organization will do to accomplish its objectives
 is the combination of completing & analyzing
information dreaming up ideas using logic imagination
& judgment in order to arrive at a decision
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126

 dictates the objectives & activates toward which

managers lead of other members of the organization
 is deciding in advance what to do, how to do, when to
do, where and who will do activities:
 it is charting a course of action for the future
 bridges the gap b/n where we are now and where we
want to go
 is deciding about what should be done in the future
prospectively

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127

Health planning
 is the process of defining community health problems,

identifying needs & resources, establishing priority

goals, and setting out the administrative actions
needed to achieve those goals
►Common point to all definitions
 Planning is the process that lays the base for future action.

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128

►While planning answer the following questions:

 Where are we now? ------- assess the present situation
 What are we here for? -----problems at hand

 Where are we going?-------objectives

 With what? -----------------resources

 How? -------------------------strategies & activates

 When? -----------------------future (period of time )

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129

Rationale for planning

 Focus attention on predetermined objectives

 Coping with future uncertainty & changes

 Provides performance standards & facilitates

controlling
 Helps foreseeing & identifying potential risks

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130

 Helps efficient utilization of resources while

achieving objectives
 It sets the direction for the other functions of
management and teamwork.
 Planning improves decision-making.
 Note: All levels of management engage in planning.

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131

Decisions related to planning

 Planning is making implementation decision before starting
implementation, & making evaluation decision before
implementation.
There are 3 main planning decisions
1. Decision on objectives
 describing or identifying the problems
 target population & their locations
 How much of the problem can be reduced
 Planning function means analyzing the problems & deciding on
the changes to be made
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132

2. Decision on activities
 Deciding on detailed activities required to achieve the
objectives set.
 Which type of activities?

 Whom? Target population addressed by the activity

 How much? The amount of each activity

 How, which & where? The approach, the time, the

frequency and the location each activity can be delivered.
 By whom? Who does what?

 Planning function entails the detailed design of the

activity of the team.

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133

Decision on resources
 identification, specification & quantification of
resources to be utilized
 based on contribution of the health sector, the
community & other sectors

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134

Scope of Planning
 Is determined by:

1. What is the target client?

 what the plan intends to address →Population, institution &
program
2. Target geographical region or area
 At what level is the planning?

→Village /kebele/ district / zonal / region

3. For what level of comprehensiveness should service be
planned?
→Curative, preventive, primitive & rehabilitator health care
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Features of Planning
 is an intellectual activity
135
 is a continuous Process (cyclic /spiral)

 is flexible as it is based on future conditions, which are

always dynamic
 must be systematic & action oriented

 is collective undertaking

→Requires participation of
 Professionals ( health & other sectors
 Community /NGO
 Government bodies /parties

 is needed & practiced at all managerial level

regardless of the size (small & complex) & type ( non–
profit or profit making ) of organization

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A good plan should give:
136
- Clear vision/mission, goal & objective
- A clear picture of the tasks to be accomplished
- A clear summary of physical, human & technical
resources.
 Note – the general policies & guidelines of a health
system are laid down by MOH.
 The role of middle level managers is to interpret policies

at local levels plan their implementation & make sure

that they are implemented.

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Elements in planning
1. Goals, aims, objectives & targets
137
 all are ways of describing the desired direction of a
service though they differ in terms of breadth & details
 are end states/outcomes of the program

Goal
 Is the end that the organization strives to attain

 Is a broad statement and generally there is one goal for

a health system /HSO.

 Often referred as the ultimate objective of the desired

state & hence formulated at a higher level

 E.g. HFA by the year 2015

03/07/20
Aim
 There are a number aims related to a goal.

138  Is specific to a particular health problem

 E.g. decrease IMR a community
Objectives
 is the object or aim of an action

 for each program aim there may be a number of objectives

which are specified in measurable terms
 is planned or intended end result of a program or an activity

 is related to output & it is precise

 E.g. decrease IMR a community by 10%
Target
 For each objective, there may be various targets which
specify various points on the way to the attainment of the
objective.
 Defined in relation to apoint in time.
 E.g. decrease IMR a community by 10% by the03/07/20
year 2015
2) Policy
 a policy might be considered as a broad statement of intent or a
statement designed to convey the long term objective of a state or
an organization
139  A general guide for decision making & individual actions

3. Procedures
 a detailed method for carrying out a policy

4. Budget
 numerical expression of the anticipated results in monetary terms

 Planned expenditure required to achieve the objectives

5. Action plan
 states specifically what steps or tasks will be accomplished to
achieve an objective
 helps the supervisor stay organized, coordinate activities, and keep
projects on schedule
 Each objective should include an action plan, which "operationally
defines" the objective by expressing it in terms of specific actions or
operations.

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6. Broad programming
 The translation of health policies in to strategies to
140
achieve the clearly stated objective
 A policy is a general statement designed to guide

employees' actions in recurring situations.

 It establishes broad limits, provides direction, but
permits some initiative and discretion on the part of
the supervisor. Thus, policies are guidelines

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 A procedure is a sequence of steps or operations
describing how to carry out an activity and usually
141 involves a group.
 It is more specific than a policy and establishes a
customary way of handling a recurring activity.
 Thus, less discretion on the part of the supervisor is
permissible in its application.
 An example of a procedure is the sequence of steps
in routing of parts.

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142

 A method sets up the manner and sequence of

accomplishing a recurring, individual task. Almost no
discretion is allowed.
 An example of a method is the steps in cashing a
check.
 A rule is an established guide for conduct.
 Rules include definite things to do and not to do.
 There are no exceptions to the rules. An example of
a rule is "No Smoking."
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Types of planning
1. Based on time dimension (duration)
143
 According to planning horizon (i.e. the time elapsed
between the formulation and execution of a planned
activity)
There are 3 types of planning
i. Short term plans (1-2 yrs) ~~ tactical planning
E.g. annual plans of immunization
ii. Intermediate plans (3-5yrs)
E.g. replacing old medical equipments with new ones
 iii. Long term plans (5-10yrs) or strategic plans

E.g. the 20 years HSDP

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2. Based on the scope or breadth of activities they
repressed
144
i. Strategic Plan
 Process of setting agreed priorities & directions for

health sectors in the light of given resource constraints

 Are comprehensive in scope & reflect long–term needs
& directions of the organization.
 Is a top management plan

 Referred as allocative planning

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ii. Operational /Tactical plans
 are plans used to implement strategic plans
145
 short range planning that emphasis current operations
of various parts of the organization
 are more limited in scope & address those activities

and resource required to implement strategic plans

 deal more with the implementation resources &

scheduling of actual work activities than with the

selection strategies
 referred as activity planning

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146

Major differences
Area of difference Strategic tactical
Individuals involved Top level middle/front-lFacts
facts to be based on Facts are general -difficult to gather facts are generally- easy
Amount of details relatively little detail substantial
Length of time covered long period (> 5yrs) Short period (< 1yr)

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Strategic Planning
 Definition: a process of setting agreed priorities and
147
directions for the health sector in the light of given
resource constraints.
 May also be regarded as:

A means of ensuring technical, political and financial

sustainability.
 A process of developing intersectorial collaboration for
health development.
 A means of institutional change.

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148

 Outcomes of a strategic plan

 Includes mission, Vision, Value, Objectives, Operational
programs, Policies and procedures.

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149

Mission
 Identifies the purpose for which the organization exists

 States the purpose and reasons for the existence of

the organization i.e, “What it does for whom”
 Reflect the view that senior managers have for the

future of the organization

 Gives a way to judge the appropriateness of all
potential activities that the organization might engage
in
 is usually accompanied by: 03/07/20
Vision
150
 Creates a picture of where you, singly or collectively,
want the organization to be after some years.
 “best” picture

 A guiding concept of what the organization is trying

to do or to become
Value
 guiding principle in the organization’s conduct

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Mission, vision and Value
 reflect a philosophy about the organization and its
151
roles in health services delivery
 are the foundations on which the rest of the strategic

planning process is built

 are the basis for all other organizational planning

 are determined by the governing body

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152

Planning Tools
 are techniques that help in planning process

1. SWOT analysis
 Is a strategic planning tool that matches internal
organizational strength & weakness with external
opportunities & threats
 E.g. SWOT analysis of HSDP III:

03/07/20
153 Strength
 Strong effort and success in mobilizing external

resources and technical assistance

 Development and implementation of several relevant
policies, strategies, guidelines, proclamations,
treatment protocols a regular framework of planning
cycle
 Democratization and decentralization of the health

system and existence of formal organizational

structure that addresses key health interventions at all
levels
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154
Weakness
 Poor follow-up of implementation of policies, guidelines,
standards and protocols
 Shortage, high turnover and poor management of
human resource
Opportunities
 Government’s commitment to improve the health service
delivery and quality of care by giving priority to the
HSDP and focusing on poverty related diseases
 Initiation of the process of harmonization between the
Government and Donors’ procedures
 Increasing participation of the private sector in the
health service delivery and human resource
development 03/07/20
Threats
 Exacerbation of socio-economic problems due to
155
climatic anomalies and man-made disasters
 Illiteracy, poverty and high level of population growth.

 Rising cost of medical equipment, drugs, supplies and

construction materials
 Lack of capacity to implement the decentralized
health system

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156

SWOT Matrix – A framework for selecting strategies

Internal External

Positive (1) strength (3) Opportunities

Negative (2) Weakness (4) Threats

03/07/20
Steps of planning
 Aim: To provide a general framework of action to be
157
performed thereby ensuring a systematic approach in
the planning process.
● There are six steps in the planning process:
Step1: SITUATIONAL ANALYSIS
 Gives improved understanding of the current situation

from various perspectives

 Answers the question “where are we now?”

03/07/20
 The current situation is described with identification of
 healthand health related needs and
158

 available resources

 Outcomes:
A common reference point for the rest of the planning
process
 Allows the selection of priority areas of concern for
planning

03/07/20
Contents
159
1. Population characteristics
 Study the size, composition and distribution of the

population.
 Identifythe target groups
 Determine population size by category

 Estimate overall population growth

 Determine religious, educational and culture

03/07/20
2. Review area characteristics and infrastructures
160
 Assess:

 Geographical and topographical situations

 Infrastructures: transport modes and routes, means of

communication, water supply and sanitary facilities,

electric supplies etc
 Socioeconomic situations: distribution of family income,

housing condition
 Public and private sector structure

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161

3. Policy and political environment

 The national programs should be used as a guide

 relate actual situation in the area of concern with

these guidelines

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162
4. Health need analysis
 analyzing the health needs and the magnitude of health
problems is a basic prerequisite for planning
 two broad approaches

i. Medically perceived health needs

 Information sources
 community health survey
 morbidity rates –incidence, prevalence
 mortality rates- GMR, ASMR
 disability rates
 records of health service contacts
 perception of health professionals

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163 ii. Community perceived health needs
 less easily available and less structured

 two sources of information

 from survey of the attitudes and views of the

community members about their health needs
 from existing community structures
E.g. village health/dev’t committees

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Step 2: PROBLEM PRIORITIZATION
 is identifying priority health problems
164
 setting priorities for HSOs in the light of competing
needs and limited resources
 A problem is a difficulty or an obstacle seen to exist

between the present situation and desired future

objectives
 Perceived gap between what exists and what should
exist.
 People perceive problems differently ; this is the most
critical and hardest stage of the planning process

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In analyzing problems:
 Define clearly what the problem is
165
 Find all possible causes of the problem
 Don’t confuse ‘problems’ with ‘causes’
E.g. Diarrhial disease ………..problem
 Inadequate and unsafe water supply
 Poor sanitary conditions
 Inappropriate winning practice ……..are all
causes

03/07/20
Grouping problems
1. Environmental problems
 Poor sanitary conditions
166
 Poor housing conditions
 Inadequate and unsafe water supply
 Air pollution and so on
2. Diseases/health problems
 Malaria, tuberculosis, HIV/AIDS, malnutrition,
respiratory diseases and so on
3. Socio-economic problems
 Low per capita income
 Low literacy rate inadequate distribution of health
services
 Cultural and religious beliefs and values

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4. Health services problems
 Poor quality and quantity of drugs
167
 Old medical equipments
 Lack of qualified personnel
 Difficulty in visiting out-reach areas
► Grouping helps seek common solutions to groups of
problems.
 There are always discrepancies between problems that
need to be solved and the available resources.
 Planners are obliged to solve certain problems before
others
 problem prioritization is of paramount importance in the
planning process

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●Priority problems are often selected by setting
selection criteria and giving scores for each
168
problem according to the criteria.
●Criteria for problem prioritization
 Magnitude of the problem: the public health

burden imposed by the problem

 Degree of severity: consequent suffering and
disability
 Feasibility: in terms of cost effectiveness, social

acceptability and local sustainability

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 Government concern: political acceptability with
169 consideration of equity and multisectorial approach,
consistency with government plan and budgetary
system
 Community concern: how much does it relate to

community perceived health needs?

●Ranking is then done by using criteria on 5 point scale
 veryhigh (5), high (4), moderate (3), low (2) and very
low (1)

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170

problems [Link] [Link] Mgnofpr Severity Fesebilty Total

n o
Malaria 4 3 5 4 4 20
DaDiseae 5 4 2 5 5 21

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171
Step 3: SETTING OBJECTIVES AND TARGETS
 Describing the desired direction of a service

 Answers the question “where do we want to go?”

Importance
 Clear statement of objectives enables:

 to decide how to achieve the plan

 to evaluate how effective one is in achieving/reaching

objectives
 Objectives of a program must be ‘SMART’

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172

Specific
 An objective must be specific with a single key result.
 If more than one result is to be accomplished, more than
one objective should be written.
 Just knowing what is to be accomplished is a big step
toward achieving it.
 What is important to you? Once you clarify what you
want to achieve, your attention will be focused on the
objective that you deliberately set. You will be doing
something important to you.
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Measurable → allows monitoring / Evaluation
173  Only an objective that affects behavior in a measurable way
can be optimally effective.
 If possible, state the objective as a quantity.
 Some objectives are more difficult to measure than others are.
However, difficulty does not mean that they cannot be
measured
 Avoid statements of objectives in generalities. Infinitives to
avoid include to know, to understand, to enjoy, and to believe.
 Action verbs are observable and better communicate the
intent of what is to be attempted. Examples include to apply, to
revise, to contrast, to select, to conduct, to compare, to
investigate, and to develop.
 How will you know you've progressed?

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 Attainable
174  An objective must be attainable with the resources that
are available.
 It must be realistic.

 Many objectives are realistic. Yet, the time it takes to

achieve them may be unrealistic. For example, it is
realistic to want to lose ten pounds. However, it is
unrealistic to want to lose ten pounds in one week.
 What barriers stand between you and your objective?
How will each barrier be overcome and within what
time frame?

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 Result-oriented
 The objective should be central to the goals of the
175
organization.
 The successful completion of the objective should make a
difference.
 How will this objective help the organization move
ahead?
 Is the objective aligned with the mission of the
organization?

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Time specific (bound)
 The objective should be traceable in time period.
176

 Specific objectives enable time priorities to be set and

time to be used on objectives that really matter.
 Are the time lines you have established realistic?

 Will other competing demands cause delay?

 Will you be able to overcome those demands to

accomplish the objective you've set in the time frame
you've established?

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Write Meaningful Objectives
 Although the rules are difficult to establish, the following may be
useful when writing an objective.
177
1. Start with an action or accomplishment verb. (Use the infinitive form
of the verb. This means to start the with "to.")
2. Identify a single key result for each objective.
3. Give the date of the estimated completion.
4. Be sure the objective is one you can control.
5. To test for validity of SMART objectives, ask yourself the following
questions.
S = Exactly what is my objective?
M = What would a good job look like?
A = Is my objective feasible?
R = Is my objective meaningful?
T = Is my objective traceable?
E.g. By the year 2015, 50% of eligible pregnant mothers in D/Markos
town will receive antiretroviral therapy.
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Step 4
178 IDENTIFYING POTENTIAL OBSTACLES & LIMITATIONS
 situations that may prevent the achievement of each
objectives & targets
 The limitations may be :

(i) Resources
 Human –lack of interest/skill

 Equipment –not available/Expensive

 Money- lack of budget

 Time- people may not have time

 Information- needed for implementation, not

timely/well processed
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(ii) Environmental obstacles
179  Geographical features→ lakes, rivers, mountains

 Climate –affect nature of health problem

 Technical difficulties

 Social factors- most serious obstacle, taboos, traditions

→ unacceptability
 Three groups of Obstacles

1. Obstacles that can be removed

2. Obstacles that can be reduced or modified
3. Obstacles that can’t be changed

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Step 5
 DESIGNING STRATEGIES
180
 Strategies are the tactics or techniques which could be
devised or adopted & utilized to facilitate the
achievement of objective & targets.
 Strategies are different ways for achieving objectives
& targets
 Selecting potential strategies often consider

 Technology to be applied
 Procedures to be used &
 Defining the role of communities and other sectors

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181

For each chosen strategy the corresponding activities to be

undertaken & the resources needed should be detailed.
►Including:
 What is to be done (activities)?
 Who will do the activities?
 Which resources are needed?
 How?(procedures for technical, administrative,
community workers, contribution of other sectors)
 When to do it? (beginning , end)
 Where the work will be done?
 The methods of controlling

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Gantt chart
 is a bar graph with time on horizontal axis and the resources

182
/activities to be scheduled on the vertical axis
 Help you to plan out the tasks that need to be completed

 Give you a basis for scheduling when these tasks will be

carried out
 Allows to plan the allocation of resources needed to
complete the project
 Helps to monitor whether the project is on schedule. If it is
not, it allows you to pinpoint the remedial action necessary to
put it back on schedule.
 Columns of a Gantt chart
 list of the project activities
 a column that makes a filed time period showing when the
activities will occur
 list of the person(s) responsible
 Resource column.
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183

Activities Responsible body Time Resources

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Step 6
WRITING UP THE PLAN
184
 Purpose of writing a plan

 to request funds or resources from the government or

funding agencies
 For monitoring & evaluating the implementation process
by all concerned
 Several ways of writing a plan, a simple outline includes:

 Introduction (General background, Summary of main

points)
 Statements of the problem

 Objectives and targets expected outcomes

 Strategies & activities

 Resource needed & their method of utilization

 Monitoring & evaluating

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IMPLEMENTATION FUNCTION
185  Definition: Implementation is putting into action the
selected program or intervention
 Is the penultimate stage in the managerial functions
 Is the most important management function that would
enable to translate the plan into practice
 Requires co-ordination of activities, human power and
other organizational resources with proper use of
information on day to day basis.
 Planning is useful only if it ends up in implement able
action.

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Main Decisions to be taken in Implementation
 Execution of activities
186

 Deployment of human resource (The right amount at

the right time and place)

 Decision about how to allocate physical resources

 Decision about information (processing and

communication)
Execution of activities
 Decide when and where a given activity is to be

accomplished and make sure that all preceding

activities are carried out on time.

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Activities could be:
Sequential (linear)
187  Activities are dependent on other activities being
completed first
 These dependent activities need to be completed in a
sequence, with each stage being more-or-less
completed before the next activity can begin.
parallel activities:
 Activities are not dependent on completion of any
other tasks.
 May be done at any time before or after a particular
stage is reached
 Enables to decide either to go ahead, or modify the
plan, input etc - - -

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188

Deployment of human resource into effective action

This decision can be regrouped into 3
 Organizing and coordinating

 Monitoring and redirecting

 Supervising

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Group work/for presentation/10%
189

 1. Write the topic of your organization

 2. State its mission
 3. State its vision
 4. State one measurable result/objective/
 5. Assess the current situation in relation to your objective
 6. Identify the obstacles and their causes
 7. Define your key challenges
 8. Develop an action plan

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Decision Making and Creative Problem Solving
190

Decision making is a major part of management because

 When planning, organizing, staffing, leading, and
controlling, managers make decisions on a daily basis.
 it requires choosing among alternative courses of
action.
 Decisions must be made at many levels in an

organization from executive decisions on the goals to

the day to day repetitive operations performed by
lower level managers.

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Decision making…
191  Decision is a choice made from two or more
alternatives.
 many decisions are made in order to solve problems

Problem is the difference between actual and desired

states of affairs
 Gap where one is and wants to be

 the definition put managers in a better position to

create more effective and efficient solutions.

i.e. problem solving
 Depending on the situation, problems can be resolved
, solved, or dissolved 03/07/20
Decision Making…
192

Identifying problem
 Is problem finding an easy task?

The problem finding process emanates from:

 Deviation from past experience, E.g. Community
image of physicians
 Deviation from a set of plans, E.g. medical care and
non-medical services in a hospital
 Other people, E.g. community, media people
 The performance of competitors, E.g. private/non-
governmental

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Decision making….
193
Problem solving
 conscious process of closing the gap between actual and
desired situations.
 the reorganization of experience into new configuration.

Creativity
 It is a function of knowledge leads imagination and
evaluation
 more knowledge: more ideas patterns combination

 knowledge must lead to imagination new ideas and then

the idea must be evaluated and developed into usable

idea.
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Decision making….
194
The formal decision making process may be
described in 7 steps:
1. Defining the problem or opportunity
2. Identifying limiting factors
3. Developing potential alternatives
4. Analyzing the alternatives
5. Selecting the best alternative
6. Implementing the decision
7. Establishing a control and evaluation system

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Decision making….
195
Types of decisions
1. Ends-means
 Ends: Objectives/outputs

 Means: Strategies/operational programs/activities

2. Administrative-operational
 Administrative decisions made by senior managers
 “Policy decisions”
 Resource allocation and utilization
 Operational decisions made by mid-level and first-line
managers
 Day-to-day activities, e.g. personnel deployment, purchases,
specific work assignments 03/07/20
Decision making….
3. programmed – non-programmed
196
 Programmed decisions are elements of some decisions which

are similar and made so often repetitive and routine

 Includes procedures rules and manuals, e.g. patient admission,
scheduling, inventory and supply ordering
 Non-programmed decisions are unique and non-routine and
may have unclear implications for the organization, requiring
creative problem solving because they are unfamiliar, Unique
and non-routine, e.g. decision to expand, add or closes services
 The above three types of decisions are not mutually exclusive.

Factors influencing decision making process.

 The internal environment: superiors, colleagues, subordinates,
and organizational system
 The external environment such as customers.
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Organizing
197 next step after planning.
 A key issue in accomplishing the goals identified in the
planning process.
 structuring the work of the organization.
 Is a process of deciding what work needs to be done,
 deals with formal assignment of tasks and authority
and coordination, and
 is arranging them into a decision-making framework.

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Organizing…
198

 Purpose
 to make the best use of the organization's
resources to achieve organizational goals.
 To make the organization a stable place
for employees

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Organizing….
199 The steps in the organizing process include:
1. review plans,
2. list all tasks to be accomplished,
3. divide tasks into groups one person can accomplish -
a job,
4. group related jobs together in a logical and efficient
manner,
5. assign work to individuals,
6. delegate authority to establish relationships between
jobs and groups of jobs

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Organizing….
200 Thus , organizing is not only
 deciding what work to be done, or

 dealing with formal assignment of tasks and authority

and coordination but also
 arranging them into a decision-making framework.

What is the decision-making framework?

 Organizational structure

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Organizing….
201 Characteristics of organizations:
Whatever their purpose, all organizations have four
characteristics:
1. coordination of effort
2. common goal or purpose
3. division of labor, and
4. hierarchy of authority.
If even one of these characteristics is absent, does an
organization exist?

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Organizing….
What is the difference between organizational design and
202

structure?
Organizational Design
 The determination of the organizational structure that is most
appropriate for the strategy, people, technology and tasks
of the organization.
 Matching goals ,strategic plan, capabilities with
environment.
Organizational structure
 The way, in which an organization’s activities are divided,
organized and coordinated.
 Is the formal decision-making framework by which job tasks
are divided, grouped, and coordinated. Why formal?
 its policies, procedures, and goals are clearly stated.
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Organizing….
Organization charts
203

 The formal organization can be seen and represented in

chart form.
 An organization chart
 displays the organizational structure and shows job titles, lines of
authority, and relationships between departments.
 is helpful for managers as it is an organizational blue print for
deploying human resource.
Dimensions of Organization charts
 vertical hierarchy and
 horizontal specialization

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Organizing…
204

Why do we need an organizational structure ?

A clear organizational structure
 clarifies the work environment,

 creates a coordinated environment,

 achieves a unity of direction, and

 establishes a chain of command

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Organizing….
205 Functional Steps in Organizing
 The four building blocks are:

 Division of work
 Departmentalization
 Hierarchy
 Coordination

03/07/20
Organizing….
206
1. Division of work / Division of labour/ work
specialization
 is the degree to which tasks in an organization are
divided into separate jobs.
 is breaking of a complex task into components

 Individuals are responsible for a limited set of

activities instead of the entire task.
 Work process requirements and employee skill level
determine the degree of specialization
 Placing capable people in each job ties directly with
productivity improvement.

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Organizing….
207 Departmentalization
 Once work activities are divided in to jobs or jobs have
been classified through work specialization,
 they are grouped so those common tasks can be
coordinated and can be similarly and logically connected.
 Departmentalization is the basis on which work or
individuals are grouped into manageable units.
 An organization chart shows the formal relationships
 Each single box in an organizational chart represents
departments
 Number and type of departments vary in each
organization
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Organizing…
208
Departmentalization Formats
 The five basic departmentalization formats, each with
its own combination of advantages and
disadvantages, are:
 functional
 product-service,
 geographic location,
 customer classification, and
 work flow process departmentalization

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209 03/07/20
Organizing…
210

3. Hierarchy
a concept that shows how many could be effectively
handled
a pattern of multiple levels of an organizational
structure
at the top the senior-ranking manager
bottom - low-ranking managers located at various
levels

03/07/20
Hierarchy
211 Span of management or span of control
 The number of people/departments directly reporting to

a given manager.
 After work is divided, departments created and span of
control chosen decide on chain of command.
Chain of command
 The plan that specifies who reports to whom

 Fundamental feature of an organization

 The result of the two decisions lead to a pattern: hierarchy

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Hierarchy….
212
Span of management control
Does it have an effect:
 on working relationships? and

 on the speed of decision making? How?

Effects
A. Determines the working relationships in a
department
 Too wide: Create flat hierarchies (fewer
management levels between the top and the
bottom)
 Implications:
 Overburdened manager,
 Little guidance or control of employee
 Overlooking or ignore serious errors
03/07/20
Hierarchy…..
213 B. the span can affect the speed of decision making
 Too narrow: Create tall hierarchies (many levels between
the highest and lowest managers)
 Implications:
 Managers are underutilized
 In-efficient
 Affects the speed of decisions (delay) in this changing
environment
Coordination:
 The integration of activities of separate parts of an
organization for accomplishing the organizational goals

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214

03/07/20
215

Presentation outlines

Definitions of leadership
Who are leaders
Leadership and management
Dimensions of leadership
Leadership at different level
Leadership, authority and power
Leadership trait and skill
The role of leadership in HSO/HS
03/07/20 21
216
Objectives (what I hope you are able
to do)
At the end of this session, you will be able to:
define leadership;

describe each of the four leadership and the

four management practices;

describe the links between management and

leadership;

explain the differences between leadership and

management;
Describe the different leader ship theories
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217

Students, we don’t want to be like the

leader of the French Revolution who
said:” there go my people. I must find out
where they are going so I can lead them.”
John F. Kennedy

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218

Brain storming and exercise (5minutes)

What is leadership?
Is leadership
synonymous with
management? In what
ways are they different,
or how are they the
same?
Think of some
individuals whom you
feel are really exceptional
leaders, what, if any
thing, do they have in
common?
03/07/20 5
219

03/07/20 6
220

Leadership
Defined: in different ways,
Leadership is not domination, but the art of
persuading people to work toward a common
goal. Goleman and Daniel,1995.

• Leadership is the process through which an

individual attempts to intentionally influence
another individual or a group in order to
accomplish a goal.
• Fiedler and Chemers(1974) defined it as “unequal
influence and power relationship” in which
followers accept the leaders right to make
certain decisions for them.
03/07/20 7
221

Definitions cont’d….
Bass(1990) “leadership occurs when one group
members modifies the motivation or
competencies of others in the group.”
Management sciences for health (2006) defines:
Leadership is Enabling Groups to Make
Progress in Complex Conditions.
It is helping groups of people to identify their
critical challenges, and mobilizing them to learn
and take effective action.
Leadership is an activity that takes place
at all levels, not a position of authority
03/07/20 8
222

03/07/20 9
223
Who is a leader?
As Bass stated “ leaders are agents of change,
persons whose acts affect other people more
than other people's acts affect them.”
A leader is someone who has a vision, and
ability to see it through to reality, while keeping
everyone else concerned on board.

Exercise To To
leader leadership influence achieve
s behavior followers’ objectives
behavior

Fig:1 The process of leadership (Longest,etal,2000)

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224

Great leaders
We can all think of great leaders who have
changed history, Gandhi, Nelson Mandela,
mother Teresa, Abraham Lincoln and
Martin Luther King. Etc…..

These are people who inspired millions to

challenge their existing conditions and to
take action.
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225

Who are leaders?

03/07/20 12
226

Abraham Lincoln
Vision
“ No man will be a
slave. Everyone man
is created equal.”
Initial reaction
“You are going to break
the nation apart!”
Price paid
His life

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227

Mother Teresa
Vision
“Care for the dying.”

Initial reaction
“You will die yourself!”

Price paid
Life of sacrifice

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228

Mahatma Gandhi
Vision
“An independent India”

Initial reaction
“ But that will never
happen!”

Price paid
His life

03/07/20 15
229

Nelson Mandela
Vision
“A democratic South
Africa
Free of apartheid.”
Initial reaction
“You are crazy!”
Price paid
27 years in prison

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230

Everyday leaders
But what about those leaders in our midst,
those people who enable groups to make
progress at the local and district levels.
What can we learn from those who lead
others everyday, in difficult conditions.

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231

03/07/20 18
232
Leadership at All Levels
When people think of leaders they often
think about highly placed public figures in
governments or organizations who are
admired for their extraordinary, and often
charismatic, qualities.
The assertion, however, is that there are
people at all levels in both the public and
private sectors who are leading their teams,
large or small, towards the realization of a
specific vision.
We call these people "managers who lead."
03/07/20 19
233

03/07/20 20
234

Discuss with your neighbor

What are the differences between leadership
and management?(5minutes)

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235

Leading Vs. managing

• Leadership and management are not the
same thing; they are not synonymous.
• There are well managed organizations but
lead poorly.

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236

Differences between leadership and

management
"Leadership is different from
Management, but not for the reason most
people think. Leadership isn't mystical or
mysterious," John Kotter.
It has nothing to do with what people
sometimes call 'charisma,' some vague
quality that some people have and others
don't. Nor is leadership dependent on
exceptional personality characteristics.
03/07/20 23
237

Differences cont’d
If we were to depend on the availability of
some very gifted individuals, born as
natural leaders, the world would be in
trouble (Kotter ) .

leadership is not the province of a chosen

few. Nor is leadership necessarily better
than management or a replacement for it;

03/07/20 24
238

Differences cont’d
Leadership and management have
different functions and activities, both
necessary for success in an increasingly
complex setting.

Smart organizations value both leadership

and management and encourage
personnel to develop their skills in both
areas. "managers who lead,"
03/07/20 25
239

Leading Vs Managing

Leading well means enabling others to face

challenges, achieve results, and create the
positive future that people envision.

Managing well means ensuring that sound

strategies and approaches are in place and
resources are used effectively.

03/07/20 26
240

Differences cont’d
Four management practices
Effective managers carry out four essential
management practices:
they plan
they organize
they implement and
they monitor and evaluate.
This is how these practices are carried out
in daily life:
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241

What do good leaders do?

SCAN their environment for challenges and

opportunities
FOCUS their attention around the critical
challenges
ALIGN and MOBILIZE their organizations to
make progress
INSPIRE those around them to learn and create
effective solutions

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242
Leading and Managing at All Levels
Sustainable Performance

Leading Managing
• PLANNING
• SCANNING Outcome - Organization results
Outcome - Awareness of defined and resources assigned
conditions • ORGANIZING
• FOCUSING Outcome - Functional
Outcome - Clarity of direction structures, systems, and processes
• ALIGNING/MOBILIZING for efficient operations
Outcome - The whole is greater • IMPLEMENTING
than the sum of the parts: synergy Outcome - Individuals at all
and complementarities levels are able to carry out the
• INSPIRING organizational direction
Outcome - A culture that • MONITORING &
encourages commitment and EVALUATING
creativity Outcome - Improved information
and knowledge
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Authority and Power

Authority is a role that people take on because of
the position they are in.
Authority is the power vested in a person by
virtue of their role to expend resources
(financial, material, technical and human).
Sometimes people in positions of authority are
also leaders, but not necessarily so.
Conversely, some people without authority can
be very effective leaders.

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Power and Influence

The essence of leadership is the ability to
influence followers
Influence is the means by which “people
successfully persuade others to follow their
advice, suggestion or order.
Power is crucial to the ability to exert influence,
and the ability to influence is essential to the
ability to lead.
To understand influence, one must first
understand power.

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Sources of power
The classical scheme for categorizing
interpersonal power includes:
[Link]
[Link]
3. coercive
4. Expert and
5. Referent Power

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Sources of power cont’d…

Legitimate power: is power derived from a

person’s position in an organization. It is also
called formal power or authority and exists
because organizations find it advantageous to
assign certain powers to individuals so that they
can do their job.
Reward power: emanates from the leaders
ability to reward desirable behavior. It stems
partly from the legitimate power. Reward
includes pay increase, promotions, work
schedule, recognitions of accomplishment, etc
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Sources of power cont’d…

Coercive power: is the opposite of reward power
and is based on the leader’s ability to punish or
prevent them from obtaining desired rewards.
Expert power: derives from having knowledge
valued by the HSO/HS, such as expertise in
problem solving, critical tasks, etc.
• Expert power is personal to the individual who
possess expert power
• In organizations in which work is highly technical
or professional expert power alone makes some
people very powerful.
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Sources of power cont’d…

Exercise: in what way/s, expert power differs

from legitimate, reward and coercive power?

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Sources of power cont’d…

Referent power: Results when individuals engender
admiration, loyalty, and emulation to the extent
that they gain the power to influence others.
It is some times called charismatic power.
Charismatic leaders typically have a vision for the
groups or organizations that they lead.
They are perceived by their followers as agent of
change

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Sources of power cont’d…

The five bases of power are not necessarily
independent, in fact can be complementary.
Leaders who use reward power can strengthen
their referent power.
Leaders who abuse their coercive power will
quickly weaken their referent power.
Effective leaders are those who can translate
power into influence.
Effective leaders understand the cost, risks and
benefits of using each kind of power and are
able to recognize which to draw on in different
situations and with different people.
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Sources of power in organization

Position power: formal authority, control over
rewards, control over punishments, control over
information,

Personal power: expertise, friendship/loyalty,

charisma.

Political power: control over decision processes,

coalitions, co-optation, institutionalization.
By Yukl, in leadership in organizations,1998
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253

Why is Leadership Important?

To provide overall policy direction and guidance

on health programs
– Good policies Vs bad policies
– Priority setting
To advocate for the necessary support
– Good advocacy if health seen as priority by
leaders
To mobilize and make resources available for
health programmes
– Allocation of funds
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Why cont’d…

To monitor and evaluate health programmes

– Concept of all stakeholders participating in
M&E
– Support for using lessons learnt for
improvement
To enforce accountability by service providers,
to the population
– Accountability by leaders themselves

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Evidence of Good Leadership

When those in leadership are showing political

commitment
When the political commitment is translated into
adequate resource allocation for health
programs
When good policies are formulated
When leaders lead by example
When people begin to see leaders as role models
When there is good governance and there is
accountability to the public
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256

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.
Beaufort.B, Longest,Jr, Jonathon S. Rakich, Kurt
Darr,J.D. Managing Health service organization and
systems 4th edition 2003,Hamilton printing company,
Rensseleaer, New York.

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257

References
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. (2000). Essentials of
Health Care Management, Delmar Publishers
• “Managing Performance Improvement of Decentralized
Health Services.” TheManager (Boston) vol. 13, no. 1,
2004a, [Link]
• “Leading Changes in Practices to Improve Health.” The
Manager (Boston) vol. 13, no. 3, 2004b,
[Link]
in-practices-to-improve-health.
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Motivation
Session outline
The nature of Motivation
Motivation and Management
Theoretical models of Motivation
Content perspectives
Process perspectives
Empirical findings of health workers
motivation
Motivating human resources for health
Motivational problems
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Aims of the session

(what I hope to do)
Characterize the nature of motivation,
including its importance and basic historical
perspectives
Provide insight to motivational models
Provide guidance on the technical concepts
and graphical representation of the model
Show the implications of the model – and
highlight some criticisms

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Objectives
(what I hope you are able to do)
After completing this session, students should be
able to:
Define motivation and distinguish it from other
factors that influence individual performance
Recognize popular but misleading myths about
motivation
Understand that motivation depends heavily on
the situations in which individuals work
Understand managers’ roles in motivating
people
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Objectives cont’d
Identify key characteristics of the contents of
peoples’ work that motivates them
Identify important processes involved in
motivating people
Assess the deal with motivational problems

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Key terms
Performance
Motivation
Motivators
Incentives (financial, non financial)
Self actualization
Hygiene factors
Hierarchy of needs
Reinforcement
Expectancy
Equity
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empowerment
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The Nature of Motivation

Brain storming (3Minutes)
What is Motivation????
your experience as a manager or worker
What motivates you on your work??
Write down

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Motivation and management

A primary task of management is to motivate
people to perform at high levels toward
meeting organizational objectives (steers and
porter,1987)
Nonetheless, many managers are unclear as
to how this should be accomplished(
kovach,1995; Medcof &Hausdorf,1995)

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Importance of Motivation
Health sector performance is critically
dependent on worker motivation,and thus,
service quality,
efficiency, and
equity are all directly mediated by workers’
willingness to apply themselves to their tasks
(Franco, etal 2002).

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Importance cont’d
Motivating individuals improves
Maximum use of factors for production
Willingness to work
Reduce absenteeism and tardiness
Reduce labor turn over
to get people to take on added responsibility
Building of the good relationship
Increase efficiency
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Importance of motivation….
Sense of belonging
Basis for cooperation
Helps in realization of organization goals
Improvement up skills and knowledge
Managers, leaders, policy makers need to know
What motivation is and is not before they design
strategies and policies in order to prevent futile
exercises
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Definition
Motivation is a state of feeling or thinking in
which one is recognized or aroused to
perform a task or engage in a particular
behaviour (steers & poter,1987)
This definition focuses on motivation as an
emotional or cognitive state that is
independent of action
This focuses clearly distinguishes motivation
from the performance of a task and its
consequences
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Definition cont’d
Kanfer R (1999) Motivation in a work context
can be defined as an individual’s degree of
willingness to exert and maintain an effort
towards organizational goals.
It is a set of psychological processes that
influences workers’ allocation of personal
resources towards those goals, which in turn
affect workplace effectiveness and
productivity (Ibid).

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Definition cont’d
Work motivation refers to an unobservable
set of psychological processes that cannot be
seen or measured directly.
That, motivation is not an attribute of the
individual or the organization: rather, it
results from the transaction between
individuals and their work environment
(Ibid)

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Myth about motivation

There are Several popular but misleading myths
about motivation
Myth [Link] workers are more productive
Motivation should not be confused with
performance
People can be highly motivated but still
perform poorly.
There are several factors for performance
ability, situational variables, availability of
resources
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Myth about motivation

worker performance is a consequence of three factors
(Bennett S and Franco LM (1999):
The ability of staff to do their job: (their knowledge,
skills, and experience to perform the job; in other
words the capacity or "can do" factors);
The motivation of staff to put in effort to do the job
("will do" factors);
The organizational support or opportunity to do
the job well (availability of resources and the
presence of policies and practices conducive to
performance, physical and social environment).
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Myth about motivation…

Thus if employee lacks knowledge the
manager can provide training or replace the
worker.
If there is environmental problem, the
manager can make an adjustment
But if motivation is the problem the task for
the manager is more challenging.

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Myth about motivation cont’d

Myth 2. some people are just motivated and
others are not
This assumption/ view is from the point
that motivation is a personality trait or
characteristics that remains stable from time
to time and place to place
If this is the case managers have to do little to
influence motivation and behaviour

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Myth about motivation cont’d

Kanfer (1990)Motivation is more specific to
situation influenced by factors in an
individuals environment) than it is a stable
personality trait
Individuals who are motivated at certain
times and particular situations can loose their
motivation if their work condition changes

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Myth about motivation cont’d

Myth [Link] can be mass produced
An assumption that speeches by charismatic
leaders to large groups of people or placing
motivational posters through out the work
place will result in mass produced motivation
Contrary to this, studies demonstrate that
individuals vary widely from each other in
many ways

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Myth about motivation cont’d

In order to motivate people effectively, managers
need to treat them as individuals
They have to consider individuals and
situational difference like
Job position or occupation
Career stages
Personal factors

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Myth about motivation cont’d

Myth 4. Money makes the world “go round”
Many if not, most individuals are motivated
by money
Too often managers think only of money
when trying to motivate workers
Fortunately, money is not always the most
important motivator; in deed, It seldom does

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Historical Perspectives on
Motivation
I. Earlier views
The Traditional Approach
Human Relations Approach
Human Resource Approach

II. Contemporary views

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The Traditional Approach

Work of Fredrick W. Taylor
Suggested the use of an incentive pay system
Management knows more about the jobs
being performed than the worker did
Economic gain was everyone’s primary
motivation
People could be expected to perform any
kind of job, if they were paid enough.
However, this theory failed to consider other
motivational factors
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Human Relations Approach

Work of Elton Mayo
Emphasize the role social process
Basic assumptions were employees have
strong social needs, and this needs are more
important than money in motivating
employees.
Allow work group to participate in decision
making; even though, the decision is already
made>>> no real participation
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Human Resource Approach

Work of Douglas McGregor
Carries the concepts of needs and motivation
one step further
It assumes that people want to contribute and
are able to make genuine contributions.
Management’s task then is to encourage
participation, create a work environment.

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Contemporary view on
Motivation
Modern approaches to motivation theory and
practice can be classified in to five categories:
Need theory, reinforcement theory, equity
theory, expectancy theory, and goal setting
theory
Enables managers and employee to fill the
following statement in a different way
“ a person is motivated when he or she____”

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Contemporary view cont’d

Research attempts to explain work
motivation through two basic types of
theories
Content perspectives: {need theory
(Maslow’s, ERG,), Herzberg’s two factors,
McClelland's Learned Needs (individual
human needs}
Process perspectives : (Expectancy, equity,
reinforcement, goal setting
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Content perspectives/theory on
Motivation
The purpose of behavior is to satisfy needs
A need is anything that is required, desired,
or useful.
A want is a conscious recognition of a need.
The content approach to motivation
The assumption is that individuals are
motivated by the desire to fulfill inner needs.
Content theories focus on the needs that
motivate people (what factor or factors
motivate people)
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Content theory cont’d

Motivation can be increased to the degree
that peoples need can be satisfied on the job
In content perspectives motivation is a
function of pay, working hours, and working
conditions.
Others suggest Autonomy and responsibility
Others still believe both sets are important
Two widely known are the “need hierarchy”
and “the two- factor theory”
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The need hierarchical

model/theory
Focuses on what people require to live
fulfilling lives.
A person is motivated when he/she has not
yet attained certain level of satisfaction

Need Drive

Satisfaction Action

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The need hierarchical

model/theory…

Developed by Abraham Maslow(1943)

He proposed that people want to satisfy
various needs and that these needs can be
arranged in hierarchy of importance
Maslow hierarchy of needs have five levels
that must be satisfied sequentially

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Maslow’s hierarchy of needs

General ex Organiza
tional Challenge jobs
Achievement S.a
examples

Status Esteem Job title

Friendship
Belongingness Friend at work
Stability
Security Needs
food Pension plan
Physiological needs Base salary

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Maslow’s hierarchy cont’d

Peoples are motivated first by the lower level
needs. As long as these remains unsatisfied
the individual is motivated only to fulfill
them.
(satisfaction progression) as individuals
satisfies one set of needs, the next higher level
of needs, will dominate.

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Research support, criticism/evaluation

Little evidence that a step-wise hierarchy
actually exists
Order of the level is not always present and
not the same
Research has not confirmed the deficit
principle, In which un met needs
systematically motivate
behaviour(schwartz,1983)
E.g. some employees strive for excellence
despite their low-salary.

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Research support,
criticism/evaluation cont’d
In other case higher wage jobs with numerous
opportunities, and their lower level needs
being met, they do not strive to achieve their
higher level needs

Unmet needs do motivate most employees most

Of the time
Organizations should provide employees with
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295

Wages sufficient for food, shelter

Reasonable protection of jobs, health and
safety
A satisfactory physical and social
environment at work
Reward or recognition
Provide opportunity for career advancement
Organizations polices must pay attention to
all of these needs
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The organization helps to satisfy employees'

physiological needs by a paycheck.

The organization helps to satisfy employees'

safety needs by benefits.
The organization helps to satisfy employees'
social needs through sports teams, parties,
and celebrations.

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The supervisor can help fulfill self-actualization

needs by assigning tasks that challenge
employees' minds while drawing on their
aptitude and training.
The supervisor can help fulfill esteem needs by
showing workers that their work is appreciated
Strength:
Maslow’s theory keeps managers aware of
employees’ high level needs when considering
motivation strategy
Challenges:????????1….. 2……..
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ERG Theory(Alderfer,1972)
Collapsed Maslow’s need hierarchy in to three
levels (see next figure)
Existence>>> corresponds to the physiological
and security needs of Maslow’s theory
Relatedness>>> focuses on how people relate to
others similarity with Maslow’s belongingness
Growth>>>> includes both the need of self
esteem and self actualization

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Maslow’s Theory Vs ERG’s

SA
Growth

Esteem

Relatedness
Belongingness

Safety and security Needs

Existence

Physiological Needs

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ERG Theory(Alderfer,1972) cont’d

The theory suggested that more than one
level of needs can motivate behaviour at the
same time
E.g>> the emergence of relatedness and
growth needs doesn’t require satisfaction of
the existence needs
Employee can be motivated by a desire for
money (existence), friendship (relatedness),
and the opportunity to learn new skills
(growth) all at once
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ERG Theory(Alderfer,1972) cont’d

ERG theory has a” frustration regression element”
I.e>> if employee receiving “adequate pay” seeks
opportunities for personal growth fail to attain
this need is frustrated and the employee may
regress to being motivated to earn more money
ERG theory suggests that needs are not fixed
The opportunities available in an organization
may affect employees needs

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ERG Theory(Alderfer,1972) cont’d

Research support and evaluation
More valid than Maslow’s needs hierarchy
How ever, both suggests that some needs are
more important than others
What is the difference you observe between
the two???? 1……..,2……..
Applications
Managers should assume all employees have
the potential for continued growth and
development, transfer opportunity,
promotion and career planning
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McClelland's three Needs

Focuses more on important need with out
concern for ordering them
- Need for Achievement: ( like to take
responsibility, motivated by challenging
work)
- Need for Power :the desire to be influential
in a group and to control one’s environment
- Need for Affiliation: the desire for human
companionship and acceptance

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Hertzberg's two factor theory

Developed by Fredric Herzberg(1987)
Identified that job dissatisfaction and
satisfaction arise from two different sets of
factors/dimensions

See the next figure

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Satisfaction No satisfaction

Motivating factors

Achievement, recognition, the

work itself, responsibility
Advancement and growth

Dissatisfaction No dissatisfaction
Hygiene factors

Supervision, working
conditions, Interpersonal
relations, pay and security,
organization policy and
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306

Hertzberg's two factor theory

cont’d
Dissatisfiers (Which he called“hygiene”factors)
The hygiene factors are organizational Policy
and administration, supervision, salary,
interpersonal relations and working conditions
All of these affected the context in which work
is conducted (the work environment)
If this factors are absent or negative
dissatisfaction results.

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Hertzberg's two factor theory cont’d

The presence of positive hygiene factor, by them
selves, prevent dissatisfaction, but does not lead
to satisfaction and motivation
Why Do you think so???

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Hertzberg's two factor theory

cont’d
Satisfiers (motivating factors)
Include achievement, recognition,
responsibility, and advancement
Factors influencing the satisfaction
dimension/motivation are related to the Job
content and the rewards of work performance
(i.e. intrinsic factor)

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Hertzberg's two factor theory

cont’d
These factors are labeled as motivators since
their presence increases job satisfaction and
motivation but their absence doesn’t lead to
dissatisfaction, but to no satisfaction
Why Do you think so???

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Hertzberg's two factor theory cont’d

A manager who tries to motivate an
employee using only hygiene factors such as
pay and good working conditions will likely
not succeed to motivate employees and a
high level of satisfaction
Managers must also offer factors such as
responsibility and the opportunity for
advancement (Motivator factors)

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Research support and evaluation

Has several limitations and weakness
His sample were not representative (200
engineers and accountants)
Some factors such as salary appear to be
associated with both satisfaction and
dissatisfaction (motivator and Hygiene)
Research also shows that both categories of
factors serve to motivate
Study suggested that hygiene factors were as
frequently associated with self-report of high
performance as were the motivators
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Research support and evaluation

cont’d
In reality these two factors don’t operate
separately from one another in a given person
The desire for advancement and for
recognition( both motivators) are connected
to feelings and attitudes about salary (a
hygiene factor)

Has a major impact in increasing manager’s

awareness of motivation & its importance
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Content…. Summary
Provided useful insight in to factors that
cause motivation
they do not explain why people might be
motivated by one factor rather than by
another at a given level or how people might
go about trying to satisfy the different needs.
Each theory leaves room for considerable
variation from person to person and “within”
a person over time
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Process theory of motivation

Process perspectives are concerned with how
motivation occurs
Four theories
Equity theory(Adams,1963)
Expectancy theory (Vroom,1964)
Reinforcement Theory (Skinner)
Goal setting theory(Locke,1968)

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Process theory of motivation

cont’d
Expectancy theory (Vroom,1964)
A theory of motivation that suggests
motivation depends on two things- how
much we want something and how likely we
think we are to get it.

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Process theory of motivation

cont’d
Adams Equity theory
Equity -perception of fairness
An individual’s belief that the treatment
he/she is receiving is fair relative to the
treatment received by others.

-For example, enough pay (output) for work

(input),
increased or reduce the amount of work
being done
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Reinforcement theory
Employee who did good should be
appreciated and rewarded.
Positive reinforcement -pleasant consequence
Negative reinforcement -unpleasant
consequences

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Empirical findings/studies
Ethiopian studies
For doctors, higher wages and quality
housing incentives had the biggest impact on
their willingness to practice in towns in rural
areas.
For nurses, improvements in the
availability of medical equipment and supplies
were the factors most likely to bring about a
move to a rural village (Kara Hanson)
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Empirical findings/studies…
Health workers with higher intrinsic
motivation – measured as the importance
attached to helping the poor –
as well as those who had grown up in a rural
area and catholic were all significantly more
willing to work in a rural area.

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Factors for motivation

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323

Common employee motivational

problems& solutions
Problems
[Link] performance definition (I.e., lack of
goals, inadequate job description, inadequate
performance assessment)
[Link] to performance (i.e. bureaucratic or
environmental obstacles, inadequate support or
resources, poor employee job matching,
inadequate information

[Link] performance-reward linkages

(timing, kinds, inequity…)
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Solutions
Well defined job description
Well defined performance standards
Feedback on performance
Enhanced hygiene factors
Pay for performance
Etc…..

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Managers Role
Systematically assess the motivation of their
employees
To be aware that motivation can vary over
time and with the kind of work they are
performing
Periodically assess motivation and
performance, from the perspectives of
occupational, career development and
personal factor
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Exercise
What methodologies one has to use to
assess motivation and performance??
What factors make people energized or
aroused to work?

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327

Conclusion
Identify employee needs and then take steps
to satisfy them
Remember there is no rule of thumbs/no
simple set of needs and need satisfiers that
would be universally applicable
No one set of motivators is likely to be
appropriate for all employees since their
needs will be different

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References
Dovlo D. The Health Workforce in Africa:
Challenges and Prospects. A report of the Africa
Working Group of the Joint Learning
Initiative on Human Resources. WHO, World
Bank & Rockefeller Foundation. Global
Health Trust. March 2004b.
Joint learning initiatives(2004) human
resource for health overcoming the
crisis,Harvard USA
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329

References cont’d
Stoner J.A.F, Freeman R.E., Gilbert Jr. D.R.
Management. 6th edition, 1996.
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.
Beaufort.B, Longest,Jr, Jonathon S. Rakich, Kurt
Darr,J.D. Managing Health service organization and
systems 4th edition 2003,Hamilton printing
company, Rensseleaer, New York.
Shortell S. M. and Kaluzny A.D. (2000). Essentials of
Health Care Management, Delmar Publishers
03/07/20
12/16/2010 74
330

Conflict Management in the Health Sector

03/07/20
Issues to covered
331

 Definition
 Philosophies of OC
 When does conflict occur?
 Outcomes of conflict
 Classifying Organizational conflict
 Conflict Management

03/07/20
Definition
332

 “Conflict is the perception of differences of interests

among people” (Thompson 1998).
 Conflict is “an interactive state in which the
behaviours or goals of one actor are to some
degree incompatible with the behaviours or goals of
some other actor or actors” (Tedeschi et al 1973).

03/07/20
Definition…
333

 Conflict is “a type of behaviour which occurs when

two or more parties are in opposition or in battle as
a result of a perceived relative deprivation from
the activities of or interacting with another person
or group” (Litterer 1966).

03/07/20
Definition…
334

 Conflict is a process of social interaction involving a

struggle over claims to resources, power and status,
beliefs, and other preferences and desires.
 The aims of the parties in conflict may extend from
simply attempting to gain acceptance of a preference,
or securing a resource advantage, to the extremes of
injuring or eliminating opponents. (Bisno 1988, Coser
1968)

03/07/20
Definition…
335

 Baron (1990), after reviewing a number of recent

definitions of conflict, concluded that although
definitions are not identical, they overlap with
respect to the following elements:

03/07/20
Definition…
336

 Conflict includes opposing interests between

individuals or groups in a zero-sum situation;
 Such opposed interests must be recognized for
conflict to exist;
 Conflict involves beliefs, by each side, that the other
will prevent (or has already prevented) its interests;

03/07/20
Definition…
337

 Conflict is a process;
 itdevelops out of existing relationships between
individuals or groups and reflects their past interactions
and the contexts in which these took place; and
 Actions by one or both sides do, in fact, produce
obstructing of others’ goals

03/07/20
Philosophies of OC
338

 Robbins (1974) presented three philosophies of

organizational conflict:
1. The classicists’, or traditionalists’ philosophy which
was based on the assumption that conflict is
detrimental to an organization and, as such, must
be reduced or eliminated.

03/07/20
Philosophies…
339

2. The behaviouralists’ philosophy, which can best be

described as
 the recognition that conflict is inevitable in
organizations.
 Behavioralists accept the presence of conflict and even
occasionally advocate the enhancement of conflict for
increasing organizational effectiveness.
 But they have not actively created conditions that generate
conflict in organizations.

03/07/20
Philosophies…
340

3. The interactionist philosophy is characterized by

the following:
 Recognition of the absolute necessity of conflict;
 Explicit encouragement of opposition;
 Defining conflict management to include stimulation as
well as resolution methods; and
 Considering the management of conflict as a major
responsibility of all administrators

03/07/20
Philosophies…
341

 Organizational conflict as it stands now is considered

legitimate and inevitable and a positive indicator of
effective organizational management.
 Therefore, the central theme is that too little conflict may
encourage groupthink, but too much conflict may lead to
organizational disintegration.

03/07/20
When does conflict occur?
342

 Conflict occurs when one or (two) social entity(ies):

 Isrequired to engage in an activity that is incongruent with
his or her needs or interests;
 Holds behavioural preferences, the satisfaction of which is
incompatible with another person’s implementation of his or
her preferences;
 Wants some mutually desirable resource that is in short
supply, such that the wants of everyone may not be
satisfied fully;

03/07/20
… conflict occur?
343

 Possesses attitudes, values, skills, and goals that are

relevant in directing one’s behaviour but that are
perceived to be exclusive of the attitudes, values,
skills, and goals held by the other(s);
 Has partially exclusive behavioural preferences
regarding joint actions; and
 Is interdependent in the performance of functions or
activities.

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Causes of conflict in modern organizations
344

 Globalization with the consequent need for greater

understanding and effectiveness in dealing with cross-
cultural dynamics
 Constant and a more rapid rate of change especially in
the external environment for organizations causing a lag
effect
 the organization experiences an unprecedented state of trying to
“catch up”
 Greater employee diversity

03/07/20
Causes of conflict…
345

 Increasing complexity of work in most organizations,

which leads to myriad perspectives and viewpoints
 Increasing electronic communication, particularly e-
mail, which causes
 lessface-to-face contact (losing the benefit of non-
verbal cues) and
 more “freedom” to communicate in confrontive,
potentially hostile ways

03/07/20
Causes of conflict…
346

 Constant pressure on organizations to be

cost conscious and effective at managing
costs causing
a scarcity of resources, which in turn increases
competition among managers, in particular, and
employees, in general

03/07/20
Outcomes of conflict
347

 Functional Outcomes
 Conflict may stimulate innovation, creativity, and growth.
 Organizational decision making may be improved.
 Alternative solutions to a problem may be found.
 Conflict may lead to synergistic solutions to common
problems.
 Individual and group performance may be enhanced.
 Individuals and groups may be forced to search for new
approaches.
 Individuals and groups may be required to articulate and
clarify their positions.

03/07/20
Outcomes…
348

 Dysfunctional Outcomes
 Conflict may cause job stress, burnout, and
dissatisfaction.
 Communication between individuals and groups may be
reduced.
 A climate of distrust and suspicion can be developed.
 Relationships may be damaged.
 Job performance may be reduced.
 Resistance to change can increase.
 Organizational commitment and loyalty may be
affected.
03/07/20
Outcomes…
349

 Pondy (1967) observed that organizational theories

“that do not admit conflict provide poor guidance in
dealing with problems of organizational efficiency,
stability, governance, and change for conflict within
and between organizations is intimately related as
either symptom, cause, or effect, to each of these
problems”

03/07/20
Classifying conflict
350

 Conflict in organizations/systems can be addressed

and understood at four levels or interfaces:
 the individual with the organization,

 individuals with one another,

 organizational units with other units,

 inter-organizational relationships.
03/07/20
Classifying…
351

 Conflict can also be classified according to its

source
1. Affective Conflict
 a condition in which group members have
interpersonal clashes characterized by anger,
frustration, and other negative feelings
 Psychological, relationship, emotional, and
interpersonal conflict

03/07/20
Classifying…
352

2. Substantive Conflict
 This occurs when two or more organizational members
disagree on their task or content issues
 disagreements among group members’ ideas and
opinions about the task being performed
 Task, cognitive, and issue conflict

03/07/20
Classifying…
353

3. Conflict of Interest
 inconsistency between two parties in their
preferences for the allocation of a scarce
resource
 involving either a distribution of scarce resources
between them or a decision to share the work of
solving a problem

03/07/20
Classifying…
354

4. Conflict of Values
 This occurs when two social entities differ in their
values or ideologies on certain issues
 E.g. Conflict between pro-life and pro-choice groups
in connection with abortion

03/07/20
Classifying…
355

5. Goal Conflict
 This occurs when a preferred outcome or an
end-state of two social entities is inconsistent
 A zero-sum game is a possibility

03/07/20
Classifying…
356

6. Realistic Vs Non-realistic Conflict

 Whereas realistic conflict is associated with
“mostly rational or goal-oriented”
disagreement,
 non-realistic conflict “is an end in itself having
little to do with group or organizational goals”

03/07/20
Classifying…
357

7. Institutionalized Vs Non-institutionalized
Conflict
 Institutionalized is characterized by situations
in which actors follow
 explicit rules,
 display predictable behavior, and
 their relationship has continuity

03/07/20
Classifying…
358

8. Retributive Conflict
 This conflict is characterized by a situation where the
conflicting entities feel the need for a drawn-out
conflict to punish the opponent
9. Misattributed Conflict
 This relates to the incorrect assignment of causes
(behaviours, parties, or issues) to conflict

03/07/20
Classifying…
359

10. Displaced Conflict

 occurs when the conflicting parties
 either direct their frustrations or hostilities to social
entities who are not involved in conflict or
 argue over secondary, not major, issues

03/07/20
Conflict Management
360

 Although conflict is often said to be functional for

organizations, most recommendations relating to
organizational conflict still fall within the realm of
conflict resolution, reduction, or minimization.

03/07/20
Conflict Management…
361

 If we have to confirm with the suggestion that “conflict

is functional for organizations” the emphasis must be
in conflict management, as opposed to resolution of
conflict.
 Conflict resolution implies reduction, elimination, or
termination of conflict.

03/07/20
Conflict Management…
362

 Conflict management does not necessarily imply

avoidance, reduction, or termination of conflict.
 It involves designing effective strategies to minimize
the dysfunctions of conflict and enhancing the
constructive functions of conflict in order to enhance
learning and effectiveness of an organization.

03/07/20
Conflict Management…
363

 When conflict arises, managers and supervisors who

are in a position to influence and affect the attitudes
and actions of those in disagreement may find it
helpful to: [Case]
 identify the causes and feelings of the parties involved,
 redirect tension and hostility,

 work to integrate ideas rather than accept a compromise,

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Conflict Management…
364

 achieve unity between the parties in conflict,

 accomplish real and permanent solutions,

 achieve a sense of fairness among those involved, and

 result in satisfaction for all of the parties involved

03/07/20
Conflict Management…
365

 Individuals and groups with a positive outlook tend

to be more
 optimistic and have hope for a good resolution of
conflict
 forgiving of others and will use more creativity in
seeking solutions
 accurately perceive the arguments that others may
present and
 relaxed so that defensive barriers are lowered and
listening is done more effectively

03/07/20
Conflict Management…
366

 The three most important approaches to

conflict management are:
 The Leadership Grid Approach
 The Thomas-Kilmann Conflict Mode

 Robbins’ Approach to Conflict Management

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The Leadership Grid Approach
367

 Developed by Blake and McCanse

 Each of the Grid positions represents a

different philosophy and a different set
of priorities.

03/07/20
The Leadership Grid
368

03/07/20
The Leadership Grid …
369

 The (1,1) type of leader

 isafraid that performance goals and people-related
efforts are in conflict;
 the supervisor’s role is to remain neutral and not get
involved in the struggle
 The (9,1) leader
 has a primary concern for productivity.
 all efforts are directed at getting work done whatever
the cost may be.

03/07/20
The Leadership Grid …
370

 The 1,9 leader has

a low concern for performance but a high desire to
have happy, satisfied people.
 Whatever makes people happy is what the 1,9 leader
concentrates upon.
 The 5,5 leader has
a moderate concern for performance and for human
needs simultaneously.

03/07/20
The Leadership Grid …
371

 The 9,9 leader

 believes that high performance results from the
integration of task and human requirements.
 aims to attain high performance as well as a high level
of satisfaction through participation and involvement

03/07/20
The Thomas-Kilmann Conflict Model

372

03/07/20
The Thomas-Kilmann…
373

 Take the Personal Feedback Conflict Management

Style Survey

 Suppose you find yourself in conflict with your boss.

03/07/20
The Thomas-Kilmann…
374

Here are the ways you could use the different styles
to handle the conflict:
 Avoider:

 You keep your mouth shut and don’t express any

dissent.
 Neutrality continues to be important.
 You keep a low profile and are at least outwardly
compliant with the boss, making no demands.

03/07/20
The Thomas-Kilmann…
375

 Competitor:
 You take a win-lose approach and fight to win your
own points as long as possible.
 You would probably do this only if you believe the
cause is important and your position is correct.
 In this case, you fight to win your own position.

03/07/20
The Thomas-Kilmann…
376

 Accommodator:
 You avoid conflict by conforming to the thinking of the
boss.
 You seek knowledge of the boss’s position and never
“go out on a limb” against the boss.
 You never give the boss any information that would be
upsetting, and you try to keep the boss pleased and
happy.

03/07/20
The Thomas-Kilmann…
377

 Compromiser:
 You concentrate on compromises and tentative statements.
 To the boss you might state, “We could do this or we could
do this. . . .”
 Collaborator:
 You confront conflict directly.
 You communicate your feelings as well as facts so that there
is a basis for understanding and working through the
conflict.

03/07/20
The Thomas-Kilmann…
378

 The approach to be used in handling conflict may

be altered somewhat if you as a supervisor
perceive conflict between two workers or between
yourself and a worker.

 The following statements suggest some of the

possibilities:

03/07/20
The Thomas-Kilmann…
379

 Avoider:
 You don’t get involved.
 You avoid issues that might give rise to conflict by not
discussing them with subordinates.
 Competitor:
 You suppress conflict through the use of authority.
 You fear the disruptive effects of conflict on
organizational achievement, so you beat down
impending threats.

03/07/20
The Thomas-Kilmann…
380

 Accommodator:
 You smooth over conflict.
 You attempt to encourage people to relax and forget
about their troubles and suggest that some troubles have
a way of disappearing or resolving themselves.
 You encourage those involved to “count their blessings”
and be happy with what they already have.

03/07/20
The Thomas-Kilmann…
381

 Compromiser:
 You split up parties in conflict and keep them
separated, talking with each party individually.
 You discuss their positions and blend their ideas to
reach a solution.
 You attempt to get acceptance of the compromise, even
if each party tends to be only moderately satisfied
with it.

03/07/20
The Thomas-Kilmann…
382

 Collaborator:
 You confront conflict directly and work it through at the
time it arises.
 Conflict is accepted so that the clash of ideas and
people can generate creative solutions to problems.
 Those involved are brought together to work through
their differences.

03/07/20
Robbins’ Approach to Conflict Management
383

 In his description of managerial actions related to

conflict, Robbins identifies nine possible responses:
 problem solving,
 development of superordinate goals,
 expansion of resources,
 avoidance,
 suppression,
 smoothing,
 compromise,
 authoritative command, and
 alteration of the behaviour of one or more parties involved.

03/07/20
Robbins’ Approach…
384

 Robbins states that the scientific process is used as

causes of conflict are identified and solutions are
developed.
 Individuals affected by a decision are involved in
making the decision.
 Conflict is avoided or reduced as people come to share
common goals requiring combined efforts.

03/07/20
Robbins’ Approach…
385

 Expansion of resources may be useful when it is

possible to obtain more money, equipment,
inventory, or whatever scarcity is causing conflict.
 Behavior alteration comes about when employee
actions are changed by rising education, training,
reinforcement, and so forth.

03/07/20
Mediation and Arbitration
386

 Are additional procedures frequently

discussed as management activities for
handling conflict

03/07/20
Mediation and Arbitration…
387

 Mediation
 a sort of cross between compromise and collaboration.
 similar to compromise in its result; it aims to bring about a
middle-ground, mutually acceptable decision or solution.
 similar to collaboration in that people are brought together to
talk about their positions and to find a solution.
 Manager’s role is to act as a leader in bringing the parties and
their views together.
 The leader does not make decisions for the parties involved.

03/07/20
Mediation and Arbitration…
388

 Arbitration
 isunlike any of the concepts above
 the arbitrator listens to all sides of an issue as the
different parties in conflict are encouraged to state their
positions.
 The arbitrator reviews the evidence and then makes a
decision or agrees to a solution.
 Usually, the arbitrator’s decision is binding for all
individuals and groups involved.

03/07/20
Choosing an Appropriate Approach
389

 The best approach selected from the styles for

dealing with conflict can be determined by factors
in the situation in addition to the philosophical
desires of the manager.

 There is no one best way to handle all conflict, since

each situation is different.

03/07/20
Choosing…
390

 Robbins suggests that the interactionist

approach to conflict is appropriate
today.
 He sees conflict as absolutely essential for
growth and change.
 He suggests creating conflict if necessary, but
he expects conflict to occur naturally in
vibrant, thriving organizations.
03/07/20
Choosing…
391

 His view
 recognizes the absolute necessity of conflict,
 explicitly encourages opposition,
 defines conflict management to include
stimulation as well as resolution methods, and
 considers the management of conflict as a
major responsibility of all administrators.

03/07/20
Choosing…
392

 The choice of approaches will be

dependent upon forces within the
leader,
other employees,
organization, and
task situation.

03/07/20
Choosing…
393

 Problem solving and superordinate goals in

particular are a part of the contemporary view.

 In the Thomas-Kilmann scheme, the collaborating

view of conflict would be contemporary in its
techniques.

03/07/20
Choosing…
394

 Although the collaborative approach to the

resolution of conflict has the potential for
accomplishing all of the objectives of conflict
management, it also requires skill and commitment
to this approach from the manager.

03/07/20
Choosing…
395

 Where problems exist that have available solutions

(the resources, the knowledge, the skill needed for
resolutions), the changes that will provide the
necessary correction should be implemented.

03/07/20
Choosing…
396

 Conflict caused by issues needing resolution benefits

from corrective action.
 Ifthe worker’s perceptions are accurately based upon
an actual loss of authority, a real role conflict, unequal
or unfair treatment, and so forth, the corrective action
should be to modify the conditions so that the problem
no longer exists.

03/07/20
Choosing…
397

 However, REMEMBER that

Some solutions to conflict cannot be
identified, and some identifiable
solutions cannot be accomplished.

03/07/20
398

Health communication

03/07/20
Objectives of the lecture
399

 Define communication
 Identify purposes of communication
 Identify Basic mechanism of communication in public health
 Identify Methods and types of communication
 Differentiate barriers of communication
 Understand rules for effective pubic communication

03/07/20
Communication Defined

400

 Communication – Latin = communis = common

 An attempt of trying to establish commonness or

common understanding

 The process of sharing of ideas, information,

knowledge, and experience among people

 It is the exchange of facts, ideas, opinions or emotions

b/n two or more people (Newman and Summer).
03/07/20
Communication defined…
401

 The art and technique of informing, influencing, and

motivating individuals, institutional and public
audiences about important health issues” (Healthy
people 2010 ).
 Allen Louis defines” it is the sum of all things one
person does when he wants to create understanding
in the minds of another.”
 Communication is not restricted to words alone; it
includes all methods [verbal and non verbal] by
which meaning is conveyed. Even silence conveys
meaning and is part of communication.
03/07/20
402

 If the information is not understood by the receiver in the same

meaning in which the sender wants him to understand it, the
purpose of communication is defeated.
 Communication defeat result in confusion, chaos and
organizational inefficiency, leading to non-fulfillment of
organizational goals.
 When managers communicate, 4 things may be accomplished:
1. Information is transmitted,
2. someone is motivated,
3. something controlled or
4. Emotions or feeling are expressed.
 Communication provide the information that people need to
understand what to do.
03/07/20
Purposes of Communication
403

1. Initiating actions.
2. Making known needs and requirements.

3. Exchanging information, ideas, attitudes and beliefs.

4. stimulating understanding

5. Establishing and maintaining relations.

(U.S. Office of Disease Prevention and Health Promotion, 2004).

03/07/20
Purposes…
404

 Managers can affect motivation by informing others about

rewards based on performance, and by helping employees to
understand and fulfill their personal needs.

 Managers can influence public policy makers to establish fair

regulations.
 Many kinds of communications facilitate control of performance
in HSOs/HSs through budgets, establishing standards policies
and face to face directives.

03/07/20
Purposes…
405

 Permitting people to express their emotions and feelings

such as satisfaction, dissatisfaction, happiness, anger etc
permits necessary venting to occur among people in
HSOs/HSs.

 Emotive communication helps managers increase

acceptance of the organization and its actions both
internally and with external stakeholders and
constituencies
 Tells the commitment level
03/07/20
406

The Basic Process of communication

Source Encode Message Channel Decode Receiver

Feedback

03/07/20
The Basic Process of communication
407

A simple sequenced of 6 steps.

1. The sender wants the receiver to understand the message.

Ideation
2. The message is encoded by the sender, who structures it into a logical form
of code = language.
3. When the sender is satisfied with the encoding of the message; he/she
transmits the message verbally or in writing or electronically, etc.

4. The message passes through a channel from the sender to the receiver.

5. The receiver decodes the message.

6. The receiver then understands the idea that the sender wants to convey.
Reaction --- response/Feedback
03/07/20
Ways of Communication
408
1. One-way communication.
Sender  message  Channel  Receiver.

 Linear type of communication.

 No feedback.
 No opportunity to clear up misunderstanding
 Meaning is controlled by a receiver
 what message
 how much communicated
 No input from the receiver
 Motivation of the sender may be personal gain or public good
 Quick if the message is simple and needs quicker communication
 e.g date & time of meeting
 may be less effective 03/07/20
Two-way communication
409

Feedback

Sender Message Channel Receiver

03/07/20
Two-way communication…
410

Advantages
 Suitable for more complex message

 Feedback is added

 Allows the sender to find out how much the message is

received - can be monitored
 Can be adapted to suit the receiver’s needs

 Sender can affect the quality and quantity of the

feedback through the type of question chosen and the

way it is asked.
03/07/20
Methods of Communication
411

There are four major methods of communication

1. Intra-Personal communication

2. Inter - Personal communication

[Link] communication

4. Mass communication

03/07/20
Methods of Communication…

412

Intra-Personal communication
 It takes place inside a person. It includes the beliefs, feelings,
thoughts and justification we make for our actions
Interpersonal Communication
 face-to-face interaction between two people.

Group communication
 face – to – face communication with several other people.

 A small group is considered between 3-15 people

 The members may have a common interest to work together for a

common goal.
 Groups have an impact on decision making.

Mass communication
 a means of transmitting messages to a large audience, that usually
reaches a large segment of the population. 03/07/20
Steps in the preparation of Health Communication
413

1. Stating the Problem or Issue - Defining the problem or

the issue
 identifying the “real’’ issues at hand
 Specific information for developing message
2. Stating Assumptions; are understandings that drive the
planning process , and may hold conflicting notions if not
considered in advance
 demographic trends, reimbursement practices, and other
aspects
 political climate
 other options for services
03/07/20
Steps in preparation…
414

3. Reviewing Available Data

Gaps in available information
◦ The incidence /prevalence of problem
◦ The characteristics of those affected
◦ The consequences of the health problem
◦ The possible causes for the condition
◦ The possible solutions, treatments, or interventions
4. Conducting Additional Research
Research into intended audiences’ culture, lifestyle, behaviors
and motivations, interests, and needs is a key
Eg conducting exploratory focus group discussions with an
intended audience at the start. 03/07/20
415
5. Defining Communication Objectives- objectives will help set priorities
among possible communication activities and determine the content.
Make them SMART
- serve as a kind of contract or agreement about the purpose and
outcomes to be measured.
- must be suitable to evaluation
6. Practically Assessing the Health Communication Approach-
communication alone may accomplish little or nothing without policy,
technological, or infrastructure changes. Eg .No effective
solutions/technology exist to support, it fails.
7. Profiling the Intended Audience(s)- identification of the intended
populations for a program - who is most affected, who is at the
greatest risk, and what factors ? 03/07/20
Steps in preparation …
416

8. Formulating a Strategy- choosing between a public health

approach, a free market approach, an educational
model
 should provide overall direction .
 fit the available resources,
 minimize resistance,
 reach the appropriate targeted groups
9. Choosing the type of Appeal/readiness – choosing ways
in which to capture the intended audience’s attention.
EG – emotional status of receiver, their intellect, or their
pocketbooks 03/07/20
Barriers of communication
417

Factors that might influence include:

 Selective attention on the part of the receiver.

 Selective distortion on the part of the receiver (e.g.

changing the message to fit preconceptions).

 Selective recall whereby the receiver only absorbs

part of the message, and

 Message rehearsal by sender whereby the receiver is
reminded by the message of related issues .

03/07/20
Barriers of Communication …

A breakdown can occur

at any point resulting in:
 Misunderstanding

 Lack of response  conflicting views

 Lack of motivation  insecurity
 Distortion of the message  inability to make
 Prevent the achievement effective decisions
of goals
- If not aware of them
- If not prepared for them
418 03/07/20
Sources of communication barrier
419

1. Transmission Barriers - defect in channel

◦ sometimes called “noise.’’
◦ A bad cellular phone line or a noisy restaurant can inhibit
communication.
◦ If an E-mail message or letter is not formatted properly, or if
it contains grammatical and spelling errors,
2. Conflicting Messages
 Messages that cause a conflict in perception for the

receiver.
◦ Eg Jargon or slang, a supervisor requests a report
immediately without giving enough time.03/07/20
Sources of communication barrier …
420

3. Information Overload
 people do not pay attention to all communications they
receive but selectively attend to..
4. Channel Barriers
 If a sender chooses an inappropriate channel of
communication, overwhelming barriers may be imposed.
 Detailed instructions presented over the telephone.

03/07/20
Sources of communication barrier …
421

5. Social and Cultural Barriers

 Cultures provide people with ways of seeing, hearing,
and interpreting the world.
 cognitiveconstraints- frames of reference or world views
 behavior constraints- own rules about proper behavior

6. Literacy Levels
 The literacy level of target audience must be taken into

consideration.
 the ability to read, understand, and act on health

information.
03/07/20
Sources of communication barrier …
422

7. Low Health Literacy

 Low health literacy—the inability to read, understand,

and act on health information -

 Medical information is becoming increasingly complex and, all
too frequently, physicians do not explain this information in
layperson’s terms
 easy to read and understand.

03/07/20
Classification of barriers of communication
423

Can be classified in to:

1. Physiological / Physical
2. Psychological
3. Environmental
4. Social/cultural

03/07/20
Classification of barriers…

424

1. Physiological / physical
 Illness,fatigue, pain etc
 Sensory impairment
 Clothes, jeweler, perfume
 Eye contact, tattoos
 Poor listening skills and receiver distortion
 Personal problems
 Lack of common experiences
 Misreading of body language
 Age and sex difference
 Sender used too many technical words for the audience
03/07/20
Classification of barriers…
425

2. Psychological
Attitudes/Beliefs related to:
 Sender or the information
 Lack of interest in the message
 Fear and mistrust
 Negative attitude and distorted perception
 More affinity to self rather than audience
 No entry point of agreement
 Aggressiveness
 Power play
 Communication apprehension
03/07/20
Classification of barriers …
426

3. Environmental
 Noise and Distractions
 Problems associated with media
 Time of day, day of the week
 Room set up, color, temperature
 Place of the education center
 Lack of services

03/07/20
Classification of barriers …
427

4. Social/cultural
 Cultural differences
 Socioeconomic differences
 Problems at home
 Language (use of Jargon, lack of word picture, Lack
of vocal variety, “no road map”
 Intransigence: "We've always done it this way!"
 Blindness: "It'll never happen to us!"
 Secrecy: “we don’t want any interference”

03/07/20
How to remove communication barriers
428

 Good communication skills (telling, listening, asking,

observing, understanding)
1. The sender must know his/her audience’s background
 age and sex
 social status
 education
 job/work
 interests/problems/needs
 language

03/07/20
How to remove barriers …
429

2. The messages must be:

 timely
 meaningful/relevant
 applicable to the situation.
3. The audience must remove their own barriers.
 The non-listener type – who refuse to listen
 The know-it-all type – who thinks he/she knows the answer
to everything.
 The impatient type – who is reluctant to sit and jumps to
conclusion.
 The negative personality – who enjoys saying ’’ No ’’ to
everyone.
03/07/20
Elements of effective communicator
430

1. An effective communicator must have a desire to

communicate being influenced by both personal values
and the expectations that the communication will be
received in a meaningful way.

2. An effective communicator must have an understanding

of how others learn, including how others perceive and
process information.

03/07/20
Elements of effective communicator…
431

3. The receiver of the message should be cued as to

the purpose of the message , whether the
message is to provide information, elicit a
response or reaction or arrive at a decision.

4. The content importance, and complexity of the

message should be considered in determining the
channels through which communication is
transmitted.

03/07/20
Elements of effective communicator…
432

5. The achieved or ascribed credibility of the sender

affects how the message must be considered,“ trust ’’
is most significant.

6. The time frame that is associated with the content of

the message must be considered in choosing the
channel/s and the manner in which the message is
communicated. The faster channels are, more precise
cues are needed with shorter time frames.

03/07/20
Effective communication model
433
Feed-back

Desire to Effective
communicate Communication
Being understood
Making meaning
 Not agreement

Understanding how Purpose

Others learn Content
Sender's credibility
Time frame
03/07/20
Channels of communication
434

 A channel defines the route or method by which

communication occurs.

 A channel of communication can be

1. In writing [e.g. a scientific manuscript, a memorandum,

news letter. or news release] or

2. By verbal means [e.g. news conference, radio

interview, or conference call].

03/07/20
435

3. Electronical- During recent decades additional

methods have evolved, including
 Videoconferencing ,
 computer networking,

 electronic mail and

 video taped messages etc

[Link] channels include heath-fairs, pamphlets,

posters, and public heath announcements. Each mode
have certain advantages in certain situations.

03/07/20
Some typical communication purposes with preferred channels

436

Purpose Communication Intended

channel audience
Disease outbreak News media General public
announcement

Research study Scientific journal Public health

results practitioners

Policy News paper Policy makers

recommendation
03/07/20
Some typical communication purposes with
channels…
437

Behavioral Television/ General public

change commercials
New program Press conference General public
initiative
Outreach Lay health Limited
workers communities
Strategic planning Community Community
meeting members
General heath Heath fair Community
information members
03/07/20
438

 The choice of an appropriate channel depends on

content as well as audience.

 Certain audiences prefer certain communication

channels. e.g. visually oriented messages- ---video-
young people.

 In contrast, technical audiences prefer written

documents, often with oral explanation available.
03/07/20
Rules for effective public communication
439

1. Accept and involve the public as a legitimate

partner:
 Demonstrate your respect for public and underscore
the sincerity of your effort by involving the community
early before important decisions are made.
 Involve all parties that have an interest or a stake in
the issues under consideration.

03/07/20
440

2. Plan carefully and evaluate your efforts;

Begin with clear, explicit communication
objectives- such as
 providing information to the public, motivating
individuals to act,
 stimulating response to emergencies or
contributing to the resolution of conflict.
 Classify and segment the various groups in your
audience and aim your communications at
specific sub groups in your audience.
03/07/20
441

3. Listen to the publics’ specific concerns ;

Do not make assumptions about what people knew,
think or want done about risks. Take time to find out
what people are thinking; use techniques such as
interview, focus groups, and surveys.
4. Be honest ,frank, and open; state your credentials,
but do not ask or expect to be trusted by the public. If
you do not know an answer or are uncertain, say so.
Get back to people with answers. Admit mistakes.

03/07/20
442

5. Coordinate and collaborate with credible sources;

Take time to coordinate all inter organizational and intra
organizational communications. Devote effort to the slow,
hard-work of building bridges with other organizations.

6. Meet the needs of the media; Be open with and

accessible to reporters. Respect their deadlines. Do not
hesitate to follow up on stories with praise or criticism, as
warranted. Try to establish long term relationship with
editors and reporters.
03/07/20
443

7. Speak clearly and with compassion /sympathy

 Use simple, non-technical language. Be sensitive to local
norms, such as speech and dress .Use examples that
make technical risk data come alive. Avoid distant,
abstract, unfeeling language about deaths, injuries and
illness.

03/07/20
CONTROLLING
444

 It is the measurement and correction of performance in

order to ensure those enterprise objectives and the
plans devised to attain them are being accomplished.

03/07/20
CONTROLLING cont…
445

 It is the process by which management sees if

what did happen was what was supposed to
happen. If not needed adjustments are made.
 Controlling as a management function is
closely related to planning, organizing &
leading.

03/07/20
CONTROLLING cont…
446

 It helps managers monitor the effectiveness of

planning, organizing, leading and take
corrective actions as needed.
 It is a managerial function & the
establishment of control systems is usually the
concept of top and senior managers.

03/07/20
CONTROLLING cont…
447

 Although some form of control is needed at

all levels of the managerial hierarchy, it is
mostly exercised at lower points in the
managerial hierarchy.

03/07/20
CONTROLLING cont…
448

 Control is not an end in itself rather the

primary aim of control is to improve
performance by ensuring that resources are
more effectively deployed, and that mistakes
are rectified. Therefore, an essential part of the
control process is taking corrective actions as
needed.

03/07/20
CONTROLLING cont…
449

Pre-requisites of Control System

1. Control require plans
The clearer, more complete and more
integrated plans are, the more effective
controls can be.
2. Controls require clear organizational
structure. The existence of O.S. and the
clearer, more complete, and more integrated
this structure is, the more effective control
can be.

03/07/20
CONTROLLING cont…
450

Important Components of Control

1. Standards
2. Measurements
3. Comparison
4. Appraisal and intervention or change.

03/07/20
CONTROLLING cont…
451

[Link] Standards
- The control process begins when
standards are set.
- Standards are units of measurement
established by management to serve as
benchmarks for comparing performance level.

03/07/20
CONTROLLING cont…
452

2. Measuring Actual Performance

- Measurement is an ongoing, repetitive
process,
- The frequency of measurement dependent
on the type of activity being measured.
- It involves comparison between what is
accomplished & what was intended to be
accomplished.

03/07/20
CONTROLLING cont…
453

- The unit or the yardstick thus chosen should

be clear, well defined and easily identified,
and should be uniform and homogenous
through out the measurement process.

03/07/20
CONTROLLING cont…
454

- To make sure that any standard, any

managers measure performance levels
accurately and correctly should pay close
attention to:
A. Timelines of Information
To maintain work standards, control
measures must be taken at the right time.

03/07/20
CONTROLLING cont…
455

B. Appropriate of Measurements
- Organizations use several different
measurement units to ensure that performance
is being gauged adequately.

03/07/20
CONTROLLING cont…
456

C. Reliability of Information
-Accurate information has consistent data and
measures all aspects of the situations.
D. Validity of Information
- Even though information may be reliable, it
may be invalid if it does not reflect what it is
intended to measure.

03/07/20
CONTROLLING cont…
457

E. Channeling Information to the

proper authority
- To the person who is accountable for the
operation and who has authority to take
corrective action.

03/07/20
CONTROLLING cont…
458

F. Simple
- Control measures must be simple, otherwise
they may take too long to apply and to produce
the intended effect.
G. Flexible
- Controls that are rigid may be self- defeating:
staff will try to evade them.

03/07/20
CONTROLLING cont…
459

C. Comparing Performance Against

Standards
- It is a matter of comparing measured results
with established indicators/standards
previously set.
- If performance matches the standards,
managers may assume that “every thing is
under control”. They should not have to
intervene activity in the organization
operations.

03/07/20
CONTROLLING cont…
460

- This is the active principle of the process of

control.
A slight departure from standards is normal
and expected. However, gross departures from
standards signal the need for immediate
corrective actions.

03/07/20
CONTROLLING cont…
461

- A manager needs to distinguish between

acceptable variation and variation indicating
that the process is out of control.
The manager can not change the past, but the
knowledge of the past will help him/her make
the right decisions today that will affect
tomorrow.

03/07/20
CONTROLLING cont…
462

-Control charts are frequently used to

compare actual data with standards.
D. Taking Corrective Action
- This step is necessary if performance falls
short of standards and the analysis indicates
action is required.
- The corrective action could involve a
change in one/more activities of the
organization’s operations.

03/07/20
CONTROLLING cont…
463

- The corrective action must be taken at the

appropriate time. This will usually be as soon
as possible after the reasons for the deviation
have been identified.
Corrective action normally implies changing the
current situation.

03/07/20
CONTROLLING cont…
464

- The manager can not see the total activity

and, therefore, must carefully avoid two types
of errors:
Taking corrective action when no action is
warranted, and
Failing to take corrective action when it is
clearly needed.

03/07/20
CONTROLLING cont…
465

Corrective Deviations
Correction actions may be done by:
1. Adjustment in the resource allocation.
2. Modification in directing, training, selection,
etc. of subordinates.
3. Improvement in supervision, motivation,
work environment, etc.

03/07/20
CONTROLLING cont…
466

4. Reassignment/ clarification of
duties.
5. Changing/ altering objectives.

03/07/20
CONTROLLING cont…
467

Developing/Designing a Control System

- Trying to control too many elements of
operations too strictly can annoy and
demoralize employs, frustrate their managers
and waste valuable time, energy, and money,
managers may focus on easy-to-measure
factors.

03/07/20
CONTROLLING cont…
468

Most of these problems can be avoided by an

analysis that identifies
- Key Performance Areas, &
- Strategic Control Points.

03/07/20
CONTROLLING cont…
469

A. Identifying Key Performance Areas

-Key performance/Key result areas (KRAs) are
those aspects of the unit/organization that must
function effectively for the entire unit or
organization to succeed.
These areas usually involve major
organizational activities/groups of related
activities that occur through out the
organization/unit.

03/07/20
CONTROLLING cont…
470

B. Identifying strategic Control Points

- It is also important to determine the critical
points in the system where
monitoring/information collecting should
occur.
- Once such strategic control points can be
located, the amount of information that has to
be gathered and evaluated can be reduced
considerably.

03/07/20
CONTROLLING cont…
471

- The most important and useful method of

selecting strategic control points is to focus the
most significant elements in a given operation,
usually only a small percentage of the
activities, events, individuals or objects in a
given operation will account for a high
proportion of the expenses or problems that
managers will have to face.
- Another useful consideration is identification
of places where change occurs in a productive
process.
03/07/20
CONTROLLING cont…
472

Managers need Eight Kinds of Control:

1. Controls that standardize performance to
increase efficiency & to reduce costs.
2. Controls that safe guard organization’s
assets from theft, waste/misuse.

03/07/20
CONTROLLING cont…
473

3. Controls that standardize the

product’s quality.
4. Controls that set limits for
Delegate authority.
5. Controls that measure on-the-job
performance of all employees in the
organization, including periodic performance
reviews.

03/07/20
CONTROLLING cont…
474

6. Controls that allow top management to keep

firm’s plans and programs in balance.
7. Controls designed to motivate people to
contribute their best efforts.
 The above mentioned types of controls can be
regrouped as quantity, quality, time, and cost
controls.

03/07/20
CONTROLLING cont…
475

CONTROL CONSIDERATIONS
When control systems are established and
maintained managerial & design
considerations are important.

03/07/20
CONTROLLING cont…
476

A. Managerial Considerations
Some managerial questions to be answered
when a control system is
established/modified are:
1. Where is the control focused?
It may be at the input point with review of
resources consumed; at the process or
conversion point.

03/07/20
CONTROLLING cont…
477

2. What types of measures are used for

standards and monitoring results?
Measures used in control depend on the focus;
the degree to which results are quantifiable.
3. Who has authority for establishing standards?

03/07/20
CONTROLLING cont…
478

4. How flexible should standards

be?
5. Who has access to control
system information results?
6. Who is responsible for
interventions?
03/07/20
CONTROLLING cont…
479

B. Design Consideration
In designing these systems, consideration of
the following will decrease occurrence of
dysfunctional aspects.
1. When possible, control should be forward-
looking?
Not all control can be forwarded- looking or
predictive. Most often, by reasons of
information flows or organizational
constraints, it must be retrospective.

03/07/20
CONTROLLING cont…
480

2. Control should be organizationally realistic

and understandable to users.
3. Control should be accurate, timely and
reliable.
4. Control should be significant and/or have
economic benefit.
5. Control should be information – appropriate.

03/07/20
CONTROLLING cont…
481

Techniques of Control
1. Planning, Programming, Budgeting System
(PPBS).
It emphasizes the planning nature of the
budgetary process & facilitates the
appropriation of funds on a current basis in
the light of anticipated total costs for the
program over its life span.

03/07/20
CONTROLLING cont…
482

2. Program Evaluation & Review Technique

(PERT)
- It involves identifying the sequence of work
activities & three estimates of completion
times for each optimistic , pessimistic, and a
probabilistic expected time.

03/07/20
CONTROLLING cont…
483

3. Management Audit
- It is a comprehensive & constructive
examination of an organizational structure, its
plans, objectives, means of operation and its
use of human and physical facilities.
- It examines the overall performance of the
organization.

03/07/20
CONTROLLING cont…
484

- It critically analyzes every aspect of the

organization and its operation.
- The valuable information generated by such
an audit assists management in making
control decision.

03/07/20
CONTROLLING cont…
485

4. Budgetary Control
- Budgets are used as control measures because
they establish clear standards of performance
and any deviations can be quickly detected
and corrected.

03/07/20
CONTROLLING cont…
486

5. Personal Observation
6. Client/Customer Satisfaction
Questionnaires
7. Performance Appraisal

03/07/20
CONTROLLING cont…
487

8. Breakeven Analysis
- This is an analytical technique for studying
the relationship among fixed costs, variable
costs and profits.
- It is a formal profit planning approach based
on established relations between costs &
revenues.

03/07/20
CONTROLLING cont…
488

Characteristics of an Effective Control System

1. The activity required should be linked to the
objectives and plans of the organization.
2. The focus should be on what has been done
right and any assessment of what has been
done wrong should minimize the extent to
which blame is attached.

03/07/20
CONTROLLING cont…
489

[Link] which is expected of employees should

be clearly understood.
Only when an employee understands what is
required of him/her can effective, positive
control be exercised.

03/07/20
CONTROLLING cont…
490

4. If there is an area of tolerance, that area

should be clearly specified and understood.
It is essential for everyone involved in the
control process to understand what the
degree or parameters of tolerance are.
5. It would help if the employee felt a degree
of ownership over which is being assessed.

03/07/20
CONTROLLING cont…
491

6. Work should be allocated on the

basis of individuals being able to
control its outcome.
7. Targets must be realistic.
8. All those who are subject to control should
receive adequate feedback as to their
performance and what, if any, remedial action
is necessary.

03/07/20
CONTROLLING cont…
492

Feedback in the Control Process

An essential elements in the control process is
feedback. Any feedback system must have a
number of characteristics:
Timely, Reliable, Precise, and right – recipient.

03/07/20
MONITORING
493

- It is the day-to-day watch on, or continuous

follow up of, the on going activities.
- It is carried out through observation of men
and materials, discussion with workers,
supervisors and beneficiaries, and review of
reports, diaries and statistical data.

03/07/20
MONITORING Cont…
494

- It is regularly checking to see that program

activities are being done as planned.
- The goals of monitoring are:
 To identify any problem early, and
 To solve without delaying the progress of the
program.

03/07/20
MONITORING Cont…
495

Steps in Monitoring
- Collecting data to monitor
- Summarize the data,
- Analyze, use data,
- Action.

03/07/20
EVALUATION
496

- It is the methodological process of

determining the worth of a system, project,
course of action, campaign, etc.
- It involves the comparison of the actual
performance of the system.

03/07/20
EVALUATION Cont…
497

- It is also defined as a systematic way of

learning from experience and using the lessons
learned to improve current activities and
promote better planning by careful selection
of alternatives for future action
- Ask “Did we achieve what we set out to do?”
and comparing the present situation with the
past in order to find out to what extent
organizing purposes have been achieved.

03/07/20
EVALUATION Cont…
498

- It is carried out mainly as a way of looking at

program activities, human resources, material
resources, information, facts, and figures; in
order to monitor progress and effectiveness,
consider costs and efficiency, show where
changes were needed, and help to plan more
effectively for the future.
- Evaluation is a continuous process.

03/07/20
EVALUATION Cont…
499

Steps in Evaluation
1. Assess the evaluation situation
 Determine the evaluation goal
 Clarify what is at stake, e.g. human lives,
change in policy, etc.
 Specify how much confidence and reliability
to aim for.

03/07/20
EVALUATION Cont…
500

2. Choose the evaluation design

appropriate to the evaluation situation:
 Assess the feasibility of achieving
 Assess potential threats to internal validity

 Choosing the evaluation design appropriate to

the situation, and
 Assessment of evaluation criteria.

03/07/20
EVALUATION Cont…
501

3. Develop evaluation indicators and

instruments.
4. Plan your approach for analyzing data.
5. Plan for optimal use of results for
learning and action.
Three key steps are important:
 Know you audience
 Organize results according to importance
 Simplify, Simplify, Simplify.

03/07/20
EVALUATION Cont…
502

The results of evaluation are expected to show:

- What a program has been trying to do;
- What actually happened;
- Where are the differences/gaps
between plans and what happened;
- The reasons for the difference/gaps, and
- What needs to be done about them.

03/07/20
EVALUATION Cont…
503

Evaluation involves finding the answers to the

following questions:
- Are workers performing well as
planned?
- Is equipment functioning as
effective as expected?
- Are resources being utilized fully?

03/07/20
EVALUATION Cont…
504

- Are records being maintained

correctly?
- Are the collective actions of the
workers producing expected
results?
If the answers to one/more of these is NO, then
the reasons for the deficiency are explored.
Where do the faults lie?

03/07/20
EVALUATION Cont…
505

PURPOSES OF EVALUATION
 To note the short comings, deficiencies,
duplicates, etc. in the system. Suitable
corrective actions need to be undertaken.
 To justify the governmental/supporters
expenditure on a program by demonstrating
its worth and convincing the people that their
money is being well utilized.

03/07/20
EVALUATION Cont…
506

The evaluation process takes place before,

during, and after program implementation.
If the evaluation is well designed and
conducted, the findings can be extremely
beneficial to the program stakeholders.

03/07/20
EVALUATION Cont…
507

TYPES OF EVALUATION
Some authors use the terms
 Input, Process, output ,Outcome and Impacts to
determine the value of a program.

03/07/20
EVALUATION Cont…
508

Others use the term

Formative/diagnostic or progressive
Evaluation to Evaluate input and it is
performed during implementation
 Summative or Terminal Evaluation to
evaluate output and it is done at the
conclusion of the program.

03/07/20
EVALUATION Cont…
509

1. Process Evaluation/Program Monitoring

Document the implementation of a project
and explain cause and effect.

03/07/20
EVALUATION Cont…
510

2. Impact Evaluation
- Document and explain cause and
effect.
- Focus on the immediate observable
effects of a program leading to the
intended outcomes of a program,
immediate outcomes.
- Requires at least 5 years from the
inception of a program.

03/07/20
EVALUATION Cont…
511

3. Formative/Diagnostic Evaluation
- Any combination of measurements obtained
and judgment made before or during the
implementation of materials, methods,
activities or programs to control or assure or
improve the quality of performance or
delivery.

03/07/20
EVALUATION Cont…
512

- It is providing information on
progress.
- It is designed to inform about the
amount still has to go before
achieving objectives.
- It measures the progress or gains made
from the beginning until completed.

03/07/20
EVALUATION Cont…
513

- It enables activities to be adjusted in

accordance with progress made or lack of it.
Therefore, it is a teaching method.
- It is very useful in guidance and prompt to
ask for help.
- It is carried out frequently.

03/07/20
EVALUATION Cont…
514

4. Summative/Certifying Evaluation
- Any combination of measurements and
judgments that permit conclusions to be
dawned about impact, outcome, or benefits of
the program or method.

03/07/20
EVALUATION Cont…
515

Who will conduct the Evaluation?

- The evaluator may be someone associated with
the program or someone from outside.
- If he/she personally involved with the
program conducts the evaluation, it is called
an Internal Evaluator.
- An External Evaluator is one conducted by
someone who is not with the program.

03/07/20
EVALUATION Cont…
516

SUMMARY
Evaluation can be thought of as a way
 To make sound decisions regarding the worth

for effectiveness of health promotion

programs,
 To compare different types of programs,

 To eliminate weak program components,

 To meet requirements of funding sources, or

 To provide information about programs.

03/07/20
EVALUATION Cont…
517

INDICATORS
- It is a standard used to measure changes in the
state of health and welfare of the community.
- They are predetermined and pre-defined and
are employed to compare the expected with the
actual performance.

03/07/20
EVALUATION Cont…
518

Three types of Indicators:

1. The Input Indicators
- These specify the quantity of materials,
drugs, vaccines, etc. to be procured, the
number of personnel of different categories
to be recruited, sent for training, etc. and the
amount of money to be spent.

03/07/20
EVALUATION Cont…
519

2. Process or Performance Indicators

- These are yardsticks to determine the success
of the main, the supportive, and the
developmental activities. E.g. The number of
daily out patient attendances, % wells
chlorinated in the month, etc.

03/07/20
EVALUATION Cont…
520

3. Outcome, Effect, Impact, or Output Indicators

- These are yardsticks for assessing the impact
of the program. E.g. % decreases in IMR,
MMR, Death, Birth Rates, etc.

03/07/20
EVALUATION Cont…
521

Types of Health Indicators

A. Health Policies
- Level of political commitment
- The allocation of resources
- The degree of decentralization
- Mechanisms for community
participation, etc.

03/07/20
EVALUATION Cont…
522

B. Social & Economic Development

- Population related Indicators:
demographic characters
C. Provision of Health Care: Availability,
accessibility, and coverage.
D. Health Status: nutritional status, infant
mortality, maternal mortality, etc.

03/07/20
523

District Health System

03/07/20
Outline
524

 Concept of district health system

 Characteristics of a District Health System

 District health structures and their functions

 Relationship with other health systems

 Assessment of the operationality of DHSs

03/07/20
Concept of district health system
525

 The district is the most peripheral fully organized unit of local

government and administration.
 It differs greatly from country to country in
 size and degree of autonomy, and

 population may vary from less than 50,000 to over 300,000.

 It comprises first and foremost “a well-defined population living

within a clearly delineated administrative and geographical
area”

03/07/20
Concept of district…

526

 A district health system includes the interrelated elements in the

district that contribute to health in
 Homes,
 Educational institutions,
 Workplaces,
 Public places and communities,
 As well as in the physical and psychosocial environment.
 It includes self-care and all health care personnel and facilities,
whether governmental or non-governmental, up to and including
the hospital at the first referral level and the appropriate
support services (laboratory, diagnostic and logistic support).

03/07/20
Concept of district…
527

 The following are some of the components of a district health

system:
 District health office;

 District hospital or hospitals;

 Health centres; (PHCU)

 Community, neighbourhoods and households;

 Private health sector, NGOs.

03/07/20
Characteristics of a District Health System
528

 A district health system is large enough to justify the costs

involved for investment in and management of health services,
particularly where hospitals are concerned (favourable cost-
benefit ratio).

 It is small enough to know and take account of the demographic

and socio-economic situation.

 Both top-down and bottom-up planning approaches can easily

be coordinated because of direct contact at all levels.

03/07/20
Characteristics…
529

 Communication with the target population and its participation in

planning and organization are fairly easy to handle.

 Management (e.g. supervision) is more transparent and reliable.

 Coordination is easy to achieve between the various programmes

and services at different levels.

 Intersectoral cooperation can take place (e.g. with agriculture,

education, water, sanitation and housing sectors).

03/07/20
Conditions for a Functioning DHS
530

 A DHS can only function on a target-oriented basis when political

decisions create the required framework.
 The decentralization of the health system must be legalized and
implemented by means of regulations and legislation.
 Health service institutions and providers must have autonomy in the
use of physical and human resources, and income generated by
health services must remain at their disposal.
 The necessary financial and human resources must be mobilized.
 Sufficient personnel, qualified in planning and management
activities, must be available.

03/07/20
District health structures and their functions
531

The District Health Office

 Manages, administers and coordinates district health matters and
serves as a link between the district and higher levels: regional,
and national.
 Is managed by a multidisciplinary team usually referred to as the
district health management team (DHMT).
 The District Health Office is headed by

 the Public Health Physician/Officer, District Medical Officer or

District Health Director, depending on the system that operates
in a country.
 The District Health Office could be answerable to

 either the District Council/Assembly or local Health Board.

03/07/20
District health structures…

532

The District Health Management Team

 is responsible for the day-to-day management of the district

health system.
 Common DHMT functions include

 planning, supervision, budgeting and finance control as well as

problem-solving and crisis management.
 The DHMT is answerable to the District Health Board for day-to-

day management of the district health system.

 The DHMT leader is commonly the District Medical Officer, District

Health Officer or District Director of Health Services.

03/07/20
District health structures…

533

 Other core members usually include

 the District Nursing Officer or Matron, District Environmental
Health Officer, District Pharmacist and District Health
Administrator.
 The composition differs from country to country.

 The DHMT has the responsibility of

 Reviewing all health development plans in the district
(including private, NGOs, missions, etc.).
 Translating the national health policies into comprehensive
annual district health plans in accordance with local situations.
03/07/20
District health structures…
534

 This involves consultation with all stakeholders, including health centre

staff, health centre committees and committees at community level.

 The plans and budget should be submitted to the DHB for approval and
funding.

 The DHMT should then ensure that

 health services are provided by different levels of health care on
basis of district health plans and in accordance with national rules
and regulations.

03/07/20
District health structures…
535

The Hospital Management Team (HMT)

 Is answerable to the DHMT

 The head of the hospital (hospital director) is the chairman.

 Other members usually include heads of departments

according to the organization of the hospital.

03/07/20
District health structures…

536

Health Facility Committees: may include

 The Health Centre Committee,

 Dispensary Committee or

 Clinic Committee as applicable to the situation in different

countries.
 Composition of health facility committees

 Representatives from the community, health facility and other

community development structures.
 The committee elects its own chairman.

 The head of the health facility is the secretary to the

committee.
03/07/20
District health structures…
537

The Community Health Committee (CHC)

 is answerable to the health facility committee.

 However, in some countries, there is a village development

committee which is responsible for all development in the village.

03/07/20
District health structures…
538

The District Council

 Local legal administrative body

 Composed of councillors who are elected

 Has legal status and powers, a defined geographical area

under its jurisdiction and powers to collect and review revenue.

 Manages its own budget, makes development plans and

provides economic and social services in its area of jurisdiction

03/07/20
District health structures…
539

The District Health Board (DHB)

 A policy body consisting of elected or appointed members

drawn from both public and health sectors in the district

 Ensures that the DHMT provides quality, cost-effective and

equitable district health services

03/07/20
Assessing the Operationality of a DHS

540

 Assessment of the operationality is

 The review of the organization and management of a health
system in terms of structures, managerial processes, priority
health activities, community participation and the availability
and management of resources.

 The objectives:
 Identify the strengths and weaknesses

 Develop a plan of action to improve the operationality of the

district health system
 Strengthen the DHMT through a self-assessment process
03/07/20
541

03/07/20
542

03/07/20
Common problems of district health systems
543

 Overburdened (district) hospitals

 Under utilization HC, bad quality
 Overlap between levels
 Lack of referral system
 Weak institutional/management capacity; ill defined
authority (issue of decentralization)
 Ill defined ‘critical mass’, catchment populations
 Imbalance equity - efficiency
 Lack of community participation
 Low effective coverage of essential services
03/07/20
Role of the Province or Region
544

 Monitoring performance of district health systems;

 Monitoring financial performance in the districts;
 Assisting in development of a health management
information system;
 Assisting in human resources development in
districts;
 Assisting in development of a quality assurance
policy in districts;
 Providing technical, consultancy and training
services to the districts;
 Conveying central health policies.
03/07/20
545

03/07/20
546

Healthcare Operations
Management

03/07/20
Introduction
547

 The term operations management refers to planning & control

of processes that transform inputs into outputs
Health OM is defined as; analysis, design, planning & control of
all necessary steps to provide health services
 Ensures that adequate resources are in place to provide an
‘acceptable’ service for patiens
 Healthcare Operations/Processes can be:
 An individual patient-provider consultation
process
 Healthcare service provision of a department

 Healthcare service provision of a health facility

03/07/20
Inputs Transforming Processes Outputs
(The Agenda for Health OM)
548
Patient demand
CLINICAL PROCESSES
(Perceived
•Treatment Health
need) modality Status
•Treatment protocol
Providers •Provider–patient
• Number encounters Client

processes
• Specialty

Support
perception
• Reputation MANAGEMENT
PROCESSES
Finance • Infrastructure Use of
• O. Structure Resources
• Provider–
Suppliers
patient
encounters

Patient demand for care is the key input that influences planning & control of
required resources to transform inputs into outputs

03/07/20
Relationships & Potential Conflicts b/n Different Types of Outputs
549
E.g.
 Measures to increase patient satisfaction by
reducing waiting times may require additional
investment and the hospital can not achieve its
budgetary targets
A hospital with such budgetary pressures is unable to
invest in services that are known to be effective:
E.g. expensive Rx for rare conditions
 Hence, in its attempts to ensure effective & efficient
services, the health OM should achieve an
‘acceptable’ balance between different types of
outputs
03/07/20
Strategic Elements Of Health Care OM
550
Essential strategic issues for OM:
1. Process choice – selecting the right approach to
delivering services
2. Innovation – adapting or renewing the
organization’s processes to adapt to changes in
the external environment
3. Supply chain management – managing external
relationships with suppliers for effective & efficient
inputs supply
4. Production control – managing processes
effectively & efficiently
5. Managing & organizing the operations workforce
6. Customer satisfaction – managing03/07/20
quality
551

 The strategic issues are addressed under overarching

strategic issue - Operations/Transforming Capacity,
 Ability to transform inputs to outputs
 Is determined by the level of transforming resources
 An operations strategy to be successful, must
include at least the following required capacities:
1. Range & location of facilities
2. Investment in service & process technology
3. Formation of strategic buyer–supplier relationships
4. Organizational structure of operations-workforce

03/07/20
Managing Capacity:
Managing Transforming Resources
552

 The challenge of managing resources is that outputs are

delivered to clients in the right amount, at the right time
 Managing operations resources aligns supply with clients
services demand
• If not, outputs are produced with no immediate
demand, or inadequate outputs are produced to
meet demand
 A mismatch either way means lost revenues or increased costs
for the organization
 Good capacity management ensures that the organization
doesn’t make promises to clients that it can’t deliver

03/07/20
Measuring Capacity:
Operations/Transforming Capacity
553

 Capacity is the level of output to be achieved over a

specified period of time
 Generally measured using a combination of measures,
including time & money
 Time is the most important measure for outputs
& money for inputs
 Many activities in service operations cannot be
initiated except by customers request implying;
 Either the operations must wait for customers
(idle time) or customers must wait for the
operation (queuing)
03/07/20
554

 Capacity comparisons for hospitals are generally presented as:

1. No. of beds,
2. Service coverage &/or utilization
3. Average No. of pts seen in a given period of time,
4. [total bed days in a period (actual) / total
available bed days in the period]*100
 When making capacity management decisions, effects of each
input on performance must be considered
E.g. No of patients to be served depends on:
 No. of staff,
 No. of beds,
 Availability of adequate space, equipment & other
03/07/20
technologies
Inputs/Transforming Resources

555

1. Facilities
 Capacity management is concerned both with the:

 Absolute service output level of the operation

 Range &/or mix of service outputs
 Organizations match capacity with demand through changing
the number, location & processing capacity of facilities
o At organizational level: the No & location of
facilities is a strategically important decision
affecting total output
o At operational level: a major influence on the
capacity of an individual service facility is the
physical space available
03/07/20
A) Facility Location
Factors influencing facility location decisions:
556

 Locations of clients
 How local conditions affect business operations,
and
 Costs of doing business (including
infrastructure)

An organization may:
 Centralize production of all of its outputs in a
single large facility,
 Or invest in multiple facilities, either located
close to markets or specializing in a particular
output or range of outputs
03/07/20
557

 Physical location is no longer central for some

services
 Working on a remote basis; tele-working &
telecommuting (to work from home on a computer
linked to the workplace via modem) are:
o Becoming popular alternatives to commuting to
the office via crowded roads or railways
o Becoming increasingly important to customer
choice, rather than physical location
 Discussion Point: Do you think that physical
location can also be no longer central for
healthcare operations? Justify your arguments.
03/07/20
B) Economies of Scale

558

 Deciding the best size for a service facility,

 Selects a size that minimizes average cost per unit
of output
 The concept: costs decrease as the client volume
increases, because fixed costs can be spread over a
greater number of clients whilst variable costs
increase proportionally

 Fixed costs – costs that remain constant over a

range of volume of outputs,
Variable costs - costs that are proportional to
the volume of outputs 03/07/20
C) Layout

559
 Operations can be high-contact or low-contact operations in
time &/or space with patients
 High contact operations are described as front-
room operations &
 Low contact operations are called back-room
operations
 Obviously, physical space alone doesn’t determine capacity;
E.g. Adequacy of physical space at a dept determines an aspect of
service quality – capacity
 But, capacity is also determined by the No of rooms & their
arrangement (triaging) that the dept can handle simultaneously

03/07/20
2. Technology

560

 A 2nd influence on capacity next to physical size

 Includes investments in:

 Machines,
 Equipment,
 Computer & communications systems and
 Technological know-how
3. Workforce
 3rd major determinant of an operation’s capacity

 Service organizations generally rely more on

employees than on capital equipment

 የሰው ኃይል……
03/07/20
Measuring Workforce Capacity (Work Study)
 Unlike machines & other automated equipment,
561
workers do not work at a programmed & uniform pace;
Human beings Machines
Rarely repetitive performance Repetitive
(exactly)
Often vary considerably in the Usually very much the same as
level of work that they can other machines of the same
achieve type
Usually need time off Can often be run continuously
over a long period

More flexible in responding to Less flexible

changing needs and variations
in the environment

 Challenges measuring workforce capacity

03/07/20
562

 Principle of work study is linked to the principle of scientific

management which states:
• “Once jobs had been analyzed & reorganized, precise
time standards & production targets could be set up”
 Two complementary areas of work study are:
1. Method study &
2. Work measurement

1. Method Study
 Looking critically at processes in order to improve

performance
 Approach - ‘SREDIM’

 A practical approach in modern OM

03/07/20
563

The ‘SREDIM’ approach:

 Select a specific area of work/process to be improved
 Record all relevant facts of the particular area/process
 Examine all factors in the present process
 Develop a better approach/process
 Install a new method as a standard of excellence
 Maintain this new standard as the minimum whilst actively
seeking for further continuous improvements
E.g. Current processes can be measured in terms of time
& other factors like:
o Time: Operation, Delay, Transportation
o Other factors related to:
- SCM (Controlled inventories
03/07/20
- Supervision/mentoring
564

 Thus, method study:

 Aims to have pure ‘operation’ activity that adds
value -vs- the nonproductive ‘cost’ factors
preventing utilization of capacity
 Is a powerful approach to continuous
improvement
 Can benefit key areas such as:
 Department &/or work place layout,
 Materials handling,
 Tools & Process designs,
 Quality standards
03/07/20
2. Work Measurement
565

 Tools & techniques to measure what work

levels people can achieve under normal
circumstances
Includes:
a) Time study: Identifies & eliminates wasted time,
and sets time standards for tasks
-Standard time is defined as the total time in which
a job should be performed, including rest time
b) Pre-determined Motion Time Study
(PMTS)/Process Study:
- Eliminates unnecessary operations & waste
- Looks critically at processes for improvement
03/07/20
566

 Jobs are broken down in to tasks activities

called elements job motions or basic
physical movements
E.g.
o Job- ANC service

o Tasks- Exam, Counseling, Preventive Rx……

o Activities/elements
- Exam (P/E, V/S, ..)
- Counseling (immunization, danger signs....)
- (Bgp/Rh, PITC, U/A, VDRL….)
- Preventive Rx (FeSo4, …..)
o Job motions or basic physical movements………
03/07/20
567

 Data sources: Historical records,

observations/recordings of work being done

 Work measurement can have direct impact on

the following areas:
 Costing systems
 Incentive schemes
 HR planning
 Production scheduling
 Capacity planning – Demand forecasting

03/07/20
Learning Curve
568

 An aspect of workforce that can affect capacity

 The idea & mathematical representation that workers get

better at particular tasks with experience

 Every time cumulative output increases

 Time to produce/serve subsequent clients decreases

 The curve is drawn by plotting observed service times &

cumulative numbers of clients

 The concept of learning curve is important to capacity,

because organizations can expect to achieve higher levels of
outputs with the same amount of resources03/07/20
569

Supply Chain Management

“When the rate of change outside exceeds the

rate of change inside, the end is in sight.”

03/07/20
Supply Chain Management

570

Supply Chain:
 Movement & storage of raw materials, work-in-process
inventory, and finished goods from point of origin to point of
consumption
 Tracking, Receiving, Storing, Finding & Delivering of
supplies
SCM:
 Process of planning the most efficient & effective ways of
structuring supply chain/process
Effective SCM Requires:
1. An integrated supply chain strategy
2. Logistics coordination to deliver products to desired
location
 Inventory & Warehouse Management 03/07/20
Health Care Suppliers

571

1. Pharmaceuticals
2. Medical-surgical
3. Medical devices
4. Equipment
5. Food and dietary
6. Office suppliers
7. Cleaning suppliers

03/07/20
The strategic supply wheel model
572
 An integrated approach to supply strategy

4
Organizational
Structure

1
Performance Relationship
Measures Corporate Portfolio 2
Supply
Strategy

Skills & Cost/Benefit

Competencies Analysis 3

03/07/20
1. Performance Measures

573

 Can be thought of as both internal and external

measures
 External measures are often referred to as ‘vendor
assessment’ schemes
 Mechanisms to assess performance of suppliers
E.g. - Delivery performance,
- Price competitiveness,
- Quality and defect rates
 Internal measures focus on the buyers; generally
focusing on price, delivery and quality

03/07/20
574

 Measures should be appropriate,

 If buying nuts-and-bolts (low value, high volume

items), it is likely to use efficiency measures
 How quickly these things are being bought

 If buying more complex and expensive items –

E.g., a computer system (low volume, high value)
 It is less likely to be measured as how quickly it is
bought; rather, how the item has met our design
specifications
 Effectiveness measure
03/07/20
575

 Make sure that these measures are aligned with the

relationship strategy that the firm wants to pursue

 If to build long-term relationships, it needs to

develop more effectiveness-focused
relationships

 If it is short-term cost savings, it needs to focus

more on efficiency measures

 Can pursue both strategies, depending on what

is being bought

03/07/20
2. Relationship Portfolio

576

 Range of relationships with suppliers

Two extremes:
A. Transactional relationship, characterized by:

 Focus on driving hard deals (usually) around price

 Many suppliers

 Competitive approach

 Nuts-and-bolts/routine products ……applies

efficiency-based measures

03/07/20
577

B. Much more collaborative relationship

Also called ‘partnership sourcing’/problem solving approach
 Characterized by:
 Complex products ………..effectiveness–based
measures are suitable
 Few suppliers
 The firms work with each other to find ways of
reducing costs (the use of cost transparency)
 They may also share technologies & innovation
ideas, jointly developing products between them
03/07/20
3. Cost-Benefit Analysis

578

Cost - Cost incurred for the strategy

Benefit -Amount of money saved by pursuing a given
strategy
 If cost > benefit, it is unlikely to follow the strategy

 If cost < benefit, it is a good strategy to follow

 Whatever strategy is considered be clear about

possible outcomes,

03/07/20
579

E.g. If you want collaborative relationship strategy;

 You must ask about cost related issues;
 Risk of focusing on only one/few supplier(s),
 Exposing cost information, etc.

 Then evaluate potential benefits:

 Reduced overall costs for both firms,
 Improving time-to-market,
 Developing new technologies, etc.

03/07/20
4. Organizational Structure
580

 Refers to the type of control mechanism the firm is

using
i. Centralized purchasing:
 Head office is responsible for all purchasing
 Advantage - economies of scale from bulk
purchasing
 Disadvantage - potentially not satisfying local
customer needs

03/07/20
ii. Decentralized purchasing:
581

 Purchasing is conducted at a divisional level

 Each division has a budget & focuses on its own
individual requirements
 Advantage - securing customer satisfaction
 Disadvantage – loss of economies of scale &
management

03/07/20
582
iii. Hybrid:
 A middle ground model (both centralized & decentralized)
 Consists of a centralized purchasing area that
focuses on supply chain effectiveness
 Negotiates corporate deals and examines ways of
optimizing supply chain efficiency
 Day-to-day procurement is handled by the divisions
(decentralized areas)
 Advantage - advantages of both the centralized &
decentralized models
 Disadvantage - very difficult to control
03/07/20
5. Skills and Competencies
583

 To pursue any of the wheels in the model,

appropriate skills & competencies within employees
is a must
 If you want to develop long-term relationships with
suppliers, make sure that various supply personnel
are correctly trained
 So that they are capable to think strategically!

03/07/20
584

 The appropriate skills & competencies must:

 Match the strategic direction,
 Be supported by appropriate measures,
 Operate within an appropriate organizational
structure and
 Aim to achieve a range of benefits at minimal
cost
 Strategic supply must balance all elements
(wheels) in the model, rather than concentrating on
a single element

03/07/20
Logistics Coordination : Inventory & Ware House Management
585

Inventory Management:

Inventory: Any resource held by an organization

that is intended for future use to:
 Ensure a continuous supply of materials cost
efficiently
 Provide a way to decide when & how much
inventory to purchase from suppliers
 Avoid stock out

03/07/20
Holding High Stock

Advantage Disadvantage
• Ensures availability • Capital cost
• Maintains confidence in the • Expiration
system • Spoilage
• Reduces unit cost of items • Obsolescence
• Avoids shortage cost • Storage
• Minimizes ordering cost
• Minimizes transport cost
• Allows for fluctuations in demand

Tools for Reviewing Stock Movement

1. Stock card & Bin card (Drug mgt)
2. ABC Analysis (Drug & other supplies + equipment mgt)

586 03/07/20
Stock Card & Bin Card System – for Drugs Management

587

 Essential measure of internal control

 Whenever SC are updated, the totals would be checked
against those on the BC
 Creates reasonable assurance of no significant leakages

Stock Cards Bin Cards

Kept on the controller’s desk By the bin
Updated regularly Updated immediately
Updated through the distribution orders Updated through recording the item
and invoices movement in front of the shelf

03/07/20
ABC Analysis

588

 A method for classifying inventory items according to their total

amount during a specific period
 Based on the Pareto principle (80/20 rule), which suggests that only a
few items account for most of the value of inventory
 Pareto efficiency = Equilibrium of economic agents:
An economic equilibrium in which it is impossible to change the
allocation of resources without improving the lot of one agent at the
expense of another
 A simple technique used to examine distribution of inventory by value,
 Useful when a large number of inventory items are in use
 Drugs, Supplies, Lab reagents, etc…..
03/07/20
589

Goal: To decide which items are important and need to be tightly

monitored & which are not
Steps:
1. List all items consumed or to be purchased
2. Unit cost of each item
3. Quantity of each item consumed or to be purchased
4. Consumption cost (unit cost x quantity)
5. Calculate the percentage of the total consumption
value/cost
6. Rearrange the list by ranking the items in descending order
(highest percentage value first)
7. Calculate the cumulative percentage value
8. Categorize your items into A, B & C
03/07/20
 Category A
• Few items accounting for 75-80% of total value
590
(cost)
• Everything to do with these items is managed
very carefully as they represent a very high
investment
• Manage with close buyer–supplier relationships that
form part of strategic supply
• Greatest potential for identifying expensive
drugs that are over used
• Greatest potential for saving

 Category B
• Items which take up the next 15-20% of total value
(cost) 03/07/20
Category C

591  Bulk of items which only account for the

remaining 5-10% of value(cost)

 Small amount of funds spent on majority of

the inventory

E.g. Syringes & needles, are often purchased

on a bulk basis & drawn down as needed,
because it is more expensive to acquire them
than to keep track of them
Look at the following example! 03/07/20
Basic Unit Total units Value(Co %Total Rank by Cumulati Classific
Product description unit price nsumptio value value ve cost ation
n cost) (cost) (cost) %
Benzylpenicillin 1MU inj amp 0.5276 60000 31656 35% 1 35% A
Chloroxylenol 5% solution ml 0.0034 5000000 17000 19% 2 54% A
592
Multivitamin tab/caps tab 0.0022 3500000 7700 8% 3 62% A
Gentamicin Sulfate 80Mg Inj, 2ml amp 0.0628 108000 6784.4 7.6% 4 70% B
Ampicillin 125mg/5ml powder for bot 0.5119 13,000 6654.7 7.5% 5 77.1% B
susp, 100ml
Water for injection 10ml amp 0.0287 220,500 6328.35 7% 6 84.1% B
Cotrimoxazole 400mg/80mg tab tab 0.0098 600000 5880 6.6% 7 90.7% B
Dipyrone 500mg/ml inj, 5ml amp 0.0898 65,000 5837 6.5% 8 97.2% C
Fort. Procaine Penicillin 4MU inj vial 0.3026 10,000 3026 3.4% 9 100.6% C
Chlorhexidine 5% solution ml 0.0073 250000 1825 2.1% 10 102.7% C
Erythromycin 250mg tab tab 0.0350 50,000 1750 2% 11 104.7% C
Hyoscine N-Butylbromide 10mg tab tab 0.0174 30,000 522 0.6% 12 105.3% C
Metronidazole 200mg/5ml ml 0.0055 90000 495 0.56% 13 105.86% C
suspension
Metronidazole 200mg tab tab 0.0052 80,000 416 0.5% 14 106.36% C
Calcium Gluconate 600mg tab tab 0.0032 50000 160 0.18% 15 106.54% C
Codeine Phosphate 15mg/5ml ml 0.0052 30,000 156 0.17% 16 106.71% C
linctus
Oxytocin 10 IU Inj, 1ml amp 0.2468 500 123.40 0.14% 17 106.85% C
Total 88,613.85

 A commonly used rule of thumb – 70% to 80% of expenditure for 20% of items (A
items) & the other 80% of items account for the remaining 20%-30% of expenditure (B
& C items) – Pareto efficiency
NB: The total cumulative cost % doesn’t add up to 100% & this03/07/20
could be due to roundings in
the calculation
Warehouse Management
593
Good Warehouse Practice Includes:

1. Arrangement
2. Quality maintenance
3. Security
4. Disposal
5. Control and rotation
6. Record keeping

N.B- Reading Assignments on these practices

03/07/20
594

Thank You

03/07/20
595

Health Service Coverage And Its Evaluation

03/07/20
Health Service Coverage and its Evaluation
596

 What is health system coverage and its evaluation?

 What are domains of health service coverage and its
evaluation?

03/07/20
Health Service Coverage and its Evaluation…
597

 Health service coverage is considered as a

concept expressing the extent of interaction
between service and the people for whom it is
intended.

 This interaction not being limited to particular

aspect of service provision but ranging over the
whole process from resource allocation to
achievement of the desired objective.

03/07/20
Health Service Coverage and its Evaluation…
598

 For the measurement of coverage , several key stages

are first identified, each of them involving the
realization of an impact condition for providing the
service.

 A coverage measure is then defined for each stage,

namely the ratio between the number of people for
whom the condition is met and the target population, so
that a set of these measures represents the interaction
between the service and the target population.

03/07/20
Health Service Coverage and its Evaluation…
599

 This definition of coverage allows for variations, which are

called “specific coverage”, by limiting the target population
to specific sub groups of differentiated by certain conditions
related to service provision or by demographic or socio-
economic factors.

03/07/20
Health Service Coverage and its Evaluation…
600

 Definition of coverage
The proportion of young people for whom services are
available/accessible/acceptable or being used by them.
i.e.
The number of young people (aged 15-24 years) for whom
services are available /accessible/ acceptable or being used
by them divided by the number of young people (aged 15-24
years)who need the services.

03/07/20
Health Service Coverage and its Evaluation…
601

 The evaluation of coverage on the basis of these concepts

enables management to identify bottlenecks in the
operation of the service, to analyze the constraining factors
responsible for such bottlenecks, and to select effective
measures for service development.

03/07/20
Health Service Coverage and its Evaluation…
602

 WHO proposes five domains of coverage measure based

on conceptual framework described by [Link] These
are:
1. Availability coverage
2. Accessibility coverage
3. Acceptability coverage
4. Contact coverage
5. Effective coverage

03/07/20
Health Service Coverage and its Evaluation…
603

1. Availability coverage
 First of all, some resources – human power, facilities,
drugs, finance etc are always required in order to
provide the service, the availability of such resources limits
the maximum capacity of the service that can be made
available to the target population. The ratio between this
capacity and the size of the target population gives the
measurement of availability coverage.

03/07/20
Health Service Coverage and its Evaluation…
604

Availability coverage
 “The % of young people (15-24 years)for whom the service

is available”
or
 “The % of children < 1 year of age for whom the service is
available”

03/07/20
Health Service Coverage and its Evaluation…
605

2. Accessibility coverage
 Even if all the necessary resources are available , the
service must be located within reasonable reach of the
people who should benefit from it. Meeting this condition
can be considered as the next stage in the process of
service provision , here, the capacity of the service is
limited by the number of people who can reach and use it.

03/07/20
Health Service Coverage and its Evaluation…
606

 Accessibility coverage
“The % young people (15-24 years) who can reach and use
the service”
or
“The % of children < 1 year of age who can reach and use
the service”.

03/07/20
Health Service Coverage and its Evaluation…
607
3. Acceptability coverage
 Once the service is accessible, it still needs to be acceptable to the
population, otherwise people may not come for it and may even
seek alternative care. This “acceptability” may be influenced by
such factors as the cost of the service to the user, the form of
religion he follows, etc. If the service is accepted by potential user,
this is another step forward in the process of service provision.
Here service capacity is limited by the number of people who are
willing to use the accessible service. Quality is most closely related
to accessibility.

03/07/20
Health Service Coverage and its Evaluation…
608

Acceptability coverage
“The % young people (15-24 years) who are willing to use
the service”
or
“The % of children < 1 year of age who are willing to use
the service”
Measuring “access” may actually measure just one or a few
domains of access (like availability, affordability and/or
acceptability, but rarely all of them

03/07/20
Health Service Coverage and its Evaluation…
609

4. Contact coverage
 The next stage in the process of service provision is the
actual contact between the service provider and the user.
The number of people who have contacted the service is a
measurement of service output, the ratio this and the size of
the target population gives measurement of contact
coverage.
 Utilization is related to contact coverage.

03/07/20
Health Service Coverage and its Evaluation…
610
 Contact coverage
“The % young people (15-24 years) who actually use the
service”
or
“The % of children < 1 year of age who actually use the
service”

03/07/20
Health Service Coverage and its Evaluation…
…
611 The concepts
Health supply terms Health demand terms
-Availability -Utilization
-Affordability -Acceptability

Access Coverage
How much a population The share of a population
Can reach health service eligible (beneficiaries ) for a
03/07/20
set of interventions
Health Service Coverage and its Evaluation…
612

5. Effectiveness coverage
 The contact between the service provider and the user dose not
always guarantee a successful intervention related to the user’s
health problem or an effective service. We can, therefore,
consider another stage in the process of service provision where
a service performance that is appraised as satisfactory by
specific criteria is achieved. The number of people who have
received satisfactory service is thus another measurement of
service output called effective coverage.

03/07/20
Health Service Coverage and its Evaluation…
613

 Quality conceptual model

User Appropriate Provider

Acceptable Comprehensive
Accessible Effective
Equitable
Efficient

System

03/07/20
The Five measurement of coverage
Tanahashi conceptual Framework for Coverage
614

(1)Tanahashi, 1978. “Health Service Coverage and its Evaluation.”

Bulletin of the World Health Organization, 56(2):295-
56(2):295-303.
03/07/20
Health Service Coverage and its Evaluation…
615

• Availability coverage
• Accessibility coverage Potential Coverage
• Acceptability coverage
• Contact coverage
Actual Coverage
• Effective coverage

 Tanahashi suggests tracing critical bottleneck in service

delivery by locating small slope sections

03/07/20
Tanahashi: health service coverage diagram

616 Goal of service achievement

Effectiveness
coverage

Contact coverage

Acceptability coverage

Accessibility (geo, fin)coverage

Availability coverage

Target population

Source: Tanahashi T. Bulletin of the WHO, 1978,56(2)

03/07/20
Health Service Coverage and its Evaluation…
617

The methods of measurement

 Coverage in immunization measures the proportion (rate) of the
population that received immunization service (regardless of
whether this service results in biologically effective immune status).
In the case of “coverage in childhood immunization”, the coverage
measures the proportion of the < 1 year old population who
received full immunization according to recommended schedule.
“coverage” with the first dose of particular antigen correspond to
contact coverage. Complete vaccination with all required doses
will represent effective coverage (three doses of DPT)

03/07/20
Health Service Coverage and its Evaluation…
618
 Based on this analysis, a step down approach can be applied to
the evaluation of health service delivery function at district level .
The evaluation should start with the measurement of effective
coverage. If the level of effective coverage is satisfactory, the
evaluation does not have to go further. If the level of effective
coverage is low, the manager should look at contact coverage. If
contact coverage is not satisfactory, the manager must determine
the factors that prevent consumers from receiving effective
services. The question to be answered is: Why does contact
coverage not translate in to effective coverage ?

03/07/20
Health Service Coverage and its Evaluation…

619
 If contact coverage is also low, then acceptability coverage should
be measured. If the physical accessibility and acceptability of
service are high, the manager must look for problem among those
factors that affect individual personal behavior (for example
through social marketing research methods). In order to find out
why acceptability and physical accessible services are not used. If
accessibility coverage is low, the manager should check whether
resources are available, and take necessary action based on the
findings.
 The usefulness of this frame work is in its ability to serve as
checklist for health policy makers & managers in the analysis of the
health service delivery function through coverage indicators.
03/07/20
Health Service Coverage and its Evaluation…
620
 Key points on the concepts
 Measuring “access” may actually measure just one or a few
domains of access (like availability, affordability and/or
acceptability, but rarely all of them
 Define country targets in national context instead of focusing on
global targets.
 Define target taking in to account the measurability of the
targeted entity (eg. District or population.)
 Over all the concept of access, coverage and associated terms
are not standardized across programs. So there is room for
flexibility

03/07/20
Health Service Coverage and its Evaluation…
621
 Key points: building a frame work on universal access
 Set the objective of the frame work.
- Communication : a comprehensive frame work displaying all the
determinants of access and their inter-relationship is required.
-Monitoring and evaluation: the frame work should be limited
to measureable determinants
 Consider a simplified (not simple) approach to building a frame
work for universal access.
 Focus on “availability” of core intervention in the area of
prevention, treatment & care, at least at district level.

03/07/20
Health Service Coverage and its Evaluation…

622

 Key points: building a frame work on universal access

 Define the steps to be taken if additional factors are to be

included:
-”acceptability”: could be measured for just a few countries using
population or facility based surveys
-’affordability”: could be measured through household surveys for
a few countries or equated to the implementation of free
services policies at district level
 Promote academic debate and under take research on how to

extract measures from geographical information (i.e.

computation generated availability data)
03/07/20
623

HEALTH PROJECT DEVELOPMENT

AND MANAGEMENT

03/07/20
624

 ‘Project management is turning a good idea into

a successful outcome. You could have a great
idea but if you don’t have the skills to bring it to
life in the real world it is only ever a good idea.’
(An Experienced clinician manager)

03/07/20
Definition of Key terms
625

 A project is an organized, time-limited, one-off

effort towards a defined goal, which requires
resources,

03/07/20
Definition…
626

 There are two essential elements of modern

project management.
• A large set of tools and techniques for
planning and coordinating the multiple inputs
required for major projects.
• The role of the project manager and the
project team.

03/07/20
Definition…

627

 In human service organizations, project management

methods are used for four basic purposes:
• The development of new services, programs or
technologies;
• To improve existing services, care processes, work
practices or service delivery models;
• The implementation of new organizational
structures or systems; and
• The construction, installation and/or
commissioning of new equipment and facilities.

03/07/20
Definition…
628

 A project is a temporary organization.

• We have a vision of a future state we wish to
achieve, and we need resources to do work to
deliver it.
• So we create a new organization within which
those resources can work.
• That organization will have only a temporary
existence, being disbanded when the new state is
achieved.

03/07/20
Definition…


629 Program
• A structured process of managing multiple ongoing
projects within an organization.
• The focus of Program Management is the alignment
of ongoing projects with the goals of the
organization
 Projects vs Programs
o While there is some overlap between program
planning and design methods, and project
management, there are some differences
 projects have a definite beginning and end whereas
programs continue perhaps for many years and
often evolve and develop 03/07/20
Definition…
630

 Portfolio
• Simply a collection of programs.

• Portfolio management is about selecting a

combination of programs that will give the
organization the most optimized profits at the
lowest risk.

03/07/20
Definition…

631

 Project Office
• An administrative function of a project.

• A Project Office does not only provide key support

to the project manager but also liaises with the
Program Management Office to ensure that its
project adopts the most current project
management standards implemented by the PMO.
 Program Management Office (PMO)
• An operation center that not only governs and
supports projects from initiation to completion,
but also plays an important role in improving an
organization’s project management capabilities
03/07/20
The Functions of Project Management

632

 The project entail work, and that scope of work must be

managed.

 We assemble the resources into a temporary organization

which must be managed.

 In order to deliver the desired benefit, the asset must

function in certain ways, and at required levels of
performance.
• Therefore, the performance, or quality, of the asset must
be managed.
• But to deliver a quality asset the work of the project
must also meet certain quality standards. Quality needs
to be managed.

03/07/20
The Functions of Project…

633

 In order for the project to be of value to both the

client and contractor, it must cost less than the
value of the benefit. Thus cost needs to be managed.
• This involves managing the consumption of all
resources, including people and material, not just
money.

 Time needs to be managed for several reasons.

• In order for the work of the project to take place
effectively and as efficiently as possible, the input
of the various resources needs to be coordinated.

03/07/20
The Functions of Project…
634

 Also there will be a time value associated with the

benefit from the asset.
• The later it is delivered, the less its value, so the
timing of the work needs to be managed to
deliver the asset within a time frame that will
give the desired benefit.

 There are seven functions of project management:

managing the scope, project organization, the
stakeholders, quality, cost, time, and risk.

03/07/20
Management of the Project
635
 There are two components of the management
approach:
• The project life cycle:
 the stages we go through from the initial germ of
an idea that there is some change we can make to
improve performance to the point where we have
an operating asset providing benefit.
• The management process:
 the management steps we follow at each stage to
deliver that stage.

03/07/20
The project management life cycle
636

03/07/20
637
Management Process

 The management process is the management cycle

that is followed to implement the work of each
stage. There are five basic processes:
• Planning the work

• Organizing the resources

• Implementing by assigning work to people

• Controlling progress

• Managing and lead

03/07/20
The management process …

638

03/07/20
Step Management Process
Perceive the problem Identify the opportunity for providing benefit to the
organization
639 Gather data Collect information relating to the opportunity
Define the problem Determine the value of the opportunity and its potential
benefits
Generate solutions Identify ways of delivering the opportunity and associated
benefits
Evaluate solutions Identify the cost of each solution, the risk, and expected
benefit
Select a solution Choose the solution that gives the best value for the money

Communicate Inform all parties involved of the chosen solution

Plan implementation Complete a detail design of the solution and plan

implementation
Implement the solution Authorize work, assign tasks to people, undertake the work,
and control progress
Monitor performance Monitor results to ensure the problem has been solved and
the benefit obtained 03/07/20
Levels of management

640

 A project is fractal:
 each component of a project is a mini-project in
its own right; it is a temporary organization to
which resources are assigned to deliver beneficial
change, the beneficial change in that case being
a component of the main project.

 There are three fundamental levels over which a

project is managed:

03/07/20
Levels of management…

641

 The integrative level:

• The desired performance improvement is
identified, and the facility (output) required to
deliver it is defined through quantitative and
qualitative objectives.

• Areas of work and categories of resource required

to undertake them are defined, and basic
parameters or constraints determined for time
scales, costs, benefits, and performance.

• Any risks and assumptions are stated.

03/07/20
Levels of management…

642
 The strategic or administrative level:
• Intermediate goals or milestones required to
achieve the objectives are defined.
• The responsibility of organizational units,
functions, and disciplines for work packages is
defined.
• Work packages are scheduled in the project, and
budgets developed.
• A stable plan which remains fixed throughout the
project is created.
03/07/20
Levels of management…
643
 The tactical or operational level:

• The activities required to achieve each milestone

are defined, together with the responsibilities of
named people against the activities.

• Changes are made at this level within the

framework provided at the strategic level.

03/07/20
644

03/07/20
PLANNING
645

 Major undertakings
• Identifying a specific issue, target group and
focus for a program
• Designing the program

• Developing the action plan

03/07/20
Identifying a specific issue, target group and focus for a
646
program

03/07/20
A. Conducting consultations

647

 Consulting with people from within and outside the

organisation who know about the health issue and
the individuals who are affected by it.

Consulting with key people

Have consultations been conducted to gather
information on:
• The nature of the perceived issue(s)?
• Who is most affected by the issue(s)?
• How to contact and engage communities involved?
• The types of programs that have been attempted
and how successful or unsuccessful they have
been?
03/07/20
B. Gathering information about the issue

648

 Collecting and analysing data and information

about the problem from a variety of sources.

Reviewing the relevant information

 The type of information may include:
• Demographic information
• Literature about the effectiveness of previous
programs
• Mortality and morbidity data
• Social and economic factors

03/07/20
C. Examining the organisational context
649

Considering the organisational context in which the

project will operate.
 Current policies from relevant government and

non-government agencies
 Local councils annual reports

 Overall priorities of the Local Health Service

 Other programs operating elsewhere in the Local

Health Service
 Likely stakeholders in this program

03/07/20
D. Analysing the information and
making a Judgement
650

 Making a judgement about all this information in

order to select a health issue, target group, setting or
focus for a program.
Analysing the issue
 Relationships between the various factors which
contribute to the health issue
 Which factors is it possible to influence? Which
factors are amenable to intervention?
 What does this analysis imply for the kind of
strategies which may be effective in redressing the
issue?
 Is more information required to further understand
the issue? If so, how can it be obtained?
03/07/20
Analysing the information…
651
Selecting the focus of the program
• What best meets the needs of the:
 Target group
 Stakeholders
 Funding body
 Organisational environment?

• Will the focus of the program be:

 A single issue; a set of issues;
 A setting; a service characteristic; an
environmental /organisational issue?

03/07/20
Designing the program
652

03/07/20
Planning 2 involves:
653

 Converting the analysis of the issue into a draft

plan (strategies)
 Developing roles with key people
 Reviewing available sources
 Ensuring the program is realistic and achievable

03/07/20
A. Converting the analysis
of the issue into a draft plan
654

 What is the range of potential strategies which could

achieve the possible objectives?
 Are the potential strategies a mixture of:
• Developing personal skills
• Strengthening community action
• Creating supportive environments
• Building healthy public policy
• Reorienting health services?
 Are the objectives “SMART”?
 Is there a logical relationship between the program goals,
objectives and strategies?
 Will the strategies enable the goals and objectives
03/07/20 to be achieved?
B. Developing roles with key people
655

 The role of every stakeholder?

 Would a committee or working party be useful?
 Are there any potential stakeholders who might
not support the program?
 Can the stakeholders offer any resources “in
kind”?

03/07/20
C. Reviewing available sources
656

 How many staff are needed to conduct the

program? What skills do they require?
 How much money is required for the program? Is
this funding available? If not, what are the
alternatives?
 What resources are available in the community to
support the program? What skills or resources
can the target group offer?

03/07/20
D. Ensuring the program is realistic
and achievable
657

 Are there significant gaps between the resources

required to achieve the objectives and those
available?
 What are the opportunity costs for conducting
the program?
 What are the short/long term benefits of
proceeding with the planned program?

03/07/20
Developing the action plan
658

03/07/20
A. Planning for the organisation of tasks
659

 Tasks required to implement each strategy

• Sequence of these tasks
• Who will perform these tasks?
 What quality control measures will be used to
ensure the program progresses as planned?
 At what intervals will the progress of these tasks
be reviewed?
 What are the indicators of success for completion
of key tasks?

03/07/20
B. Constructing a time frame
660

 What tasks need to be completed before other

tasks are started?
 What are the most critical tasks?
 Is there enough time allocated to complete these
tasks?
 Is the overall time frame for the program
realistic?

03/07/20
661
C. Developing a communication strategy

 Does the program plan include a communication

strategy?
 This involves decisions about:
 the type of information to be conveyed,
 to whom,
 when they require the information and
 what format is most suitable.

03/07/20
IMPLEMENTATION
662

 Major undertakings

 Ensuring quality implementation of the program

 Following up additional opportunities

 Effectively documenting and communicating the

program’s progress

03/07/20
663
Ensuring quality implementation of the program

03/07/20
A. Implementing the action plan
664

 Is the list of tasks outlined in the action plan being

used to guide implementation?
 Is the program running on, or close to, the time
frame?
• If there are delays, how are they to fit the overall
program?
 Is the program on, or close to, budget?
• If not, what changes need to be made and how
will they affect the direction of the program?

03/07/20
B. Ensuring effective communication
665

 Maintaining clear roles and responsibilities

• Are the individuals involved clear about what
the program is trying to achieve? Is this
evident in their work?
• Are the people involved communicating
effectively with each other, the target group
and the stakeholders?
 Providing feedback to people involved with the
program

03/07/20
C. Contingency planning and action
666

 Assessing the situation and making changes

• Are there problem(s) or delays with a particular
aspect of the program?
• What are the options for overcoming, minimising
or avoiding the problems or delays?

03/07/20
Following up additional opportunities
667

03/07/20
A. Identifying opportunities to raise the program’s role
668

 Have any opportunities occurred as a

result of the program's implementation, or
circumstances in the wider community,
which could raise the program's profile?

03/07/20
B. Maintaining support for the program
669

 Have any changes occurred in the organisational

or wider environment which reinforce the
importance of the issue being addressed by this
program?

 Have any changes occurred which could weaken

management/external support obtained for the
program during the planning phase?

03/07/20
C. Identifying opportunities to broaden the impact of the
program
670

 Policy development
 Reorientation of services
 Strengthening community action

03/07/20
Effectively documenting and communicating the
671 program’s progress

03/07/20
A. Documenting the program’s progress

672

 Has the following information been documented?

 Goals, Objectives, Strategies, Action Plan
 Baseline data about the issue and target group
 Performance Indicators
 Evaluation methods

 Has a system been set up to record the program’s

progress?
B. Communicating the program’s progress
• Are the Districts Health Services/other equivalent
executives, stakeholders and target groups being
kept informed of the program’s progress?

03/07/20
EVALUATION
673

 Major undertakings
 Developing the evaluation plan

 Assessing the program’s results

 Communicating the evaluation results and

recommendations

03/07/20
674 Developing the evaluation plan

03/07/20
Developing the evaluation plan involves:
675

 Clarifying the purpose of the evaluation.

 Selecting the scale and scope of the evaluation.
 Determining the methodology.
 Planning implementation of the evaluation.

 Establishing protocols and quality control

measures to ensure the evaluation produces are
valid and reliable results.
 Planning analysis of the data.
 Planning distribution of the evaluation findings.

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Assessing the program’s results
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Assessing the program’s results
677

 Measuring the results in relation to each

objective and performance indicator.
 Analysing the data for patterns, trends,
consistencies and inconsistencies.
 Interpreting the results to determine how they
can be attributed to the program and/or to
other factors.

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Communicating the evaluation results and
recommendations
678

 Reporting the findings of the evaluation to

stakeholders and other interested parties.

 Publishing results and conclusions in refereed

journals or presenting them at conferences.

 If appropriate, disseminating the results and

conclusions to the public through the mass media,
in newsletters, and/or at seminars.

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Sustainability
679

 Major undertakings
 Assessing the value of continuing the program

 Marketing the program so that others can use

it
 Establishing structures which help others to
apply the program

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680
Assessing the value of continuing the
program

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Assessing the value of continuing…
681

 Deciding whether or not the program should be

discontinued, ongoing or repeated.

 Determining what changes the program will need to

continue successfully.

 Deciding whether the benefits of modifying the

program outweigh the associated costs.

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Marketing the program so that others
682
can use it

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Marketing the program...
683

 Determining who may be interested in - or able to

sustain – the program.

 Determining what could motivate others to

sustain the program.

 Deciding how these circumstances could be

created or enhanced to encourage others to take
up the program.

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Establishing structures which help others to apply
684 the program

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Establishing structures…
685

 Determining what form of support organisations

will require to successfully sustain the program.

 Determining how this support will best be offered.

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Tips
686

 You cannot always achieve your objectives in one

step
 You must continually adapt your plan in response to
changing circumstance
 You cannot plan the detail, you can only plan the
strategy
 Even still it is possible to achieve an accurate
forecast of the cost and duration of the project
 The winners are the most competent team, with the
best strategic plan, who respond best to the
conditions actually encountered
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Term paper… Writing a project proposal
687

 Assume that you are a member of the PHC of JU and your

team comprises
• health systems manager, health economist, communication
specialist, epidemiologist, biostatistician etc
 And let one of you be the head of Jimma Zonal health
department
 Write a full project proposal to be submitted to the
International Development Research Centre (IDRC), Canada
 Problem: to be decided by the team

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Term paper…Writing a project proposal
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a. Project Title
b. Project Overview
c. Background Information/Statement of the Problem
d. Project Detail
a. Goals and Objectives

b. Clientele

c. Methods
d. Staff/Administration

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Term paper…
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5. Available Resources
6. Needed Resources
a. Personnel
b. Facilities
c. Equipment/Supplies/Communication
d. Budget (with justification)
7. Evaluation Plan (use logfram)
8. Appendices
 Don’t miss detailed CV of the principal investigator
and shorthand CV of all other research team members
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