Health System Management Basic Concepts

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Health System
Management
Basic Concepts
AhmedRefat AG Refat
www.SlideShare.net/AhmedRefat

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dministration :
A
>>>>>>
The process of achieving defined goals at a defined time through the guidance, leadership
and control of the effects of a group of individuals and the efficient utilization of non
human resources bearing in mind adequacy, speed and economy to the utmost possible
level
>>>>>>Administration :The art and science of guidance, leadership and control
of the efforts of a group of individuals towards some common goal
>>>>>>Public administration when it concern the public
>>>>>>Business Administration when it concern with private and for profit .
>>>>>>Public health Administration = the application of the principles of
administration in the field of public health

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What is management:
>>>>>>It is a processes of interactive processes through which the utilization of resources
results in the accomplishment of organization objectives
Many authors consider it like administration
What is the role of management :
Management serves the role of a conversion mechanism .
Input------------→ ↓ processes----------------→ output
Human+nonhuman conversin meets objectives
Why is management crucial ? without it there would be no determination of objectives ,alack of
purposeful direction manifested by haphazard activities
Good management ensures that the right things occur ,when they should and how they should i.e.
the right things occur in the right time & in the right way

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Elements of administration :
P.O.S.D.Co.R.P
1. Planning things to be done
2-Organizing the formal structure of the agency.
3-Staffing
4- Directing the work of the agency
5-Co- ordinating all staff activities
6-Reporting to executives&the responsible authorities.
7-Budgeting&all financial management
Other elements :
1. Supervision
2. Evaluation
3. the non human resources
4. determination of the goals & objectives

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Levels of administrations:
On the national basis the three levels are called >>>>>>
 central,
 intermediate
 & local
e.g. the ministry of health,the directorates of health affairs in the different governaments and the
local level is a health office,primary health centre ,MCH unit ….. etc.

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Definition of Goals& Objectives :
>>>>>> Goals: is a long range specified state of accomplishment towards which
activity is directed. Goals are not constrained by time or existing resources.
>>>>>>Objectives :is measurable state of accomplishment aimed towards
the goal,The objectives should include a description of what outcome is desired,
when it is expected, where it will result
Example:
the goal of public health services is to attain optimum health for all the people this may
be accomplished through many objectives like provision for safe water for all villages
within so many years ,other objectives like raising the covering of vaccination to 100%
after 2 years in a specific city-

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PLANNING
.
>>>>>> Definition : A plan is a projected or predetermined course of action designated to
achieve a prescribed goal or objective.
Planning is the process by which objectives are determined and courses of action are
decided-upon& carried out that is to say planning determines What?Where?When ?How? Why ?
and by Whom? Things will be done .
It involves decision making by the planner regarding future events i.e. planning is a
futuristic process ,another definition of planning is (anticipating and making decisions about the
future )
Planning can be considered the most important element of the administration process. It is
necessary in all types of work or activities, it is practiced by all administrators whether at the
highest or the lowest level in the hierarchy of the organization.

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A good plan is the basis of any successful program.
So the ethics of planning are :
1-Sufficient time to the process of planning.
2-More than one plan should be available.
3- All details should be mentioned
Process of systematic planning
1-Establish goals &objectives
2-Designing alternative courses of action
3-Analyse & predict the consequences of alternatives
4-Select the best course of action
5-Implement the selected plan
6- perform periodic evaluation

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Principles of planning :
>>>>>>
a)Planning is an intellectual activity; it requires knowledge,
experience, imagination,foresight,reasoning and mastering of
special skills
b)Planning is a continuous circular process whose other
components are execution and evaluation i.e. it involves continuous
reappraisal and decisions reflecting the demands of a changing world,
planning is a dynamic process &not a static the plan should be
flexible
>>>>>>

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Participative planning :
A good administrator shares program planning with his staff and with other people and or
agencies
Advantages of participative planning :
1-Administrator gains from the experience of his staff
2-He increases the interest and enthusiasm for the plan
3-It helps to develops employees & teach them how to set plans
4-Participation of consumer representatives facilitate acceptance and success of the program
- Disadvantages of participative planning :
1-Employees expect that their opinion will be always taken concerning every details.
2-They might allow themselves to set changes during the execution phase without referring back
to administration.
3-Must be done with individuals who are knowledgeable.

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Areas to be identified and accurately assessed in
putting plans:
1- Needs and demands of the public:
public health>>>>>> Need is a problem affecting the health of the people , and requires solution
its solution only by the medical profession
>>>>>>Demands: are what the people ask for or claim
The more the health awareness of the people the smaller the gap between the needs &
demands.
2- Available resources
; human, nonhuman as :legal basis,funds,equipements,supplies………etc
3-Attitude of the public: we need the support of the recipients for the program
Attitudes of the people may be actively favorable, indifferent or actively unfavorable for the
last two we should start on a small scale
4- Establishing priorities :whatever funds available they cannot solve all health
problems. Factors in establishing priorities between different health needs ,Is it an emergency
problem? Does it cover many people ? Does it cover vulnerable or productive age group ? Is
it economical to solve ? Does it result in sizable financial revenue ? Does it helps in improving
public relation .

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Organization of health services
>>>>>> It means any collection of persons ,materials, procedures, ideas or facts so
arranged & ordered that each case the combination of parts makes a meaningful whole that
works at achieving organizational objectives
The organizational process may be classified as :
>>>>>> 1-Structural organization (anatomical part ):
Deciding on the overall arrangement or architectural plan Fitting the right persons ,materials
,equipment ……etc in right place .
>>>>>>2-Functional organization (physiological part )
Breaking down the work into individual jobs
Determine the relationship between different departments Assuming maximum co- ordination
between different departments.

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Classical principals of organization :
>>>>>>1))-Departmentation :The process of grouping activities into units
for the purpose of administration . these units may be called departments,sections,offices……..
>>>>>>Patterns of groupings :
1- By services e.g. curative services in the department of curative medicine, and the
preventive services in the department of preventive medicine.
2- By location e.g. inpatient & outpatient department .
3- By geographic area
4- By clients , to make attention to certain groups like mothers and children.
5- By time e.g. morning ,afternoon & night shifts
2))Acquisition of human & non human resources:
On appointment every employee must be informed of what is expected of him (his
responsibility ) & what is with –in his power(his authorities ) this is usually found in his job
description

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3))Specialization &Division of labour :
Dividing the work into specialized tasks has these advantages:
# each individual has limitations
#You can get greater uniformity & skill in performance
Disadvantages of extreme specialization :
Has a bad effect on job satisfaction & the psychology of workers
>>>>>>4))Coordination :
it means assembling synchronizing work efforts so as they function harmoniously to
attain organizational objectives.
Factors involved in coordination :
1-parts and features that needs to be arranged i.e. human and non human
resources
2- Means by which these parts are held together like :laws,skills ,norms, committees
3-Environment in which the parts to be coordinated and means to hold them are
existing e.g. time , place , distance of physical facilities ……

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5))Equal Authority and Responsibility:
>>>>>>Authority :The power vested on the organizational
head giving him the right to command and the subordinates the
duty to obey.
>>>>>>Responsibility :refers to the tasks and functions
which a person is pound to perform for the organization and for
which he is accountable to the organizational head .
>>>>>>Accountability :refers to the extent to which a
subordinate may be held by his superior to be held directly
responsible for results good or bad.
There must be an equal relationship between the responsibilities of a
manager and his authority.

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>>>>>> 6))Centralization and Decentralization :
Refers to the level at which most of the operating decisions will be made .
It is advisable that decisions concerning day to day matters should be pushed down into the
organization structure ( more decentralized ) and not be handled by top management .
Advantages of decentralization :
1-Quick actions regarding specific problems.
2-Adaptation of decisions according to local needs.
3-Save the time and energy of top management .
4-Increase flexibility of action .
5- Training of junior staff to hold top management positions.
6- Improve the morale of lower level employees.
Advantages of centralization :
1-Uniformity of policy and action
2-Maximum use of skills and knowledge of centralized staff.
3-Better control of the organization s activities
4-Enables the use of not highly skilled subordinates since every little details is set by the top
management.

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To determine the degree of decentralization we have to know:
1-Who knows all the facts on which the decision will be made
2-Who has the capacity to make sound decisions
3- Must speedy on the spot decisions be made to meet local needs ?
4-Must the local activity be coordinated carefully with other activities
5-How significant is the decision ?
6- How busy are the executives who might be assigned ;planning tasks and decision making?
7- Will moral be improved by decentralization ?
>>>>>>Delegation of authority :
By this concept the head of the organization accomplishes the work by delegation (Pass on)
authority to his subordinates.
Such delegation does Not relieve the responsible holder of his ultimate accountability ( i.e. does
not relieve him of responsibility ). The more the delegation of authority the greater the
decentralization .
>>>>>>Unity of Command :
It means that each individual in the organization should be directly responsible to and
receive orders from only one supervisor .
This prevents reception of conflicting orders 'no man can serve two masters "

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>>>>>>Organizational Charts :
Line relationship: is one in which a superior exercises direct supervision over a subordinate
Stuff relationship: for support and advices
These are drawings or diagrammatic presentation of certain aspects of the organization, it
clarify the following :
1-Formal relationships between the people in various positions in the organization
2-Main channels of communication
>>>>>>a-downward flow of authority(orders, command ) from superior to
subordinate
>>>>>> b-Upward flow of accountability from subordinate to superior
>>>>>>c- Horizontal flow of communication between employees of the same level
>>>>>>3-In a chart solid lines (_________) denotes lines of command
>>>>>> Dotted lines (………..) denotes functional or advisory lines

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Types of charts:
1- >>>>>>Skeleton charts : presents only the main units or
departments of the organization
2- >>>>>>Personal charts : it shows the main positions or
titles and may be the names of persons occupying them
3- >>>>>>Functional charts : include a brief description of the
functions, purposes, duties and activities of each person.
These are always replaced by manuals including job description &job
specification
>>>>>>Hierarchy denotes a rank order on the vertical scale.

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Advantages of organization charts:
1-It forces the executives to think more about the actual relationships between workers
(personnel charts ) & between departments (skeleton charts )
2-quick visual illustration of the structural design & communications in the organization .
3-It familiarizes outsiders about the organization as well as to train and orient new employees
since they show :
a- Lines of authority
b- Channels of communication
c- Who does what
d- The position of each person.
Disadvantages of organization charts:
1-Not practical with executives who like to freely change jobs& relations of employees
2- must be updated continuously
3-preparation & circulation may be expensive in a large organization.
4-May produce hard feelings for those low in hierarchy .
5- Difficult to describe all relationships of the organization.

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STAFFING
>>>>>>This is the process of personalizing or manning the organization
Steps of staffing :
>>>>>>1-Identifying the types and numbers of personal needed in each unit to
deliver care the simplest method used is the descriptive method for e.g. determination of
staffing needs for nurses in a hospital.
>>>>>>2-Recruitment :Involves searching for & attracting prospective
employees to fill available jobs .it is done by advertisement in newspapers .
>>>>>>3-Selection and appointment: choose the best by :
a-Applicant’s background, experience & qualifications.
b-Interviews.
c-Testing .

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>>>>>>4- orientation :Is the process of informing new employees about the existing
work environment& their places in it .
Orientation consists of two parts :
>>>>>>A- general part (induction training ):
Information given to all new employees about the purpose ,function & structure of the
organization with the polices and procedures for all employees.
>>>>>> B-Special part (job orientation): about the specific job the
employee is to fill, each employee should be informed about his job description .its duration
varies it is 6-12 months (internships)for newly graduated doctors and nurses.

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Job –analysis ,job –
description, job –
specification :
a) Job –analysis: involves analysis each job to come out with the
information required to determine the job description & job specification
The job information for analysis could be gathered by :
1-Observation
2-Questionnarires
3-Interviews
4-Literat-review regarding similar jobs.
5- A combination of some of the above

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From these information we make the job description & job specification
documents.
b) job –description:
describes the job itself . it includes :
1-job title
2-Objectives of each position .
3- authorities & responsibilities
4-Tasks and duties to be performed .
5- Relationship between this position & other positions.(superiors
,subordinates & peers )
3-, job –specification :
Describes the persons to fill the job.
It includes the person’s qualifications, experience, sage, sex,special training
, knowledge &skills, physical requirements, professional affiliation, license,
………

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LEADERSHIP &SUPERVISION
>>>>>>Leadership is the degree of decision making authority held by the manager
>>>>>>Supervision :is the day- to- day relationship between an executive and his
immediate subordinates.it is an educative process for the less qualified by the better one
Objectives & supervision :
Supervision should satisfy both the work and the workers
For the work :supervision should help to maintain maximum standards and efficiency.
For the workers :supervision should stimulate their interest and motivate them,educate and
guide .
The draw backs of inspectorial supervision :(aims at fault finding):
a) It creates an atmosphere of fear where the tendency to do the wrong thing is very high.
b)Subordinates tend to be dishonest cover up their mistakes to avoid punishment.
c)Masks real needs of the community
d)Workers show no initiative

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Motivation:
The behaviour of individuals are goal -directed either externally or internally
induced.
Definition: motivation is a self or externally induced behaviour which
occurs in order to bring about or maintain need fulfillment.
All people have needs that they seek to fulfill and people behave in away they
feel will satisfy them.if the activity behaviour brings about the goals we need it
will be later a learned behoviour
Need -------activity behaviour---------------------- fulfillment
↑---Learned Behaviour--------------------------------↓
On the other hand if the behaviour pattern is blocked this will lead to frustration
Need --------------/ /-----------No fulfillment ----→-frustration then the
individual behaves in an irrational manner like frequent absenteeism or
negativism.

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Motivation factors :
Motivation factors :these are conditions which if present tend to build high
levels of motivation & job satisfaction. They lead to :
1-Achievement 2-recognition 3-Advancement 4-the work itself
5-salary 6-status 7- job security 8-responsibility
However .it is clear that needs vary with workers & organizational setting and
the manager has two ways to get the employees to carry out the directive :
1-By getting the employees to understand that a desired action will
increase their need fulfillment.
2- By getting the employees to understand that a desired action will
avid punishment

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Theory x and y
Theory x :One of the styles of management is the autocratic or authoritarian style which has its
roots in the religious & military organizations it is related to the classic theory of Douglas Mac
Gregor who believes that :
1-The average human being dislike work & will avoid it if he can
2-Therefore most people must be coerced ,controlled & threatened with punishment to work
effectively.
3- The average human being wishes to avoid responsibility ,
Theory y:
Mary Parker Follet management policy based on ( co- action ) as contrasted with ( coercion ) which
believes that the most effective way to get results is to move with the people not to use them
According to this theory :
1- The average human being does not inherently dislike work, it may be a source of satisfaction
2-Man will exercise self direction & self control in his job
3- fulfillment of objectives depend on rewards associated with their achievement
4- The average human being ,under proper conditions learns not only to accept but to seek
responsibility.
5-Imagination,creativity & ingenuity are widely distributed in the population

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Styles of leader
Authority:
Use of Authority by the manager
Area of freedom for
subordinates
Autocratic│consultative│Participative│Democratic │LaiserFaire
1 2 3 4 5
Continuum of leader decision –making authority

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1- Autocratic :the manager makes decisions & announces them to the group. The
subordinates is to carry out orders without any chance to alter the decisions
2-Consultative :The manager (sells ) the decision or presents ideas
&invites questions from subordinates, unless big reasons cause a change
in the decisions , his decisions stand .
3- participative :The manager presents the problem to the
subordinates, gets suggestions ,and then makes the decision.
4-Democratic :the manager defines the limits of the situation and the
problem to be solved and ask the group to make the decisions.
5-Laisser- faire (free –rein ):there is no interference by the
manager who is merely a figurehead.

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Factors affecting styles:
because no one style is appropriate at all times ,the style chosen by
the manager depends upon factors like:
1-The importance of the results :eg.under disaster or crises
conditions the best style is autocratic
2-The type of work :if uniform, clerical work the manager may be more
consultative.
3-Subordinates characteristics, i.e. training ,education skills etc…if
subordinates are skilled professionals, the manager may seek their
opinions( consultative or participative )
4-personal characteristics of the manager : the personality traits
,previous experience values &cultural background make the manager
adopt one form of style than another.

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Supervisory styles:
Supervision is the manner in which the leader oversees the accomplishment of work activity.
Styles of supervision :
1- Close versus General supervision : unskilled and new employees requires close
supervision
2-Distant versus Friendly supervision : the manager should be distant enough to retain
the respect of subordinates yet friendly enough to work effectively with them.
3-Strict versus Lenient :he should be firm but fair.
4-Employee centered versus Work centered:
Employee centered manager interested in the subordinates
well-being ,morals & aspirations.
Work centered manager concentrates on the production & technical aspect of work and overlook
the human factor.

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Span of supervision (span of control ):
Span of supervision is the number of employees supervised by an executive.
The number of supervisors depends upon the type of work and the mental capacity.
The increases number of supervisors and levels of supervision has the following
drawbacks:
1- Difficulty of communication between persons high in the hierarchy & those low in the hierarchy.
2-Inflexibility and complexity.
3-Danger of layering where communication to horizontal levels is not possible except through
higher levels.
4-Higher expenses of supervision
5-Lowers the morale of people low in the scale because they have so many layers above them .
So executives in higher levels should have a span 3-7 operating subordinates, where as the
optimum range for first line supervision of routine activities is usually from 15-20 employees .

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BUDGETING - FINANTIAL ADMINISTRATION
`
These are a series of activities where lay funds are made available to certain people in the
organization under procedures which will ensure their lawful & efficient use .
the main activities are : Budgeting – accounting -auditing –purchase & supply .
Budgeting :means the allocation of financial resources in support of program or project for
a specified period of time
Other definition :budget is a balanced estimate of expenditure & receipts for a given period of time
.
Accounting :it is the art by which the financial effects of executive action are recorded
,assembled and summarized in the form of a financial report.
Auditing : is the investigation and report on the fidelity and legality of all financial
transactions.
Purchasing : is the acquisition of property and materials needed in administration .