1. 8 Communication and decision making 3hr
Organizational communication
Types of communication
o Interpersonal communication
o Strategic communication (Partnership and networking)
Effective listening and Effective feedback
Concepts and principles of decision making
Approaches and Skills of decision making
UNIT 5: DecisionMaking and Creative
ProblemSolving
Decisionmaking is a major part of managementbecause
Whenplanning,organizing,staffing,leading,and controlling,managers make decisionsona daily
basis.
It requireschoosingamong alternative coursesof action.
Decisionsmust be made at many levelsinan organization from executive decisionsonthe goals to
the day to day repetitive operationsperformedbylowerlevel managers.
Decisionis a choice made from two or more alternatives.
many decisionsare madein orderto solve problems
Problem:
The differencebetween actualand desired statesof affairs
Gap whereoneis and wantsto be
The definitionputmanagersina betterpositiontocreate more effective andefficientsolutions. i.e.
problemsolving
Dependingonthe situation,problemscanbe resolved ,solved,ordissolved
soften
Satisfies
Optimize
idealize
DecisionMakingandCreative ProblemSolving…
Can itbe an opportunity?
Problemsolving:
Consciousprocessof closingthe gapbetweenactual anddesiredsituations.
Creativity:
The reorganizationof experienceintonew configuration.
It is a functionof knowledgeimaginationandevaluation
more knowledge:more ideas,patterns,combination
Knowledge mustleadtoimaginationof new ideasandthenthe ideamustbe evaluatedand
developedintousableidea.
2. Identifyproblem
Is problemfindinganeasytask?
The problemfinding processemanatesfrom:
Deviationfrompastexperience.E.g.Communityimageof physicians
Deviationfromasetof plans.E.g.medical care and non-medical servicesinahospital
Otherpeople.E.g.community,media people
The performance of competitors.E.g.private/non-governmental
Pitfalls of managersin problemidentification
False expectation:e.g.tuberculosiscanbe controlledbyestablishingTB- sanitariums
False associationof events:e.g.improvedmedical care improveshealthstatus
False self-perceptionandsocial image:e.g.qualityhealthservicesare providedbyreferral hospitals;
“we are the besttype of attitude”.
Decisionmakershave
to cope withacceleratingchange,
to deal withcomplexity,uncertainty,
the needforflexible thinking,
Duringdecisionmakingandproblemsolving
Needtocope withacceleratingchange,
face the challengesof dealingwith
–complexity,
–uncertainty,
– the needforflexible thinking,and
–Decisiontraps.
Factors contributingtodecisioncomplexityare
riskand uncertainty,
long-termimplications,
interdisciplinaryinput,
pooleddecisionmaking,and
Value judgments.
Managers mustlearnto assessthe degree of certaintyina situation—whether
Conditions are certain,risky,oruncertain.
Confidence inone'sdecisionsdecreasesasuncertaintyincreases.
Conditionsof certaintyexistwhen there is no doubtaboutthefactualbasisof a particulardecision and
its outcomecan be predicted accurately.
Solid factualbasisallowsaccurateprediction of decision’soutcome.
A conditionof riskexistswhenadecisionismade onthe basisof incomplete butonreliableand
factual information.
Managers can respondtoa conditionof risk:bycalculatingobjective or subjective probabilities.
–objective probabilities:derivedmathematicallyfrom reliablehistorical data
– Subjective probabilities.Are basedfrom experience andjudgment.
A conditionof uncertaintyexistswhenlittle ornoreliable factual information isavailable.Canuse
probabilities
Difficultandrewarding decisionbasedoneducatedguessratherthanonfactual data.
One of the major reasons,managers’needtoplanisinorderto cope withan uncertainenvironment.
Three typesof uncertainty:
3. •State uncertainty("Whatwill happen?"),
•effectuncertainty("Whatwillhappentoourorganization?"),and
•Response uncertainty("Whatwill be the outcome of ourdecisions?").
DECISION TRAPS
Three typesof decisiontrapsthatcan hamperthe qualityof decisions.
– Framingerror
Occurs whenpeople letlabelsandframesof reference swaytheirinterpretations.
How informationpresentedaffectinterpretation
The tendencytoevaluate positivelypresentedinformationfavourablyandnegativelypresented
informationfavourably.
Advertising.
–Escalationof commitment
Get lockedintolosingpropositionsforfearof quittingandlookingbad.
–Overconfidence
Tendsto grow withthe difficultyof the task.maybe the needforcourage for difficultsituation
Once I am in tendency.
Overconfidence onindividual,teamsuccess
Expose tounreasonable risk.
The formal decisionmakingprocessmaybe describedin7steps:
–Definingthe problemoropportunity
–Identifyinglimitingfactors
–Developingpotential alternatives
–Analyzingthe alternatives
–Selectingthe bestalternative
–Implementingthe decision
–Establishingacontrol andevaluationsystem
Limitingfactorshelprule outmanypossible choices.Time andresourcesare usuallymajorlimiting
factors to possibledecisions.
Alternativesare the potential solutionsthatcanbe identifiedafterconsideringthe limitingfactors.
Analysingthe alternativesidentifiesthe consequences,the prosandcons,the advantagesand
disadvantagesforeachpossiblechoice.
Selectingthe bestalternativeismakingthe choice thatoffersthe mostadvantagesandthe fewest
disadvantages.
Implementingthe decisionrequirestakingactiontogetresults.Thisincludes
–communicatingthe decisiontoappropriate personnel
–& puttingplans,programs,andproceduresintoeffect.
Establishingacontrol andevaluationsystemprovidesafeedbackmechanismfortracking the
implementationof the decision,andallowsformodificationsoradjustmentstobe made as necessary
Typesof decisions
•Ends-means
Ends:Objectives/outputs
Means:Strategies/operational Programs/activities
•Administrative-operational
Administrativedecisionsmadeby seniormanagers
“Policydecisions”
4. Resource allocationandutilization
Operationaldecisionsmadeby mid-level and first-linemanagers
Day-to-dayactivitiesE.g.personnel deployment,purchases,specificworkassignments
Programmeddecisions.
•Elementsof some decisionswhichare similarandmade sooften
•Repetitive androutine
•Includesproceduresrulesandmanuals.E.g.patientadmission,scheduling,inventoryandsupply
ordering
Non-programmeddecisions
–Are unique and non-routine and mayhave unclearimplicationsforthe organization,requiringcreative
problemsolvingbecause theyare unfamiliar,Unique andnon-routine. E.g.decisiontoexpand,addor
closesservices.
The abovethreetypesof decisionsare notmutually exclusive
Factors influencingdecisionmakingprocess.
The internal environmentsuperiors,colleagues,subordinates,andorganizational system
The external environmentsuchascustomers.
The manager’spersonal style ofteninfluencestheirchoice of one of three decision-making
approaches:
A. Rational/Logical (the 7-stepdecisionmodeldescribedearlier)
B. Intuitive (gut-level decisionsorhunches),
C. Predisposed(tendencytore-use previousdecisions,regardlessof new information)
A numberof otherfactors needtobe consideredaspart of the decisionmakingprocess.Some of
these include:
– Beingable to setpriorities,timing,avoidingtunnelvisionornarrow thinking,beingable to"let-go"of
previousdecisionsif necessary,andthe abilitytobe creative andinnovativeinproblemsolving
("thinkingoutside the box").
A numberof modelshave beendevelopedtoassistwiththe decisionmakingprocess.Sincedecisions
ofteninvolve multipleconstituents,some of the groupmodelsare:
–Brainstorming,Nominal GroupTechniqueandDelphi Technique.
Managers whomay be ultimatelyresponsible forthe outcome of adecisionshouldbe aware of the
advantagesanddisadvantagesof these groupprocesses.
Several quantitative toolsare availabletoassistmanagerswithdecisionmaking.Some of theseare:
DecisionTrees,PaybackAnalysis,andSimulations.
Managers mustultimatelyestablishafunctional andeffective systemformakingmissioncritical
decisionsandformakingthe more routine dayto daydecisionsthatkeepthe organizationrunning.
Helpful environmentincludes:
–Providingadequatetime fordecisionsto be made
–Havingself-confidence
–Encouragingothersto make decisions
–Learningfrompast decisions
–Recognizingthe differingnature of decisions
–Recognizingthe importance of qualityinformation
–Making the toughdecisions
–Knowingwhentohold-off
–Beingreadyto try (new) things
– Knowingwhentoaskfor help
5. Problemsolving
Problem-solvingisnotusuallyaneasytaskfora manager
It takesmuch time of the seniorandmid-level managers
The outcome of problem-solvingaffectsallocationand utilizationof resources
The creative problem-solvingprocessconsistsof foursteps:
– (1) identifyingthe problem,
– (2) generatingalternative solutions,
– (3) selectingasolution,and
– (4) Implementingandevaluatingthe solution.
(1) Identifying theproblem
–Problemanalysis:problemrecognitionanddefinitionincludesdatacollectionandevaluation
Experience andknowledgeof manager
Sensitivity:the abilitytoidentifyandinterpretinformationcues
Perceptionof theirmeaning
Orderedandsystematicthinkingaboutfacts
Knowingwhichquestiontoask
Recognizinglimits
2. Making assumptions
Structuralassumptions:
–Problemlieswithinoroutside the responsibilityof the manager
–Additional resourcestothe solve the problemare available
–The problemis causedby otherdepartments
–Uncontrollable internal orexternalfactorssuchas jobdesign,technology
Personalassumptions:
–Are unique tothe manager:
–Biasesof the manager,willingnesstodeal withriskanduncertainty
Problemassumptions:
–Perceived relativeimportance of the problem
–Urgency of solutionandchange
Assumptionsaboutpolitical implications
–Repercussionsfromactionsandinaction
–The degree towhichsuperiorswill acceptsolutions
Problem-solverattributes
–Knowledge,experience andjudgment
–Perceptionpersonality
–Valuesandphilosophy
–The situation
–Urgency of results,time pressure
–Magnitude,importance
–Structure,uncertainty,risk
–Cost-benefit
–Environment
Direct-action
Indirect-action
Beforedeciding a managershould assess:
6. –The impact on responsibility
–Whetheritaffectsotherdepartments
–Needforinformationbyhigherauthorities
–Implicationsonbudget
–Extentof responsibilityandauthority
Problemstobringotherpeople intovirtuallyeveryaspectof the decision-makingprocess?
Managers maychoose to bringotherpeople intovirtuallyeveryaspectof the decision-making
process. However,whenagroupratherthan an individualisresponsible formakingthe decision,
personal accountabilityislost.
Dispersedaccountabilityisundesirableinsome keydecisionsituations.Group-aideddecisionmaking
has bothadvantagesanddisadvantages.
–Because groupperformance does notalwaysexceedindividual performance,
– A contingencyapproachtogroup-aideddecisionmakingisadvisable.
How to increase creativity?
–Creativityrequiresthe propercombinationof knowledge,imagination,andevaluationtoreorganize
experience intonewconfigurations.
– The domainsof creativitymaybe dividedintoart,discovery(the mostrelevanttomanagement), and
humour.
–Contraryto myth,researchershave foundaweaklinkbetweencreativityandnonconformity.
–A funand energizingworkplace climate cantapeveryemployee'screativity.Byconsciously
overcomingtenmental locks,we canbecome more creative.
General environmentalpicture:
HealthService Organizations
Turbulentandhostile
Rapidlychanging
Greateruncertainty
Greaterrisk
Fast technological advancement
Increaseddemandof qualityandquantityservices
Increaseddemandforaccountability
Increasingcost
Competition
Governmentandmediapressure,etc
Approach:- Health Services marketing: an environmentallink.
Definition:The analysis,planning,implementationandcontrol of carefullycontrolledprograms
designedtopromote voluntaryexchangesof valueswithtargetmarkets.
IdearelativelynewinHSOs
An integral partof strategicplanning.
Meetsthe needsof patientsandmedical staff;fulfill organizationalmission.
It isa voluntaryexchange of somethingof value
Consumer– getsservice locate andchoose
Provider–gets feecreate andmake available
Needs
–Designingof HSOsbasedonneedsanddesires
–Effective pricing
7. –Bettercommunication
–Improveddistribution
Mechanisms
–Identifyneedswantsanddesiresof targets(know customersandconstituents)
–Creationof newor alignmentof existingservices/products
Marketing audit
Definition:systematicevaluationof the HSO’smarketingsituation,includes:
–Environmental surveillance –marketsandneeds
–Evaluationof presentservicesinrelationtothe needs
–Modificationof exchange facilitators - tobe consistentwithstrengthsandweaknesses
Target market:examplesof factorsinfluencing
–Patients
–Healthpersonnel
–Government
–Regulations
Service mix: includesservices and programs
–Can be expanded
–Reduced
–Realigned
–Specialized
Classification of specific targetmarkets
•By typeof care needed
Acute:shortterm
Chronic:longterm
Rehabilitative
•By specific service
Medical and Surgical
Obstetricandgynecology,Oncology
Partnership and Networking:
Activity 3:
Duration: 20 minutes
Group work
Referring your organization portfolio, identify individuals and partners that had good relationship
with your organization.
How did you establish that link? Was the link with the person who leads the organization or the
organization itself?
Discuss in detail the strategy you propose to sustain your relationship with the selected
organizations/partners.
The Purposes of Communication, Partnership and Networking
Initiating action, deliberation, consultation, making decisions---
Imparting information(--- Information is giving out, communication is getting through—Harris)
Establishing relations( Partnership and Networking)
52
8. Reinforcing commitment
Sharing experience
Mobilizing partners, communities, beneficiaries, stakeholders
What is Partnership?
A formal or informal arrangement to work together towards a common goal
For example, achieving universal access to health, MDGs, HIV free generation, food security…
For instance establishing networks/forum to deliberate on local, regional and international/global
issues to advance health related agendas ( The Paris Declaration, The Abuja Declaration, The GF
Forum, The Global Health Workforce Alliance, national and regional partnership forums…)
Stages of Partnership Building
Initiation: Something triggers the idea of Partnership
Preparation: The Initiator Plans how to involve others
Action: The Partnership is enacted
Continuation or Separation
What is networking?
Is important business of making informal/formal contacts, chatting, and picking up further
contacts
It is important before other more formal information giving like organizing meetings/conferences
for experience sharing…
Networks place more emphasis on connections between individuals than partnerships formed by
bringing different groups or organizations together. Ex Project Teams, Stakeholders, Development
Partners…
8.4. Effective Communication in Work Place
Session Objectives At the end of this session participants will be able to:
Time Allowed: 1:00 Hour
8.4.1. Why communication is Important in Management and Leadership?20
20 Source:
http://fmlink.info/article.cgi?type=How%20To&title=Effective%20Communication%20in%20the%20Workplace&pub=BOMI%20International& i
d=31179&mode=source Human ResourceManagement – ParticipantsManual 139
9. Communication is essential for effective functioning in every part of an organization. It is a
critical cross-cutting ingredient of effective leadership and management. Although various
departments such as technical, administration, HR and finance may receive direction from
organization‘s goals and objectives, communication links them together and facilitates
organizational success. The importance of effective communication for managers cannot be
overemphasized for one specific reason: everything a manager does, involves
communicating. Communication is needed to increase efficiency, satisfy customers, improve
quality, and create innovative products. Effective communication is so important for
organizational success that not only managers, but also their employees must be effective
communicators. One role of a manager is to help employees improve their communication
skills. When all members of a team, department, or organization are able to communicate
effectively with each other and with people outside their group, they are much more likely
to perform well. The successful manager, therefore, needs effective communication skills.
8.4.2. What is communication? Communication is a process of sharing, and exchanging
ideas, views, instructions and policies between individuals and teams in an organization to
reach a common understanding. The most important part of this definition is that the
information or ideas conveyed must be understood. To see what this definition means in
practice, consider giving or receiving incomplete information. With only a partial
understanding, problems will occur. Good communication is often incorrectly defined by the
communicator as agreement instead of clarity of understanding. If someone disagrees with
us, we may often assume the person just did not fully understand our position; but a person
can clearly understand us and simply not agree. In fact, when a manager concludes that a
lack of communication must exist because a conflict between two employees has continued
for a long time, a closer look often reveals that, to the contrary, plenty of effective
communication is going on. Each fully understands the other's position, but their
communication does not necessarily produce agreement. 8.4.2.1. Key Elements of
Communication Let us look at the ingredients of communication in order to understand it
better.
Sender: a sender or source or origin of communication. Communication must start
somewhere. The sender initiates the communication and encodes a message.
Receiver or target is the one that decodes the message. Communication is directed at
someone or at a group of people or at a certain type of person.
Message: communication without message is not really communication. Language has
meaning, even music has meaning – a certain kind of music will convey a certain kind of
Human Resource Management – ParticipantsManual 140
10. message. Even colour can have meaning. If the traffic light shows green it means something.
Coding: We use certain codes to convey our messages. Coding can be made up of non-
verbal communication. A smile whilst talking means something and a frown means
something else.
Medium of communication: the most common medium is the word of mouth, where
people speak to one another, and writing is another medium.
Channels: I can make use of a direct channel by talking to someone, or write the person a
letter, I can send the person a message via someone else, or I can send an e-mail message
to the person.
Feedback: is also essential to communication. Feedback or a response is given after a
message has been received. It is essential in daily life and in business. If one says something
to someone else and receives no reply, that in itself could be seen as feedback and contains
some information. Feedback can therefore take the form of signals, words and written
documents.
Context: is also one of the ingredients of communication. The context is the situation in
which you are communicating. The context helps determine the tone and style of your
communication.
8.4.2.2. Phases of Communication The communication process consists of two phases: the
transmission and the feedback phases. In the transmission phase, information is sent from
one individual or group-the sender-to another individual or group-the receiver. In the
feedback phase, a common understanding is assured. To begin the transmission phase, the
sender decides on the message, which is the information the sender wants to communicate.
The sender translates the message into symbols or language, a process called encoding.
Once encoded, a message is transmitted through a medium to the receiver. The medium is
simply the pathway, such as a phone call or letter, through which an encoded message is
transmitted to a receiver. The feedback phase is initiated by the receiver, who becomes the
new sender. The receiver decides what message to send to the original sender (now the new
receiver), encodes it, and transmits it through a chosen medium. The message might contain
a confirmation that the original message was received and understood, or a restatement of
the original message to make sure that it was correctly interpreted, or a request for more
information. Communication comes in many forms:
Human Resource Management – ParticipantsManual 141
11. Non-verbal (facial expressions, body language, and posture)
Written (letters, emails, blogs, and text messages)
8.4.2.4. Barriers to Effective Communication Barriers to communication are things that
prevent people from understanding a message, or understanding it the same way. Some
common barriers to communication include:
Poor listening skills. Many people consider speaking the most important element of
communication. However, good listening skills are critical to effective communication. They
help you better understand the information other people are trying to convey, improve your
rapport with others, and improve your problem solving skills.
Language barriers. The words you use to communicate may create a barrier to
communication. This can be as basic as communicating with someone who doesn‘t speak
the same language, or as subtle as interpreting the words you use in a different way. It can
also include poor use of language by the communicator or using jargon.
Emotional barriers. There is a greater potential for misunderstanding when emotions are
involved. For example, a sender who is upset or angry may not be able to effectively
communicate his or her feelings and ideas. A receiver in a similar state may ignore or distort
what the other person is saying.
Environmental barriers. This can include a number of factors including, interruptions,
distractions, physical environment issues (lighting, noise, and comfort), talking too softly,
physical distance, a physical barrier between sender and recipient, etc.
Timing barriers. The timing of a communication can affect its ability to be understood. For
example, there may not be enough time to communicate the message fully, or it may be too
early or too late in the day for someone to give the communication his or her full attention.
Perceptual barriers. Each person experiences events—including communications—in a way
that is unique to him or her. A sender will communicate in a way that makes sense in his or
her reality. A receiver understands a communication in a similar manner. However, these
two realities may not be the same, so the message may be perceived differently, hindering
communication.
Filtering. It occurs when the message received is very different from the one that was
originally sent. 8.4.4. Effective Communication Skills in Work place Human Resource
Management – Participants Manual 142
12. The workplace can be a highly stressful environment. Good communication skills are vital in
helping you to work effectively, build solid relationships and prevent unnecessary
misunderstandings, and navigate day-to-day deadlines21. So what constitutes effective
communication skills? Effective communication is a learnable skill. It takes work, but the
results are worth it. In truth, we are all public speakers. The only ‗private speaking‘ that
really goes on is in ‗privacy of our minds‘ where our ideas bounce back and forth like Ping-
Pong ball. Therefore, communication skills are important to everyone - they are how we give
and receive information and convey our ideas and opinions with those around us. It is
important to develop a variety of skills for both communicating to others and learning how
to interpret the information received from others. Knowing our audience and understanding
how they need to receive information is equally important as knowing ourselves. To
organizations, good communication skills are essential. In fact, organizations consistently
rank good communication skills at the top of the list for potential employees. Employers
expect good eye contact, good posture, and ―active‖ listening. One of the challenges in the
workplace is learning the specific communication styles of others and how and when to
share your ideas or concerns. Though some supervisors may specifically ask for your
opinion, others may assume if there is something important they need to know, you will
bring it to their attention – or if there is something you are unsure about, you will ask.
Knowing how to listen carefully and when to ask for help is important. If an employee and a
supervisor learn to communicate well (in whatever method that works), there is a greater
likelihood of job retention and promotion. Moreover, organizations need leaders to steer
them and the role of communication skills in leadership has been acknowledged universally.
The most respected leaders in the human history are the ones with high level competency in
communication. We all have certain leadership roles in our own domains. Effective
communication results from discovering better and more effective ways of relating to others
and of having them relate to us. Much like life itself, communication is a process. That
means it is dynamic, ever changing, and unending. The vehicle through which interpersonal
relationships are developed or destroyed is human communication. 8.4.4.1. Elements of
Effective Communication Skills
21 Frank-stuart. Source: http://blog.acpe.edu.au/index.php/careers/effective-communication-skills-workplace/22 Frank-Stuart (ibid)
There are many elements or characteristics of effective communication skills. Here are a few
points worth remembering22:
Self-awareness: it is the capacity for introspection or understanding one‘s self and the
ability to recognize oneself as an individual separate from the environment and other
individuals. Self-awareness is a starting point for many effective behavior including
communications and relationship. Human Resource Management – Participants Manual 143
13.
14. Listening: good listening is integral to effective communication. Communication is about
exchange, and there‘s no place like the workplace to illustrate this. While you no doubt want
to get your point across, it‘s essential to remember that so do others. Listening can help
ensure you know what everyone is thinking. When someone is speaking, focus on their face
rather than letting your eyes wander, and if appropriate, take notes. Empathy: the
workplace is about teamwork, so in order to work effectively, it‘s essential to be open to the
opinion of others, and to understand their position on any given issue. It‘s about give and
take. Putting yourself in someone else‘s shoes is often a good way to improve workplace
communication skills. Make a point to ask questions. Patience: if you rush what you say,
others may find it difficult to understand you. Similarly, if you‘re impatient for others to get
to the point, you are more likely to lose focus, and not hear what they are saying. For good
communication, it‘s important to be methodical. Take points one at a time, both when
talking and listening. Clarity: when you speak to others, whether they are colleagues, clients
or your boss, you are wise to be direct. If you dither around the point, or are uncertain with
what you are saying, others are less likely to listen to you. You don‘t need to be making a
speech to suffer nerves at work, particularly when dealing with superiors. Before heading
into a meeting, write down exactly what you need to say, and make notes in point form,
which you can refer to if needed. This will help ensure you stay focused, and not miss
anything important. The same applies if you are giving direction to others on tasks to be
carried out. Clarity is vital in ensuring others understand what they are to do. Positivity:
Maintaining a positive attitude at work is not always easy. However, anger and bitterness are
not only negative emotions; they can contribute to misunderstandings and conflicts at work.
Try to view problems and difficulties as challenges, and look at ways at overcoming them,
rather than letting them become a major, ongoing burden. If you are feeling pressured at
work, speak to your manager or another superior to see if there might be ways to help
alleviate the problems. Self-improvement: Confidence and good communication go hand
in hand. Many people aren‘t naturally gifted speakers. It takes practice to improve both
written and verbal communication skills in the workplace. Effective communication in the
workplace is within grasp of anyone. Make a point to practice listening, patience, clarity,
positivity and self-improvement, and you‘ll be a much better position to work well, and help
your workplace run smoothly. 8.4.4.2. How to improve communication skills Building up
on the previous section, there are a number of useful ways to improve communication skills
or communicating effectively and eliminating the communication barriers on a practical
level. Human Resource Management – Participants Manual 144
15. Be aware of the importance of perceptions and take special care in ensuring that
perceptions are clear and correct.
-to-face communication if the situation is problematic. This could ensure direct
feedback.
t a person be comfortable in your presence and note where messages
are not understood or where it is resisted.
give a person the idea that you want something, but rather that you are willing to
contribute or make a sacrifice.
red to admit your own mistakes.
rect medium, channels and codes to use to convey your
message.
about him/her too.
3.5 Development of Networking
In all health care organizations, there are individuals and institutions that have connections or
channels
of influence with other individuals or institutions.This leads to the development oforganizational
networking.
Management has to devote time and attention to these lateral and horizontal approaches and
not to concentrate only on activities within the structure ofthe organization. For example, inter-
personal
16. relationship may influence a link within organizations which were once not working together.
3.6 Communication
Achieving a common understanding is very crucial for the success ofany partnership. To arrive at
a common
understanding, there has to be good and effective communication, where messagesare conveyed
with a shared meaning in a two-way manner between the parties involved. Often, conflict arises
because
of barriers to communication. Such barriers could be difference in perception, lack ofknowledge,
prejudice
or bias, among others.
4.3 Factors Facilitating Partnership
Promoting partnership may be difficult and there are usually obstacles or constraints in the way.
There
are also factors that make it easier to achieve your aims.
It is good to knowwhat factors encourage partnership. Knowing those factors may help you to
create
the right climate for partnership and to recognize opportunities for collaboration when they arise.
ACTIVITY 7
From your own experience list examples ofwhat may facilitate partnership.
If you knowabout a very good example,share it with the whole
group.
B O X 2 : CASESTUDY:
PARTNERSHIP BETWEEN ORGANIZATIONS
In District A, there existed a number oforganizations, both international
and local. These organizations started functioning at different times,
with different goals and agendas, but with considerable overlap in the
health area. For a number of years, the organizations worked hard and
even expanded. They also attracted more money because the district was
one ofthe districts in the country with the highest infant and child mortality
rates. However, for the many years the organizations operated in
the district, the health status ofinfants and children never improved.A
newdistrict medical officer (DMO) was posted in the district. After
familiarizing himselfwith the situation in the district, he decided to call
all health-related organizations operating there to discussthe appalling
health status ofinfants and children in the district. After a series ofmeetings,
a common plan of action was adopted by all the organizations
alongside the district authorities.Funds were mobilized from existing
resourcesand implementation was started. Five years later, a survey carried
out in the district showed a marked drop in the infant and child
mortality rates and substantial savings on expenditure by the organizations.
D I S T R I C T H E A LT H M A N AG E M E N T T E A M T R A I N I N G M O D U L ES
Examples offactors that promote partnership between organizations include:
n Clear purpose and commitment to inter-organizational partnership by all partners. This is
sometimes called “political will”.
n Partnership at all levels. Partnership is easier to achieve ifthere is a national framework for
facilitating a similar process at regional, district and community levels.
n Partnership is facilitated by decentralization. Decentralization provides district managers with
decision-making authority over resources that facilitate partnership.
n Joint planning makes a useful contribution to partnership because planners join in efforts to
identify and agree on problems, setting objectives, identification ofresources, budgets,
timetables and procedures.
n Sometimes formal rules, regulations and procedures indicate where different agenciescan
17. make common use ofresources such as finance, personnel and transport. Agencies in various
sectors should reviewtheir policies and regulations to make provision for collaboration and joint
decision-making procedures.
n Intersectoral coordination can be further encouraged when workers at various levels maintain
contact with workers at similar levels in other organizations. Such “lateral” contacts should be
encouraged both in formal and informal ways. When regular contacts exist between many
individuals in different organizations they form a network to facilitate partnership.
n In many respects, effective partnership depends on the development ofa collaborative style of
interpersonal relationship both within and between organizations. There is also a need to trust
others and reward initiatives ofindividuals fostering partnership.
n It would help if health information systems use indicators that measure progressin key areas
of PHC activities, health status and quality of life contributed by multiple agencies.
Feedback ofthis information will eventually direct policiesin similar direction.
n If organizations are already used to innovation and inquiry to guide their inter-agency
partnerships it will be easier to establish partnership.
IV) Nursing communication
A) Summary
Nursing requires effective communication – verbal and written – between the patient and the
clinician, and among clinicians themselves to ensure proper diagnosis as well as quality care
and
treatment.
a) Written communication: This includes the written documentation of all findings,
progress, care and treatment provided to the patient by the medical team, including
the nurses. A written record permits immediate access to all information related to
the patient’s care.
b) Verbal communication: For nurses, this entails the act of reporting and conversing with
various other members of the health care team regarding the patient’s progress and
status.
B) Written communication: Medical record documentation
The following items are used by nurses to document a patient’s course of treatment. It is the
nurse’s responsibility to ensure that a patient’s medical record is complete, containing all the
necessary forms in the proper sequence. They are intended to guide the entire medical team
and
to become a permanent record maintained in the patient’s medical record.
1) Clinical forms: Nurses must record patient data and findings on clinical forms that
include:
• Intravenous Fluid Administration Record (see Appendix A: Item 1),
• Routine Observation Form (see Appendix A: Item 2), and
• Medication Administration Record (see Appendix A: Item 3).
It is the nurse’s responsibility to chart on the appropriate form and to make sure that the
information is timely and accurate.
2) Nursing Kardex: The Nursing Kardex (see Appendix A: Item 4) directs the nursing care
required by a patient. Any pertinent physician orders, including medication orders
and information about the patient’s care needs, are documented on the Nursing
Kardex, which is updated during each nursing shift to ensure its accuracy.
3) Progress Notes: On the Progress Notes, nurses document the administration of
prescribed care and treatment, the patient’s response to that care and treatment, the
patient’s emotional adjustment, the patient’s education, and any other related patient
18. care information. Nurses chart a progress note at the end of each shift worked.
4) Nursing Plan of Care: The Nursing Plan of Care is designed to provide consistency in
care and treatment to a patient by documenting all aspects of the patient’s care
regime, including routines and effective interventions. The goal of any plan of care is
to aid the patient’s return to his/her best state of health, to help him/her maintain
independence and to ensure a smooth transition to home (see Appendix A: Item 5).
Chapter VII. Nursing. Page 9 of 33
5) Discharge Instructions: Any instructions to the patient for his/her transition home should
include information regarding any procedures (wound care, etc), diet, activity and
medications to be administered at home. The instructions should be clearly written
on the discharge instruction sheet (see Appendix A: Item 7) and reviewed with both
the patient and the family.
C) Verbal communication
1) Reporting to Physicians: Whenever a patient’s status changes, the physician should be
informed. The status should be reported in an objective manner, allowing for the
physician’s recommendation(s). Any physician’s order should then be documented in
the medical record by the nurse as a verbal order.
2) Nurse-to-Nurse Report: During a shift change, the off-going nurse should verbally report
to the on-coming nurse concerning the status of each patient using a standard format
(see Attachment 7). The report consists of a general synopsis of the patient, any
significant events during the shift, as well as a progress report of the work completed.
The report also includes the patient’s name, age, chief complaint, diagnosis, present
medical history, and general hospital course. Updates should be provided on IV
administration, tests done or pending, abnormal laboratory findings, and general
patient progress.
Follow the format below for performing nurse-to-nurse shift report.
• Patient name
• Patient age
• Chief complaint: reason for hospital admission
• Patient diagnosis: present all current diagnosis
• Current IVs
• Tests completed or pending
• Abnormal lab findings: do not report normal findings
• Events during the shift: synopsis of what occurred during the shift
• Patient progress: description of patient’s response to any treatment or events that
occurred during the nurse’s shift, including the patient’s progression towards
discharge
3) Nurse to Health Assistant Report: At the start of each shift, the nurse is responsible for
reporting to the health assistant regarding patient(s) under his/her care. Specific care
information related to bathing, ambulating, eating, toileting, and other similar
concerns should be discussed. A written checklist of tasks to be completed should be
given to the health assistant (see Appendix G: Item 9).
Use the following format for performing a nurse to health assistant report. It is important
that the assigned tasks are specific to ensure that the health assistant is able to
accomplish them during their shift.
Chapter VII. Nursing. Page 10of 33
a) Vital Signs: Describe the frequency required for assessing a patient’s vital signs.
19. Is it necessary to assess them:
• Once a shift,
• Twice a shift,
• Every hour, or
• Other unique needs.
b) Bathing: Describe the level of assistance the patient requires for bathing and
changing linens. Is the level:
• Complete assistance during both bath and bed linen changing,
• Required assistance when bringing bathing materials to the patient who must
remain in the bed while linens are changed,
• Required assistance when bringing bathing materials to the patient who is
capable of getting out of the bed while the linens are changed, or
• No assistance necessary because the patient is independent during bathing and
the patient is capable of getting out of bed while the linens are changed.
c) Activity: Describe the activity level of the patient as follows:
• Bed rest: how often does the patient need to be turned?
• Out of bed (OOB) walking: is the patient OOB at will or does he/she need
assistance? If assistance is required, please inform the aide of the frequency
of OOB.
• Out of bed (OOB) to chair: what is the level of assistance required to get OOB
to a chair? If assistance is required, please inform the aide of the frequency
that this should occur and for how long.
d) Toileting: Describe the level and type of assistance the patient requires to
perform the following (if applicable):
• Out of bed to the bathroom,
• Offer the bedpan to the patient every ________ (amount of time),
• Patient uses the urinal,
• Patient has a foley catheter, and/or
• All patient output should be recorded and communicated.
e) Diet: Describe the patient’s type of diet and the assistance they require:
• Set up the food only,
• Set up and cut the food,
• Feed the patient, and/or
• Record all input.
f) Safety: Describe how often the aide needs to make rounds on the patient.
4) Patient Education: It is important to educate the patient, his/her spouse/partner, and
his/her family about the illness and course of treatment. It informs and empowers the
patient, thus improving his/her ability to achieve a higher level of wellness and ability
Chapter VII. Nursing. Page 11of 33
to manage specific needs. Efforts to educate the patient should be realistic, relevant
and provide time for patient practice and opportunity to seek clarification.
This education should include the potential role of the family, which often has a
strong role in facilitating patient care in coordination with medical staff. One
suggestion to improve the family and staff relationship is through the use of a
caregiver contract, whereby the relationship is formalized between
families/caregivers and medical staff. This allows patient families to act as “aides”
and provide certain services (feeding, bathing, ambulating, bringing fresh sheets and
20. food, etc.) within guidelines that are acceptable to medical staff. Such a formalized
process can greatly improve the patient’s quality of care.
1.2 Communication
Communication refers to the process ofrelaying messagesin a way that is effective and resulting in
a
response.The communication processis inseparable from the management aspects ofan
organization.
Good and effective communication promotesteamwork.
Personal relationships within a team can be difficult but poor communication can worsen them. To
encourage communication the following should be emphasized:
MODULE 3
6
MANAG E M E N T O F H E A LT H R E S OU RC E S
ACTIVITY 4
n Write your own job description and swap with your team
members for comment.Compare with example given in the text.
n Write an advertisement for a consultant needed to assist the
implementation ofhealth sector reform in your district. (For
instance, a legal adviser to assist the establishment ofdistrict
health board.)
ACTIVITY 5
Discuss howyou would orient a public health nurse who comes straight
after training in a consultancy hospital to become in-charge ofthe district
MCH services.
MODULE 3
Wo r l d H e a l t h O r g a n i z a t i o n R e g i o n a l O f f i c e f o r A f r i c a
7
n All team members and staffshould be clear whether their views are well taken care ofand should
be encouraged to do so.
n A message or communication should be clear whether provided orally or written and simple
language should be used.
n Conflicts are common, and they should be resolved in a way that will achieve constructive
results.
1.2.1 The communication process
The following are the characteristics ofa communication process:
n Communication involves people; to understand communication, you first have to try and
understand people.
n Communication involves shared meanings. This suggests that, in order for people to
communicate, they have to agree on the definitions ofthe terms they are using.
n Communication is done through symbolic gestures,sounds, signals, letters, numbers, charts,
graphs and words. However, all these only represent or approximate the ideas they are meant to
communicate.
1.2.2 Types of communication flow
n Downward communication: This is the most frequently used type ofcommunication.
Communicating downward can help the manager spell out objectives, change attitudes and
mould opinions. However, there is a tendency to misuse this type ofcommunication, especially
when there are no efforts to encourage response through upward communication. The
downward communication without an upward response is compared to a “one-way street”. In
other words, messages flowfrom one direction (from sender to recipient), without a feedback
system.
21. n Upward communication: This is communication which flows upwards from a client and/or
subordinate to the supervisor or manager. It enhances the sharing ofopinions and experiences
in the process ofplanning, implementation, monitoring and evaluation. Unlike downward
communication, upward communication allows decision-making to take place at the grassroots
level, managers being supporters and catalysts in this process.
n Horizontal communication: In this type ofcommunication, there is lateral communication (i.e.
between people working at the same level in the organization). Messages in horizontal
communication usually relate to task coordination, problem-solving,information-sharing and
conflict-resolution. In addition, an established horizontal communication in the district health
management system could serve as a basis for collaboration, liaison and networking with all
related sectors, government and non-government agencies,political leaders and multinationals
and donor agencies.
1.2.3 Communication channels
These are the paths through which a message is transmitted from the sender to the receiver. For
example,
these can include telephone and radio.
D I S T R I C T H E A LT H M A N AG E M E N T T E A M T R A I N I N G M O D U L ES
With the advent ofe-mail and Internet, networking is rapidly becoming a major type ofhorizontal
communication flow that knows no borders. Wherever there is an existing telephone or radio
connection
and a computer, linking up to e-mail and the Internet is possible at little expense and is in almost
all cases recommended.
1.2.4 Interpersonal communication barriers
A communication barrier is anything that stops a message from reaching its destination.
Causes ofinterpersonal communication breakdowns
Various factors can cause communication breakdowns. These include:
n poor appearance;
n strong emotions;
n prejudice or bias;
n jumping to conclusions;
n stereotyping;
n differences in perception;
n lack of fundamental knowledge;
n lack of interest;
n use ofvague or very technical language;
n faulty communication lines;
n too many assumptions made by the receiver;
n unconducive atmosphere/environment;
n no terms ofreference and/or lack ofwritten instructions;
n failure by subordinates to judge accurately what should be in reports to superiors or failure to
communicate at all;
n lack of informal or formal opportunities as a barrier to upward communication.
1.2.5 Ways of minimizing communication barriers
Use ofdifferent communication systems, including formal and informal methods,will facilitate
understanding
between the sender and the receiver ofthe message within an organization.
MODULE 3
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MANAG E M E N T O F H E A LT H R E S OU RC E S
ACTIVITY 6
Role-play: Arrange a role-play for two persons who may, for instance,
22. depict a doctor and a patient. Each player first meets with a small group
that jointly discusses howto create as many obstacles to communication
as possible. When the play is over, discussin plenary session what you
observed and what barriers to effective communication were noted.
Next, another couple plays, taking care that all the barriers to effective
communication are removed.
Monitoring and evaluation
MonitoringandEvaluation
The purpose of a good M&E practice is to properly monitor measure and demonstrate results
In this course, you will be monitoring the progress toward your measurable result, not evaluate
your program perhaps. All you really need to know is the “M”— how to monitor progress toward
your measurable result.
Indicator
Indicator—a marker of change over time that can be measured
In your team, agree on one or more indicators that are measurable markers of progress toward
your desired result and give their data sources.
You need indicators only for your measurable result—not for each of the activities in your
Action Plan. Write down where you will get the data that you will use to measure your
indicator(s). Will it be from service statistics, a questionnaire, or client interviews? Use the
handout to help you.
Indicators should be expressed in neutral terms without words like “improved” or
“decreased” (e.g., the indicator is “temperature” not “higher or lower temperature.”).
The words “increase” or “improve” can be put in the measurable result statement.
Select baseline data which describes the current situation for developing an M&E plan.
Without it, a team cannot track its progress, determine whether activities are going according
to plan, or measure the extent to which they have achieved their results. It is difficult to
correctly implement an M&E plan either.
Prepare Monitoring & Evaluation Plan
What is monitoring?
Monitoring is a systematic and continuous assessment of the progress of an activity over time.
Monitoring can be done through the process of collecting, coordinating, processing, measuring
and communicating information to assist management in decision-making.
Monitoring encompasses follow up of Inputs (vaccines, funds, personnel, etc.), the Process
(activities/ tasks being done according to accepted norms and standards), Outputs (products meet
specifications, services are delivered as planned, training results in new skills, etc.) and finally
the Outcome (the short-term effect of the programme or campaign).
Monitoring ensures that:
work progresses according to schedule;
standards such as storage and administration of vaccines are maintained;
resources are used rationally and as planned;
the required information is available and used, etc.;
problems are detected during implementation period so as to undertake corrective
measures; and
23. plans are verified to ascertain that they are being implemented in the way and manner
planned.
Tools for monitoring
These are:
Health Management Information System and periodical reports.
Supervision reports.
Programme progress reports.
Project plan of action.
Monitoring is carried out internally in the course of implementation of the district health plan.
Implementation of the district health plan should be the main focus of deliberations during the
meetings.
Evaluation
Definition
Evaluation is the systematic assessment of actions in order to improve planning or
implementation of current and future activities. Evaluation includes areas of context, input,
process and impact to assess whether the set objectives have been achieved. It can be internal,
that is carried out by the implementers, or external.
Why evaluation?
The essence of evaluation is to determine programme performance, effectiveness and efficiency.
In other words, an evaluation can be carried out to:
Decide whether an activity was worth doing.
Determine whether the objectives set were achieved.
Determine (formative evaluation) whether activities should be continued or not.
Determine whether the project should be extended elsewhere, etc.
When to evaluate
Before implementation:
To assess development needs and potentials;
To determine feasibility of the plan.
During implementation (formative evaluation):
To identify areas for changes or modifications;
To detect deficiencies and ensure immediate redesign of intervention strategies.
At the end of programme (summative evaluation): to assess programme or project effect and
outcomes with a view to obtaining information on:
effectiveness of the programme in achieving its stated objectives;
its contribution to developmental goals;
efficiency of the programme or project in utilization of resources;
sustainability of the project results; and
whether to continue, modify or terminate the project.
Comprehensive evaluation addresses context, inputs, process, and outcome. However,
comprehensive evaluation may be too demanding in terms of resources and, hence, is extremely
expensive.
Before carrying out an evaluation, proper plans must be made to include correct logistics and
methodologies to be followed in advance.
