HEALTH SYSTEM

MANAGEMENT

1
MODULE COMPETENCY
MODULE COMPETENCY
• This module is designed to develop learners competency
strengthening health care system at their level within health
care system at their level within the health sector
LEARNING OUTCOMES
Describe the concepts ,principles ,roles and function of
leadership and management
Explain the organization and coordination of health sector
 Describe principles for effective leadership and
management of human resources
Demonstrate effective communication within health care
organization
Describe principles of commodity and supplies management
module content
Introduction to leadership and management - definitions
,importance of studying management ,historical development of
management and concepts ,theories principles and function of
management ,differentiate between leadership and management
qualities of a leader and styles of leadership ,organization behavior
and group dynamics ,definition of mission ,vision ,importance of
personal and organizational mission and vision statement
Organization of healthcare services – organization structure, purpose,
types ,function, organizational structure of healthcare system,
structures, functions ,health service delivery, levels of service ,health
service at each level, actors ,cadre ,referral system in Kenya
Organization of healthcare services – organization structure, purpose,
types ,function, organizational structure of healthcare system,
structures, functions ,health service delivery, levels of service ,health
service at each level, actors ,cadre ,referral system in Kenya
• Human resource management – human resource
management ,concepts ,principles ,practices in resource
management ,recruitment ,orientation ,deployment
,performance management ,counselling and coaching
,motivation ,work climate ,resolution ,grievances ,code of
regulation ,managing change , human resource development
– cycle ,continuous profession development , job
description ,job analysis, professionalism and work ethics
• Medico-legal issues – occupational hazards ,work man
compensation act ,disciplinary process ,decision making
planning meeting
• Communication and networking – basics of effective
communication, effective communication skills, public
speaking ,report writing, networking advocacy
•
LEADERSHIP AND MANAGEMENT
OBJECTIVES
by end of lesson students should be able to:-
1. Define management and leadership
2. Explain levels of management
3. Explain neoclassical and classical theories of management
4. Explain functions of management
5. Explain difference between leadership and management
6. Explain qualities of a leader and styles of leadership
 What is management?
• Management is the art of getting things done through people
in order to achieve stated organizational objectives.
• Management is also the systematic process involving
planning, organizing, staffing leading and controlling the
efforts of organizational members and using all other
resources to achieve stated organizational objectives.
There are six main resources in an organization (6M)
1. Money
2. Manpower
3. Machines
4. Materials
5. Management (methods)
6. Minutes (time
• Management is also defined as the process by which
resources are mobilized, combined and coordinated to
effectively to achieve organizational objectives.
• It is a process that utilizes organizational resources in the
most effective and efficient manner, in order to attain stated
organizational objectives.
• Efficiency in management refers to optimal utilization of
organization resources with minimal wastage. It is also the
relationship between achieving objectives and consumption
of resources. Effectiveness refers to attaining specific
organizational goals that are timely and challenging. It is also
an outcome measure of the interventions that improve
peoples health under ordinary circumstances and in ordinary
settings.
• Management versus Administration:
Administration is part of management work but more concerned
with execution. A manager is said to be performing administrative
work when he/she is involved in interpreting policies of the
organization and putting into plans and having those plans
implemented. At every level of management, managers perform
some work which involves execution or “doing” which is one that
completes the administrative process. Therefore administration is
the total of planning, organizing, controlling, coordinating and also
operating work.
Who is a manager?
• This is an individual employed by an organization who is
responsible and accountable for efficiently accomplishing the
goals of the organization. Managers focus on coordinating
and integrating resources using the functions of planning,
organizing, supervising, staffing, evaluating, negotiating and
representing
• Characteristics of a manager
 Managers have assigned positions within a formal
organization.
They have legitimate source of power due to delegated
authority that accompanies their position.
They direct willing and unwilling subordinates.
characteristics cont.……….
Since managers work in a formal organization, they have a
greater formal responsibility and accountability for
rationality and control than leaders.
They are also expected to carry out specific functions, and
responsibilities.
Managers also manipulate people, the environment, money,
time, and other resources to achieve organizational goals
\
cont.
Managers work at various levels in an organization. The
number of levels will depend on the size of the organization.
Generally three levels of management are used.
Levels of management
1. First level management: The first level managers are also
referred as first line managers and they are responsible for
supervising the work of non-managerial personnel and the day
to day activities of a specific work units or ward. They are the
lowest level. In a hospital, setting these would include, ward
In-charge. They are responsible for clinical practice, assigning
staff to patients, interfacing with the public, patient care
delivery
• Personnel development, ensuring compliance with
regulatory and professional standards, maintaining discipline
and motivating staff to achieve the organizational goals. First
level managers are also responsible for fostering inter-
disciplinary, collaborative and strategic planning.
2. Middle level Management: The middle level managers
supervise a number of first level managers usually with related
specialties or in a given geographical area. They have a 24hr
responsibility for their defined area.
Typically middle level managers act as liaison between
upper management and first level managers. They are
responsible for implementing the policies and plans
developed by top managers. They also supervising and
coordinate the activities of first line managers.
• A middle level manager maybe referred as a supervisor,
director or assistant director. This group constitutes the
largest group of managers
• Upper level management (top managers): This refers to top
executives (such as Chief Nurse,rco) to whom the middle
managers report. They are responsible for establishing
organizational goals and strategic plans for the entire
organization and operating policies for the entire division of
nursing.
They also ensure integration of work units to achieve the
organization mission and buffering the effects of the external
environment on workers within the organization. Top
managers are relatively a small group
Managerial Skills
• Different types of skills are required to manage an
organization effectively . These skills have been classified into
three categories namely: Technical, human and conceptual
skills.
• Though the above skills are necessary at all levels of
management, their importance vary according to ranks.
Technical skills are important at lower level whereas
conceptual skills are important at top levels
• Technical skills:
Technical skills refer to the ability and knowledge in using the
equipment, technique and procedures involved in performing
specific tasks in a specialized field. Technical skills are
important in order to accomplish or understand the specific
kind of work being done in the organization.
Interpersonal/human skills:
• Human skills consist of the ability to work effectively with
other people both as individuals and as members of a group.
These are required to win cooperation of others and to build
effective teams. Such skills require a sense of feeling for
others and capacity to look at things from others point of
view. Managers interact with people within and outside the
organization and therefore require these skills to assist them
communicate with, understand and motivate individuals and
groups
Conceptual skills:
• This is the ability to see the organization as a whole, to
recognize significant elements in a situation and to
understand the relationships among elements. It is a
cognitive ability to coordinate and integrate all of an
organization’s activities. They allow managers to think in the
abstract and strategically so as to see the big picture and to
make broad based decisions that serve the overall
organization. Conceptual skills also include the competence
to understand a problem in all its aspects and to use creative
thinking in solving the problem
MANAGEMENT ROLES:
• Henry Mintzberg (1973) identified ten management roles which he
placed in three categories: Interpersonal role, informational roles and
decisional roles.
Interpersonal roles:
1.Figure head role: symbolizes the organization or department and
performs ceremonial duties
2. Leader: determines the Mission and Objectives of the organization
and sees that they are accomplished effectively. He hires, trains and
motivates employees and encourages them to do better
3. Liaison role: Involves networking with outside organizations,
expanding information sources, like conferences, professional
meetings etc. Acts as a link between people, groups or organizations
within and without the organization
• Informational role:
4. Monitor: As a monitor, the manager informally seeks
information about the organization through internal networks,
gossips, and observations. (Get information useful to
organization). He/she tours of the organization and holds
formal and informal meetings to provide information about
the needs of the organization
5.Disseminator: A manager is a link in the organization chain
of command. He shares information from outside the
organization and between work units (sharing information
6. Spokes person: The manager shares information with
individuals outside the organization, attends meetings,
offering continuing education and participates in professional
organizations
Decisional Roles:
7. The entrepreneur: The manager looks for profitable
investments for the organization to improve its performance
(start a school of nursing)
8. Resource allocator; Managers schedule their own time (work plan).
They decide how resources are distributed and with whom he will work
most closely with
9. Negotiator; Enters into negotiation with other parties e.g. to enter
into a long term relationship with a supplier
10. Disturbance handler: Responds to unforeseen circumstances eg.
Replacement of a sick staff, missing equipment, disease outbreaks (shift
staffs)
 HISTORICAL DEVELOPMENT OF MANAGEMENT
Management has been developed through the following
periods:
i) The classical theories
ii) Neo classical theories
Classical theories:
• The exponents of classical theories were principally concerned with the
structure and mechanics of organizations. They included the following
1. Henri Fayol (French Industrialist 1841-1925) – Administrative theory
(search for principles of Management
2. Fredrick W. Taylor (1856-1915) – A Mechanical Engineer in the USA
(The Scientific Management Theory)
3. Max Weber (1864-1920) – A German Sociologist. The Theory of
Bureaucracy
• Scientific Management Theory was developed by Fredrick Taylor
(1900-1930) (A mechanical Engineer) in 1911
• Taylor conducted research on methods of training workers for
increased productivity. He advocated that work be studied
scientifically to determine the one best way to perform each task.
• Taylor postulated that if workers could be taught the “one best
way to accomplish a task,” productivity would increase. He came
up with the basic principles of scientific management:
 Principles of scientific management
1. Observing the workers’ performance through time and motion
study to determine the one best way to carry out each task (develop a
science for each element of man’s work to maximize organization
output)
2. Scientifically selecting the best worker to perform each job, that is
the person with characters and abilities needed to carry out job tasks
in the most efficient manner.
3. Training the selected worker to perform tasks in the most efficient
manner
4.Paying the worker a differential piece rate to motivate them
to perform the tasks in prescribed, efficient fashion
5. Appointing a few highly skilled workers to managerial
positions and giving each manager responsibility for planning
tasks for subordinate workers
6. Appointing a foreman for each aspect of the work and
instructing the production worker to report to a different
functional foreman for each aspect of the job
Administrative theory
• Administrative theory of management was developed by (Henri Fayol
1841-1925)
• While the scientific management focused on the tasks to be performed
by the worker, administrative management focused on the development
of broad administrative principles applicable to general and higher
managerial level.
• Henri Fayol (1925) also was the first person to identify the management
functions of planning, organization, command, coordination, and control.
Fayol also described fourteen management principles as follows.
Management principles
I. Specialization or division of labor; According to this principle one
should work at activities in which he/she has comparatively higher
skills. This helps the person to acquire an ability and accuracy with
which he/she can do more and better work with the same effort.
Therefore the work of every person in the organization should be
limited as far as possible to the performance of a single function
II. Authority and responsibility. Authority is the right to give orders
and the power to exact obedience. Each person should have an
appropriate authority to go with the given responsibility
3.Discipline. This is defined as respect for agreements which are
directed at achieving obedience. Obedience must prevail
throughout the organization as its essential for smooth running of
an enterprise.
4. Unity of command. Every subordinate should receive orders and
be accountable to only one supervisor. Dual or multiple commands
is a perpetual source of conflict. Unity of command avoids
conflicting orders and ensures order stability in the organization
5.Unity of direction. According to this principle, each ground of
activities having the same objective must have one head and one plan.
6. Subordination of Individual Interests to general interests. Efforts
should be made to reconcile individual interests with common
interests. When there is conflict between the two, the interests of
organization should prevail over individual interests.
7. Remuneration of personnel. The amount of remuneration and the
methods of payment should be just and fair and should provide
maximum possible satisfaction to both employees and employers.
8.Centralization; The degree of concentration of authority should be
based upon optimum utilization of all faculties of the personnel.
9. Scalar Chain (line of authority). There should be a clear line of
authority ranging from top to down of the organization. All upward and
down ward communication should flow through each position of
authority along the scalar chain
10.Order. All materials and personnel have a prescribed place, and they
must remain there. The right man should be in the right place
11.Equity. This means that employees should be treated with
justice and kindness. Managers should be fair and impartial in
their dealings with subordinates
12. Stability of tenure of personnel. Employees cannot work
efficiently unless job security is assured of them.
13. Initiative. Employees at all levels should be given the
opportunity to take initiative and exercise judgment in the
formulation and execution of plans. Initiative refers to the
freedom to think for oneself and use discretion in doing work.
It develops the interest of employees in their jobs and
provides job satisfaction to them.
14.Esprit de corps. This refers to harmony and mutual
understanding among members of the organization. Unity
among the staff is the foundation of success in any
organization
Theory of bureaucracy
• The theory was developed by Max Weber (1864-1920).
Webber’s rational bureaucracy states that employees
performing a large variety of tasks in an organization must
follow established rules and regulations in order to ensure
uniformity and rationality of output. The following are the
characteristics of an ideal organization as described by
Weber
Characteristics of an ideal organization by Weber
I. Division of labour: there should be clearly defined authority
and responsibility given as official duties
II. Hierarchy of authority: Positions should be organized in a
hierarchical manner resulting in scalar chain
III. Formal selection: Employees should be selected on the basis
of technical skill, formal examinations or by education or training
IV. Formal rules: There must be formal rules and controls
regarding the conduct of official duties and administrations
Neoclassical theorist/ motivational theories
• Neoclassical theorists also referred as human relation or
motivational theorists were concerned with the human
factor at work place. They were concerned with motivation,
group relationships and leadership. They wanted to discover
what it is that triggers and sustains human behavior. The
major assumption of this theory is that people desire social
relationships, respond to group pressures, and search for
personal fulfillment.
Professor Elton Mayo (1880-1849 Hawthorne studies
• Prof. Elton Mayo (Australian) (1880-1949) Psychologist,
Carried research at the Western Electric Company in the USA
(1.1 1927-1932). He was concerned about studying people,
in terms of their social relationships at work. He carried out a
study at the Hawthorne plant of the Western Electric
Company with emphasis on the worker rather than the work
Conclusions from Hawthorne Theory (Elton Mayo)
I. Individuals cannot be treated in isolation, but must be
members of a group
II. The need to belong to a group and have status within it is
more important than monetary incentives or good physical
working conditions
III. Informal (or unofficial) groups at work exercise strong
influence over the behavior of workers
IV. Supervisors and managers need to be aware of these social
needs and cater for them if workers are to collaborate with
the official organization rather than work against it.
MASLOW HIERARCHY OF NEEDS (Theory of Motivation)
• Maslow’s studies into human behavior led him to propose a
theory of needs based on hierarchical model with the basic
needs at the bottom and higher needs at the top as shown in
 Maslow’s Hierarchy of needs
1. Physiological needs- These are the basic needs of air, water, food,
clothing and shelter. In other words, physiological needs are the
needs for basic amenities of life.
2. Safety needs- Safety needs include physical, environmental and
emotional safety and protection. For instance- Job security, financial
security, protection from animals, family security, health security, etc.
3. Social needs- Social needs include the need for love, affection,
care, belongingness, and friendship.
4. Esteem needs- Esteem needs are of two types: internal esteem needs
(self- respect, confidence, competence, achievement and freedom) and
external esteem needs (recognition, power, status, attention and
admiration).
5. Self-actualization need- This include the urge to become what you are
capable of becoming / what you have the potential to become. It
includes the need for growth and self-contentment. It also includes
desire for gaining more knowledge, social- service, creativity and being
aesthetic. The self- actualization needs are never fully satiable. As an
individual grows psychologically, opportunities keep cropping up to
continue growing
Central points in Maslow’s hierarchy of needs
People tend to meet their needs systematically, starting with
physiological needs then moving up the hierarchy.
Until a particular group or needs is satisfied, a person’s
behavior will be dominated by them
Herzberg’s two factor theory:
• He concentrated on satisfaction as work. From the study he
came to conclude that certain factors tend to lead to job
satisfaction while others frequently led to dissatisfaction.
Factors giving rise to satisfaction were called motivators.
Those leading to dissatisfaction were called hygiene factors.
• Important motivators (satisfiers)
1. Achievement for performing a task
2. Recognition and praise
3. Work itself
4. Responsibility for one’s work
5. Advancement: through promotion
Hygiene factors/dissatisfiers (Extrinsic to the job)
I. Company policy and administration
II. Supervision – the technical aspects
III. Salary
IV. Interpersonal relationships – supervision
V. Working conditions
• Unsatisfactory hygiene factors lead to dissatisfaction which
lead to increased absences, grievances or resignations. He
likens hygiene factors to water filtration pump. Not having
one will likely result to illness, but drinking purified water will
not necessarily keep one from becoming sick
McGregor –theory X and theory Y
• McGregor –theory X and theory Y are essentially sets of
assumption s about behavior. He saw two different sets of
assumptions made by managers about their employees, one
which is negative ,theory X and the other positive, theory Y
Theory X assumptions
I. Human beings are lazy, dislike work and avoid it as far as
possible
II. Since human beings dislike work they must be coerced,
controlled or threatened with punishment to achieve goals
III. Human beings will avoid responsibility, and want to be
directed whenever possible
IV. Human beings place security above all other factors associated
with work and will display little ambition
Theory y assumptions
I. Employees like work which is as natural as rest or rest
II. People will exercise self-control and self-direction if they are
committed to objectives
III. An average person can learn to accept responsibility and
want to be directed whenever possible
IV. The ability to make innovative decisions is widely spread
throughout the population
• function of management
 Remember in the definition of management we stated that it is a
process.
The core functions of management were identified by Henry Fayol as
we have already seen in the management theories.
The functions are planning, organizing, staffing, directing,
coordinating and budgeting—as denoted by the mnemonic
POSDCORB
LEADERSHIP
Definition of Leadership
• Leadership as the art of motivating a group of people to act
towards achieving a common goal, It is also the process of
persuading and influencing others towards a goal.
Definition of a leader
• A leader is the person who influences and guides direction,
opinion, and course of action. Also a leader is anyone who
uses interpersonal skills to influence others to accomplish a
specific goal (good or bad)
 Characteristics of a leader
Leaders often do not have delegated authority but obtain their
power through other means, such as influence.
I. Leaders may or may not be part of the formal organization.
II. Leaders focus on group process, information gathering,
feedback, and empowering others.
III. Leaders emphasize interpersonal relationships.
IV. Leaders direct willing followers.
V. Leaders have goals that may or may not reflect those of the
organization.
VI. Often do not have delegated authority
 There are two types of leadership
• Formal leadership – Is practiced by a person with legitimate
authority conferred by the organization and described in a
job description who is a manager.
• Informal leadership – Is exercised by a staff member who
does not have a specified management role. Informal
leadership depends on one’s knowledge, status and personal
skills in persuading and guiding others
 This implies that, all managers are formal leaders while not all
leaders are manager because we have seen that there is informal type
of leadership and managers work in a formal organization
ASSIGNMENT
1. List five differences between the characteristics of a leader and a
manager (10marks)
Evolution of leadership theories
Leadership has evolved over period of time as you are going to
learn in the following discussion
a. The Great man Theory (Trait Theories):
These were basis of leadership research until 1940’s. The great
man theory asserts that some people are born to lead
whereas others are born to be led. Trait theory assumes that
some people have certain characteristics or personality traits
that make them better leaders than others.
b. Behavioral Theories and leadership styles:
• During human relations era, many behavioral and social
scientists studying management also studied leadership.
Emphasis was on what the leader did or the behaviors of
leaders. The behavioral view of leadership, personal traits
only provide a foundation for leadership; effective leaders
acquire a pattern of learned behaviors.
• The behavioral theories includes the leadership styles,
system 4 management, the managerial grid and the
continuum of leadership behavior
• Leadership styles: Lewin, Lippitt and White studied
leadership styles. They identified three leadership styles
which are authoritarian, democratic and Leissez-faire
• Authoritarian leader exhibits the following behaviors
i) Strong control is maintained over the work group.
ii) Others are motivated by coercion.
iii) Others are directed with commands
Iv)Communication flows downwards.
v) Decision making does not involve others.
vi) Emphasis is on difference in status (“I” and “you”).
vii) Criticism is punitive (should be constructive)
Democratic leader exhibits the following behaviors
I. Less control is maintained.
II. Economic and ego awards are used to motivate
 III. Others are directed thorough suggestions and guidance.
IV. Communication flows up and down.
V. Decision making involves others.
VI. Emphasis is on “we” rather than “I” and “you”.
VII. Criticism is constructive.
• A Leissez-faire leader is characterized by the following
behaviors
I. Is permissive with little or no control.
II. Motivate by support when requested by the group or
individual
III. Provides little or no direction.
IV. Uses upward and downward communication
V. Places emphasis on the group and does not criticize.
VI. Laissez-faire leadership is appropriate when problems are
poorly defined and brainstorming is needed to generate
alternative solutions.
System 4 management: This theory was developed by Likert.
It is based on the premise that involving employees in
decisions about work is central to effective leadership. It has
four dimensions based on increasing levels of employee’s
involvement in decision making
I. Autocratic leaders – have little trust in employees and
exclude them in decision making.
II. Benevolent leaders – Are kind to employees but still do not
involve them in decision making.
III. Consultative leaders – Seek employee’s advice about decisions.
IV. Participative or democratic leaders – they value employees
involvement, team work and team building. They also have high
levels of confidence in employees and seek consensus in decision
making
The managerial grid: Another model of depicting leadership along a
continuum is the managerial grid. Five leadership styles are plotted
in four quadrants of a two dimensional grid. The grid depicts various
degrees of leader concern for production (structure) and concern for
people. These are
1. Impoverished – Low concern for both production and people.
2. Authority compliance – high concern for production and low
concern for people.
3. Middle of the road – moderate concern for production and
people.
4. Country club – High concern for people and low concern for
production.
5. Team – High concern for both production and people.
c. Situational and contingency theory:
• This combines traits and situation. The contingency theories
suggest that the most effective leadership style is the one
that best compliments the organizational environment, the
task to be accomplished and the personal characteristic of
the people involved in each situation. People become leaders
because of their responsibility and situational factors.
d. Contemporary Theories of Leadership
• Leadership theory has continued to evolve. Contemporary approaches
to leadership are underpinned by the belief that information power
that was previously restricted to the professionals or managers is now
available to all.
The contemporary leadership theories includes
I. The quantum leadership: A leadership style based on the concept of
chaos theory
II. Shared leadership, an organizational structure in which
several individuals share the responsibility for achieving the
organization’s goals.
III. Servant leadership; the premise that leadership originates
from a desire to serve; a leader emerges when others’ needs
take priority.
IV. Transformational leadership; A leadership style focused on
effecting revolutionary change in organizations through a
commitment the organizations vision
• Burns (1978) suggested that both leaders and followers have the
ability to raise each other to higher levels of motivation and
morality. He identified this concept as transformational leadership.
• He maintained that there are two types of leaders in management.
I. The traditional manager, concerned with the day to day operations
was termed as Transactional Leader.
II. The manager who is committed, has a vision and is able to
empower others with this vision was termed as Transformational
leader.
• Transactional Leader Transformational
• Focuses on management tasks. Identifies common values.
• Is caretaker (takes care of tasks Is committed (extra mile).
• Uses tradeoffs to meet goals. Inspires others with
• Shared values not identified. Has long term vision
• Examiner causes. Looks at effects.
• Uses contingency rewards. Empowers others.
LEADERSHIP FUNCTIONS
 Supervision (overseeing)
• Supervision is another leadership behavior.
• It includes inspecting another’s work, evaluating his/her
performance and approving or correcting performance.
• Good supervision is facilitative because a good supervisor
inspects work in progress and can remedy inadequate
performance before serious consequences develop.
• The intensity of supervision should match situational
requirements, employees needs and managers leadership skills
• Supervision must be appropriate in type and intensity for
work groups members to interact effectively e.g. technical
workers need closer supervision than professional workers
• A manager can effectively supervise a large number of
subordinates when they are confined in a small area,
perform similar jobs and are fairly educated.
• Intensity of supervision should also depend on manger-
caregiver ration.
• The purpose of supervision is to inspect, evaluate and
improve worker performance. Therefore a criteria is needed
for judging the quality of work processes and outcomes.
• Job description and associated performance standards
provide such evaluation criteria.
The following performance elements should be appraised during
supervision
I. Quantity of work output
II. Quality of output
III. Time use
IV. Conservation of resources
V. Assistance to co-workers
VI. Support of administrator
Co-ordination
• This is another leadership activity. It includes all activities that
enable work group members to work together harmoniously.
• Co-ordination ensures that everything that needs to be done is
done and that no two people are doing the same thing (or
duplication of activity).
• Coordinating means distributing authority, providing channels of
communication and arranging work so that the right things are
done, at the right time, in the right place, in the right way and by
the right people
• The overall results of coordination should be orderly work,
harmonious, efficient and successful activities
MOTIVATION
• Motivation describes the factors that initiate and direct
behavior.
• Therefore a manager’s most important leadership task is to
maximize subordinates work motivation because employees
bring to the organization different needs and goals, the type
and intensity of motivators vary among employees
 Therefore the manager must know which needs the employee
expects to satisfy through employment and should be able to predict,
which needs will be satisfied through the job duties and positions
• Motivated employees are more likely to be productive than non-
motivated employees and hence motivation is an important aspect of
enhancing employee performance.
Management Functions
1. PLANNING
DEF: Planning is a management decision making process by
which an organization decides what it wants to achieve, how it
intends to achieve, in what manner
• It is the process of deciding in advance what to do, who is to
do it and where it is to be done. Therefore all planning
involves choice; a necessity to choose from among
alternatives. Planning is a proactive and deliberate process.
• It is a function required of all managers so that personal as well
as organizational needs and objectives can be met. This cyclic
process allows for unity of goals, continuity of energy
expenditure (human and fiscal resources) and an opportunity to
minimize uncertainty and chance. The process also directs
attention to the objectives of the organization and provides the
manager with a means of control. Planning precedes all other
management functions and without adequate planning the
management process will fail
TERMINOLOGIES USED IN PLANNING
Philosophy
• It is a statement of beliefs based on core values – inner forces that
give us purpose. Philosophy states the values and beliefs held about
the nature of work required to accomplish the mission and the nature
and rights of both the people being served and those providing the
service.
Mission - It is a broad general statement of the organization reason for
existence. It states where the organization is now, where it wants to go
and how it intends to get there. The mission identifies the organization
customers and the type of services offered
Vision - A vision statement describes the goal to which the organization
aspires. It delineates the set of values and beliefs that guide all actions
of the organization. Vision statements are future oriented purposeful
statements designed to identify the desired future of an organization.
Within this context, mission and philosophy statements are crafted.
• The goal: May be defined as the desired result towards which effort
are directed. This is a specific aim or target that the unit wishes to
attain within a time span e.g. of 1 year. They are measurable and
precise. Goals like values and philosophies change with time and
require periodic re-evaluation
• Objectives : An objective is the desired end results of any activity.
They specify what an organization is meant to accomplish
• Policy : Statements of conduct, principles designed to influence
decisions and actions). They make managers take action in a certain
way. These are plans reduced to statements or instructions that direct
organization in decision making.
• Procedure: A procedure is a series of steps for the accomplishment of
some specific project or endeavor. It is a chronological sequence of
steps to be undertaken to attain an objective.
• Rules and Regulations : Are plans that define specific action or non-
action. Rules describe situations that allow only one choice of action.
TYPES OF PLANNING
• Planning can be classified on the basis of time, nature and use of plans
Based on time
We have the following types based on time
• Long period planning
This normally covers a period of more than five years though it can
extend up to 20years or so. They are developed to guide the future efforts
of an organization. Long term planning is mainly the responsibility of the
top management
• Short period planning
This refers to determination of courses of action for the time period
extending up to one to three years. In short term planning the structure
is fixed and specific activities required to achieve goals are developed.
Its formulated by lower level management
 Based on nature
We have the following types based on nature
 Strategic planning
• Strategic planning is a process that is designed to achieve goals in
dynamic competitive environment through the allocation of
resources. Drucker (1973 defines strategic planning as a continuous
systematic process of making risk-taking decisions today with the
greatest possible knowledge of their effects on the future
Steps in strategic planning process/planning cycle
1: Environmental scanning
• This involves assessment of the External an Internal-environment
• The economic, demographic, technological, social, educational and
political factors are assessed in terms of their impact on opportunities
and threats within the environment
• Internal environment assessment (SW) includes review of the
effectiveness of the structure size, programmes, financial resources,
human resources, information system, research and development
capabilities of the organization
2: Strategy formulation
• This includes the development of the mission, specifying objectives,
developing strategies and setting policy guidelines.
• Mission: The development of the mission statement provides a sense
of direction and focus and draws the organization together. The
purpose of the mission statement is to communicate what the
organization stands for and where it is heading. Mission statement
answers the question, why do we exist. Everyone should participate in
deciding of the mission statement.
• Goal Setting: This is the process of developing, negotiating and
formalizing the targets or objectives that an employee s responsible
for accomplishing (performance standards). Goals assist the managers
to focus attention on what is relevant and to develop strategies and
actions to achieve the goal.
• Objectives: Objectives should be challenging, measurable, consistent,
achievable, reasonable and clear. Smart – outcome oriented
3: Identification of strategies: Strategy determines how the
organization will go about attaining their vision i.e. how it will exploit
the external opportunities and internal strengths and counter external
threats and internal weaknesses. This involves preparing a detailed plan
of action, either short-term and long-term objectives. Formulation of
annual departmental objectives, resource allocation and preparation of
budgets is also done at this stage. Strategies may include;
retrenchment, expansion, recruitment etc
4: Strategy Implementation
• This is the action stage. The specific plans for action are implemented
in order of priority. It entails open communication with staff in regard
to priorities and formulation of area and individual objectives related
to the plan. Resource allocation (human/non human allows for
strategy execution. Resources are allocated in order of priority i.e.
established by annual objectives.
5: Strategy Evaluation
• At set periods, the strategic plan is reviewed at all levels to determine
if the goals, objectives and activities are on target. Monitors the
results of formulation and implementation of activities and includes
measuring individual and organizational performance and taking
corrective actions when necessary
• Operational planning
This is tactical planning and a short term exercise designed to
implement the strategies formulated under strategic planning. It is
based on strategic plans.
HUMAN RESOURCE FOR HEALTH MANAGEMENT
Introduction
• The greatest asset of health care organizations is the collective and
individual knowledge and intelligence of their employees and
nurses/clinical are among the health care providers called “
Knowledge workers” because the services they provide is based on
specialized expertise and complex decision making hence the
importance of investing in human resource.
HUMAN RESOURCE MANAGEMENT CONCEPTS
Human Resource Management
• Human resource management (HRM) is the strategic and coherent
approach to the management of an organization's most valued assets
- the people working there who individually and collectively
contribute to the achievement of the objectives
Human Resource: This is any individual employed by the organization
• Performance management: All that mediates the interactive process
between work motivation of the individual the performance rewards
and development opportunities provided by the organization (Frank
1998).
• Staff development It’s the process of orientation, in-service
education, and continuing education to promote the development of
personnel within any employment setting consistent with the goals
and responsibility of the employer ( Refers to both professional and
non- professional staff
• Orientation: Introducing new staff members to the philosophy goals,
policies, procedures role expectations, physical facilities, and special
services in a work setting
• In-service education: Learning of experiences provided in the work
setting to assist staff in performing their assigned functions
• Continuing education: Educational programmes that consists the
concepts, principles, research or theories related to proffrssion that
build on previously acquired knowledge, skills and attitudes
• Strategic Human Resource Management: This is the linking of HRM
strategic goals and objectives in order to improve business strategy. That
strategy then provides the framework that guides the design of specific HR
activities such as recruiting and training
• HUMAN RESOURCE MANAGEMENT PROCESS
• The following are the techniques required for Human Resource
Management
• 1. Conducting a Job analysis determining the nature of each employees Job
• 2. Planning labor needs (HR Planning) and recruiting Job candidates
• 3. Selecting Job candidates
• HUMAN RESOURCE MANAGEMENT PROCESS
• The following are the techniques required for Human Resource
Management
1. Conducting a Job analysis determining the nature of each employees
Job
2. Planning labor needs (HR Planning) and recruiting Job candidates
3. Selecting Job candidates
4. Orienting and training new employees
5. Managing wages and salaries ( compensating employees)
6. Providing incentive sand benefits
7. Appraising performance
8. Communicating ( interviewing, counseling, disciplining)
9. Training and development
• Human Resource planning
Human resource planning is the process of identifying the
member’s skills, occupational categories, and performance
and development needs of personnel in an organization.
This identification has to be linked to the strategic plan of
the organization. While the strategic plan of the organization
is to identify the future direction
 in the organization, the objective of human resource
planning is to ensure that the organization will always have
the right people in the right places to do the work required
by the organization.
It consists of forecasting human resource needs, forecasting
the availability of human resources and matching supply and
demand for personnel
 In planning, consideration must be given to:
I. The type of patient care management used
II. The education and knowledge level of staff to be recruited
III. Budget constraints
1V. The historical background of staffing needs
V. The diversity of the client population to be served
 Principles of effective human resource plan
I. The plan should be as detailed as possible
II. Plans should not extend too far into the future, as accurate
prediction of the distant future is not always possible
III. All alternative courses of action should be considered
IV. Implications of the actions envisaged should be assessed
V. Instructions to individuals and departments must be incorporated
into the plans
VI. Plans should be concise and easy to understand
Recruitment process
1: Defining requirements:
Categories and number of people required should be specified in the
recruitment programme derived from human resource plan.
The department in which the recruit will work must draft or revise a
comprehensive job specification and job description (from job
analysis) for the vacant position, outlining its major and minor
responsibilities; the skills, experience and qualifications needed;
grade and level of pay and particulars of any special conditions
attached to the job (temporary, permanent, contract, shift duty).
2. Attracting candidates: After defining requirements then the job is
advertised. This involves reviewing and evaluating alternative sources
of applicants inside and outside the company. First consideration
should be given to internal candidates, then advertising and
outsourcing
3. Selection of candidates: This is the assessment of candidates and
choice of the one who best meets the criteria for the available position.
It involves matching job requirements with the attributes of the
candidates. Normally involves the following steps
a) Short listing: List applications on a control sheet and comparing the
applications with the key criterion in the job specification and sort
them into three categories.
i) Possible
ii) Marginal
iii) Unsuitable
Scrutinize the possible again to draw up a short –list for interview.
Ideally should be 4-8 candidates per position
b) Interviewing; An interview may be defined as a verbal interaction
between individuals for a particular purpose. The goals of the selection
interview are;
 The interviewer seeks to obtain enough information to determine
the applicant’s suitability for the available position
The applicant obtains adequate information to make an intelligent
decision about accepting the job should it be offered
The interviewer seeks to conduct the interview in such a manner
that, regardless of the interview’s results, the applicant will continue
to have respect for and good will towards the organization.
Types of interviews
• There are many types of interviews and formats for
conducting them.
The unstructured interview
• The interviewer asks whatever seems appropriate and adapts
the discussion to the response. This requires little planning
because the goals for hiring may be unclear, questions are not
prepared in advance, and often the interviewer does more
talking than the applicant.
Semi structured interview
• Only the major questions to be asked are prepared in advance and
the interviewer may ask other questions that open up areas of
discussion during the interview session.
• They require some planning since the flow is focused and directed at
major topic areas although there is flexibility in the approach.
The structured interview
• The interviewer uses a prepared list of questions and does not deviate from
them.
• This type of interview requires greater planning time yet because questions
must be developed in advance that address the specific job requirements.
• Information must be offered about the skills and qualities being sought,
examples of the applicant’s experience must be received, and the
willingness or motivation of the applicant to do the job must be
determined. The interviewer who uses a structured format would ask the
same essential questions of all applicants
• Other formats of conducting interviews
Individual interviews
Interviewing panels
Selection boards
4. References: This is to obtain in confidence factual information about
a prospective employee and opinions about his or her character and
suitability for a job
5. Physical examination: The examination determines if the applicant
can meet the requirements for a specific job and provides a record of
the physical condition of the applicants at the time of hire. Also helps to
identify applicants who will potentially have unfavorable attendance
records or may file excessive future claims against the organization’s
health insurance
6. Confirming the offer
• Confirm offer of appointment after satisfactory references have been
made and applicants have passed medical exam. Contracts of
employment should be written. Applicants offered a position should
confirm their acceptance in writing
• After the employee has been given the appointment and have
reported to work they have to understand the work environment and
adjust effectively to the job. This is done through the indoctrination
process
Indoctrination Process
• As a management function, this refers to the planned, guided
adjustment of an employee to the organization and the work
environment. The process includes; induction, orientation and
socialization.
• Induction: This includes all activities that educate the new employee
about the organization and employment and personnel policies and
procedures. This takes place before the employee starts performing
the job. A handbook can be given and a form signed to verify that it
was given. The form should be placed in the employee’s personal file.
• Orientation: Induction provides the employee with general
information about the organization whereas orientation activities are
more specific to the position. Orientation is the process of
• assisting new employees to adjust to new roles and responsibilities
within the organization. It is the process of introducing new
employees to the organization and to their superior, their juniors,
colleagues and to their tasks.Recruiting and selecting high potential
employees does not guarantee they will perform effectively. People
who do not know what to do or how to do it can’t perform effectively
even if they want to.
• Socialization: Socialization involves inducting new employees to the
expectations and behaviors of the organization. This is a sharing of the
values and attitudes of the organization by the use of role models,
myths and legends. The leader introduces the employees to unit
values and culture and molds them to fit in the unit by introducing
them to norms of the group. Role models, preceptors and mentors
can be used to clarify role expectations.
• Role models are examples of experienced, competent employees. The
employee sees the role models are skilled and tries to emulate them.
• A preceptor is an experienced nurse who provides emotional support
and is a strong clinical role model to the new nurse. (Preceptors are
usually assigned and have a short relationship with the person assigned
while a mentor has a long term relationship with the mentee)
• Mentoring is a supportive and nurturing relationship between an expert
and a novice. The mentor makes a conscious decision to assist the
mentee in his or her career development
Assignment
• Read and make notes on deployment
Performance management
• Performance management: All that mediates the interactive process
between work motivation of the individual the performance rewards
and development opportunities provided by the organization (Frank
1998).
PERFORMANCE APPRAISAL
• Managing the performance of people is a fundamental organizational
strategy to gain competitive advantage through mobilization of
human resources. An important part of a manager’s job is to define
performance in advance and to state desired results
Definition of performance appraisal
• Performance appraisal means evaluating an employee’s current or
past performance relative to the person’s performance standards
• Also known as employee appraisal, it is a method by which the job
performance of an employee is evaluated (generally in terms of
quality, quantity, cost and time).
• Performance appraisal is a part of career development. Performance
appraisals are regular reviews of employee performance within
organizations and begin when an employee is hired and stops when
he/she leaves
Purpose of performance appraisal are
I. To identify an individual’s current job performance and give feedback
on performance to employees.
II. Identify the strength and weaknesses of the employees
III. Identify employee training and development needs
IV. To motivate the employee.
V. Document criteria used to allocate organizational rewards.
VI. Form a basis for personnel decisions: salary increases, promotions,
transfers, disciplinary actions, etc.
VII. Provide the opportunity for organizational diagnosis and
development.
VIII. Facilitate communication between employee and administration
IX. Validate selection techniques and human resource policies
X. Provide information for succession planning
The appraisal process
I. The management needs define the appraisal: This involves
establishing the performance standards/objectives/expectations and
Communicating the expectations to the employee
II. Allow the employees some period to work
III. Appraisal: Assess and measure the actual performance of the work
IV. Compare actual with the expected performance
V. Complete the appraisal
VI. Conduct the appraisal interview and provide feedback
Appraisal problems
1. Unclear standards: This is where the performance standards have
not been clearly defined
2: Halo and horns effect: The halo effect occurs when the appraiser lets
one or two positive aspects of the assessment or behavior of the
employee unduly influence all other aspects of the employee’s
performance. The horns effect occurs when the appraiser allows some
negative aspects of the employee’s performance to influence the
assessment to such an extent that other levels of job performance are
not accurately recorded.
3. Central tendency: This is where the appraisers stick to the middle
when filling rating scales by avoiding high or very low marks and hence
cannot be used for promotions or salary increase since everybody is
average.
4.Leniency or strictness: This is where rating an appraiser rates
employees consistently high (leniency) or low (strictness)
5.Personal bias: The tendency to allow individual differences such as age,
race and sex affect performance appraisal ratings employees receive. How
employees performed in the past can affect current appraisal
6.Recency and primacy effects: This occurs when the a superior
(appraiser) places to much weight on factors that occurred recently
(recency) or in the beginning (primacy
6.Matthew effect: The Matthew Effect is said to occur when employees
receive the same appraisal results, year after year. Those who performed
well early in their employment are likely to do well. Those who struggled
will continue to struggle.
• Assignment
Read and make notes on appraisal methods /tools of appraisal
Human resource management functions
1. Staff discipline
• Some of the very challenging problems for managers is what to do
when an employee fail to perform as per their expectations
• Discipline is the action taken when a regulation has been violated.
Discipline can be defined as the process by which an employee brings
her or his behavior into agreement with the agency’s official behavior
codes. It can also be a managerial action to enforce employee
compliance with agency rules and regulations.
• Purpose of discipline
• The purpose of discipline is to encourage employees to behave
sensibly at work or adhere to rules and regulations. Discipline is called
for when rules and regulations are violated. The purpose of rules is to
inform employees ahead of time what is and is not acceptable
behavior
• The disciplinary process
• The purpose of a disciplinary action should be to correct rather than
to punish a wayward employee. Discipline should be administered
promptly, privately thoughtfully and consistently. Discipline should
also be progressive and preceded by counseling
• Steps in progressive discipline
a) Counsel employee regarding the problem (here informal talk with
the employee and review the code of conduct.
b) Reprimand employee. A verbal reprimand usually proceeds a written
one. (others can issue both) depending on organizational policies
(i) Verbal warning
(ii) Written warning
When written, the employee must sign to verify that the problem was
discussed and a copy placed on the employee personal file and a copy
of written reprimand is also given to employee.
c) Suspend employee if the problem persists without pay (might
change) for a period of time depending on company’s policy
d) Allow the employee to return to work with written stipulation
regarding problem behavior
e) Terminate employee if problem recurs/discharge
 2. STAFF COACHING
This is the day today process of helping employees improve
performance. Coaching also should be used when performance meets
the standards but improvement can still be obtained. Before entering
into a coaching session the coach should prepare for the interaction.
The goal of the meeting is to eliminate or improve performance
problems
Cont.………………..
Performance Deficiency Coaching
• Performance deficiency coaching is another strategy that the
manager can use to create a disciplined work environment. This type
of coaching may be ongoing or problem-centered. Problem-centered
coaching is less spontaneous and requires more managerial planning
than ongoing coaching
Cont.………………………
• In performance deficiency coaching, the manager actively brings
areas of unacceptable behavior or performance to the attention of
the employee and works with him or her to establish a plan to correct
deficiencies. Because the role of a coach is less threatening than that
of an enforcer, the manager becomes a supporter and helper.
Performance deficiency coaching helps employees, over time, to
improve their performance to the highest level of which they are
capable. As such, the development, use, and mastery of performance
deficiency coaching should result in improved performance for all
3. STAFF MOTIVATION
• Motivation describes the factors that initiate and direct behavior.
• manager’s most important leadership task is to maximize
subordinates work motivation because employees bring to the
organization different needs and goals, the type and intensity of
motivators vary among employees.
• Therefore the manager must know which needs the employee
expects to satisfy through employment and should be able to predict,
which needs will be satisfied through the job duties of each employee
position.
4. SUPPORTIVE SUPERVISION
• Supportive Supervision refers to an activity of more experienced or
higher positioned personnel whereby they support the work of their
juniors so that it meets set standards. It means assisting health,
workers in achieving work outcomes, finding out work problems and
challenges and together finding solutions to the problems. Supportive
supervision should aim at encouraging team members to apply their
ability and energy to work. It also means understanding what makes
people dissatisfied at work.
CONFLICTS AND CONFLICT
RESOLUTION
Introduction
• Conflicts are generally defined as the internal or external disorder
that results from differences in ideas, values, or feelings between or
more people. Because managers have interpersonal relationships
with people having a variety of different values beliefs and
backgrounds and goals conflict is an expected outcome. The
Managers role is to create a work environment where conflict may be
used as a consult for growth, innovation and productivity
Conflict resolution methods (strategies)

Avoiding/Avoidance: This method/strategy attempts to keep the

conflict from surfacing at all e.g. ignore the conflict or impose a
solution (especially where concern for people and production is low.
• Important if in conflict a quick action is needed to prevent the conflict
from occurring.
Accommodating: This is also known as smoothing or co-operating. It
is used when a person ignores his or her own feelings about an issue
in order to agree with (accommodate) the other side.
• NB: Parties that consistently ignore feelings and give in can end up
feeling frustrated or used and may be less willing to co-operate in
future.
• More conflict can ensue if parties disagree about importance of the
issues being accommodated
Competing: One side wins the conflict and the other side loses. It is
also called forcing because the winner forces the loser to accept his or
her perspective on the conflict.
• This can cause anger and resentment to increase
withdrawal/avoidance.
• The method is useful when an issue is critical or time to resolve it is
limited. Can also help move a critical but unpopular decision quickly
through an origin
Compromising: Each side gives up something as well as gets
something. Used when both sides have a reasonable, important goal
and losing is not required.
Negotiation: This is an extension of compromise with higher stakes
and more deliberate techniques to bargain for each side’s give and
take. It is useful for high stake issues and solutions are seen as formal
and more permanent than compromise. Conflicts tend not to recur
once the negotiations are finished
Collaborating: In this method both sides in a conflict work to develop
the outcome that is best for both sides.
• The emphasis is on creative problem solving so that each side meets
its key goals.
Confronting: This method attempts to block the conflict from the
start. The method brings the parties together, clarifies issues and
achieves an outcome.
Types of conflict
Individual conflict
 common type is role conflict occurs due to incompatibility between
one or more role expectations
When staffs do not understand the role of the other staff
Misunderstanding can occur – for not doing some work
interpersonal conflict
Occurs between two people due to differences and personalities or
competition
• Intergroup conflicts – conflict occurs between groups e.g. unit service
team ,health care professional groups ,agencies
Causes of conflicts
 differences in information ,values ,beliefs ,and interest
Competition for resources,eg money skilled manpower
Inter group rivalry for rewards
Take difficulties
Skill differences
Pressure to avoid failures
Unworkable organization structure
Effects of conflict
Advantages
Prevents intellectual stagnation
Decreases likelihood of group think
stimulates employees curiosity
Facilities employees change
Disadvantages
disputes puts others in to conflict
Unresolved causes violence
Spread from peripheral to other issues
Grievances
• Grievance Process = When a union member believes that
management has failed to meet the terms of the contract or labor
agreement and communicates this to management. This process is
called grievance!
The grievance process steps
1. The employee informs the employer about the nature of the
grievance
2. The employer arranges for a formal meeting to be held without
unreasonable delay after a grievance is received
3. The meeting is held and the employee should be accompanied at the
meeting. Following the meeting a decision is made on what action if any
to take. Decision should be communicated to the employee in writing
without unreasonable delay.
4. The employee is allowed to take the grievance further (appeal) if not
resolved)
5. The appeal should be dealt with impartially
6. The outcome of the appeal should be communicated to the employee
in writing without unreasonable delay
NB: Grievance procedures differ from union to union.
Change and change management
Change is fundamental in order to guarantee long term success in the
organization. Some organizations change in response to external
circumstances (reactive change) and others change because they have
decided to change (proactive change)
a. Definition of change -To change something implies altering it,
varying or modifying it in some way. It is also the process of moving
from one system to another. It is also the process of making something
different from what it was. Also change is any shift in status from an
undesirable current status to a desirable future status.
b. Types of change
• Planned change: Results from deliberative, collaborative effort to
improve system operations and facilitate acceptance of the
improvement by involved parties
• Unplanned /accidental change: Accidental or reactive change is an
adaptive response to an outside stimulus that is directed toward re-
establishing balance between system and environment.
c. The change process (planned change)
Change is a continual unfolding process rather than an event. The
process begins with the present state, moves through a transition
period then comes to a desired state once the desired state has been
reached the process begins again. The change process is very similar to
the problem solving process and involves :-
• Assessment At this stage problem or opportunity for change is
identified. Data about change is collected from both internal and
external sources and then analyzed. Data analysis should support
both the need for change and the potential action selected
• Planning: During planning the change agent determines who will be
affected by change and when change will occur. Also all potential
actions are examined which should include how change will be
implemented. An evaluation component to assess if the change met
the organizational goals for the change is also constructed
• Implement the change: The plans are put into motion. Interventions
are designed to gain the necessary compliance. The change agent
creates a supportive climate, obtains and provides feedback and
overcomes resistance to change.
• Evaluation: Determine whether change is effective based on
outcomes (goals) identified during assessment and using the
evaluation method established during planning. The change agent
determines whether presumed benefits were achieved from a
financial as well as qualitative perspective
• Stabilization: This is achieved by using policies or procedures to make
change the norm rather than the innovation. Should occur as soon as
possible to complete the change process
d. Change theories
There are several theories that have been developed concerning the
change process. These theories are
I. Lewis force field theory
II. Lippitt’s phases of change
III. Rogers diffusions of innovations
IV. Bridges’ model of managing transitions
In this session we are going to review the Lewins’ force field model
while you can read about the other theories
• Lewin’s force-field model -Lewin provides a social psychological view
of the change process. He sees behavior as a dynamic balance of
forces working in opposing directions within a field (e.g. an
organization) He suggested that there is need to do an analysis of
change situations (which he referred as force field analysis). This
includes identifying the following
(i) Driving forces (behaviors’ that facilitate change because they push
participants in the desired direction)
(ii) Restraining forces (behaviors that impede change by discouraging
participants from making specified changes
• Therefore for change to be effective driving forces must exceed restraining
forces. To plan change one must analyze these forces and shift the balance
in the direction of change through the following three step process:-
Steps of change according to Lewin
 Unfreezing the existing equilibrium: Refers to the awareness of an
opportunity, need or problem for which some action is necessary. To
unfreeze a status quo, a change agent must increase driving forces or
decreases restraining forces in the situation. According to Lewin it involves
motivating the participants by getting them ready for change, building
trust and recognition for the need to change To their attitudes, actively
involve the participants in identifying problems and generating solutions.
• Move the target system to a new level of equilibrium (moving): This
is done by getting the participants to agree that the status quo is not
beneficial to them, encouraging them to view the problem from a
new perspective and helping them scan the environment to search for
relevant information
• Refreeze the system at the new level of equilibrium: This involves
reinforcing the new patterns of behavior (e.g. rewarding for desired
behavior or research on new system).Reinforcement can also be done
through formal and informal mechanism (e.g. formulating policies,
establishing communication channels
e. Resistance to change
• Response to change varies from ready acceptance to full blown resistance. Forces
that oppose change are labelled resistance. Resistance is anything that leads to
delay or additional costs to a change Programme. This could be an extreme delay
(non-starter) or mild (a few months)
Reasons why people resist change
• There are several reasons why people resist change. Among them are the following
I. Fear of unknown: This is where the participants wants the status quo because they
are not sure of what will happen when change has occurred
II. When people do not know what is expected of them either during the change
process or after change has occurred
II. When people do not know what is expected of them either during
the change process or after change has occurred
III. Parochial self-interests: This is where people resist change because
of personal interest is expense of organizational interests. May be they
fear that they might loose their position if change occurs.
IV. lack of information about what the change entails and the
implication of change
V. Mistrust: This occurs especially when people don’t trust the leaders.
They might assume that their leaders could be having a hidden agenda
e.g. layoff of employees.
f. Measures of dealing with resistance to change
I. Communication with employees; Speak in person and privately with
those who oppose the change. Get to the root of their reasons for the
opposition
II. Educate the people; emphasize the goals of change and how the
individual or groups will benefit. Clarify information and provide
accurate feedback
III. Facilitation: This can be done by providing the resources required.
The change agent should also maintain a climate of support and
confidence
IV. Involve people affected by change: The change agent should be open to
suggestions but clear about the overall purpose and goals. Do not
compromise on the intended outcome
V. Negotiation; It is also important to discuss the consequences of resistance
e.g. compromised patient care or closure of the organization so that the
participants can see the importance of change
VI. Manipulation: This method can be used by rewarding those who have
accepted change so that those who are resisting can see there are some
benefits and comply
VII. Coercion: This by threatening people who resist change and therefore
they comply out of fear
TEAM LEADERSHIP
a. Differentiating groups from teams
• A group is an aggregate of individual who interact and mutually influence
each other. Both formal and informal groups exist in an organization
• Formal Groups: These are clusters of individuals designated by an
organization to perform specified organizational tasks. These may include
task forces and committees.
• Informal Groups: These evolve naturally from social interactions that are
not defined by an organizational structure e.g. People who take lunch
together who convene spontaneously to discuss a clinical dilemma.
• Teams: Teams are real groups in which individuals must work
cooperatively with each other in order to achieve some goals. They
demonstrate healthy interdependence. A team is composed of a small
number of people with complementary skills who are committed to a
common purpose, set of performance goals and approach for which
they hold themselves mutually accountable. Teams have command or
line of authority to perform tasks and membership is based on the
specific skills required to accomplish the task.
. Group and team processes
Groups whether formal or informal typically through the following phases
• Forming: This is the initial stage of group development in which individual
members assemble into a well-defined cluster ( members get to know each other,
and very are cautious..
• Storming: The second stage of group development where members wrestle with
roles and relationships. Conflict dissatisfaction and competition arise on important
issues related to procedures and behavior. Members often compete for power and
status and informal leadership emerges.
• Norming: This is the third phase of Group development. The Group defines its
goals and rules of behavior. They also define acceptable and unacceptable
behaviors and attitudes. The group structures, roles and relationships become
clearer. Cohesiveness also developes.
• Performing: This is the fourth stage. The group members agree on
basic purposes and activities and came out the work. Cooperation
improves and emotional issues subside. Members communicate
effectively and interact in a relaxed atmosphere of sharing.
• Adjourning: This is the final stage of group development, in which a
group dissolves after achieving its objectives or reforming with some
major changes takes place in the environment
c. Team building/team development
• This is a group development technique that focuses on task and
relationship aspects of group functioning in order to build team
cohesiveness.
Team building involves
a) Gathering data through individual interviews, questioners and or group
meetings about the team and its functioning.
b) Diagnosing the team strengths and arcsine need of development.
c) Holding semi- structured retreat sessions usually directed by an
experienced facilitator aimed at addressing priority team problem
d. Characteristics of effective teams
I. Clear objectives and agreed goals
II. Openness and confrontation
III. Support and trust
IV. Co-operation and conflict
V. Sound procedures
VI. Appropriate leadership
VII. Regular review
VIII. Individual development
IX. Sound intergroup relations
Problem solving
a. Definition of problem solving
Problem solving is a systematic process that focuses on analyzing a
difficult situation. Problem solving is also an active process that starts
with a problem and ends with a solution.
• Problem solving always includes a decision-making step. Managers
are constantly faced with problems to solve in an organization.
b. Scientific Problem Solving
• Most problems are solved using step by step problem solving process.
Problem solving uses critical thinking to gather and analyze
data/information, creative thinking to come up with solutions and
decision making at key steps on the process.
c. Steps of the scientific problem solving process
• Problem solving process has the following seven steps
• Define the problem, Issue or Situation: The most common cause of
failure in problem solving is improper identification of the problem. In
work settings problems fall under certain categories e.g. Manpower,
methods, machines and material The definition of the problem should
be a descriptive statement of the state of affairs but not a judgmental
or a conclusion.
• Gather information/Data: Collect the facts that can provide the clues
to the scope and solution of the problem. Obtain relevant, valid
accurate and detailed descriptions from appropriate people or
sources and put the information in writing
• Analyze the information/data: Categorize information in order of
reliability. List information from most important to least important
and set information into a time sequence Information can also be
categorized in terms of cause and effect e.g. is A causing B. The
information can also Classified into categories e.g. human factors,
technical factors rules/procedures, legal and ethical issues.
• Develop Solutions: As the information is being analyzed numerous
solutions will come up and should be written down and plans made to
immediately start developing the best of them. Develop alternative
solutions, in case the first order solution proves impossible.
• Make a Decision: Select one solution that is most feasible and
satisfactory and has the fewest consequences.
• Implement the decision: The manager implements the decision after
selecting the best cause of action.
• Evaluate the solution: Review the plan instituted and compare the
actual results and benefits to those of the idealized solutions. The
Manager should ask herself or himself: Is the solution being
implemented?, are the results better or worse than expected and
how can he/she ensure that the solution continues to be used and to
work?
Problem Solving Principles
To be able to solve problems effectively it is important to apply the
following principles
I. Separate large problems from small ones, and rely on policy for small
problems while conserving managerial time for solving major problems.
II. Delegate smaller problems to subordinates trained to handle them.
III. Seek information for problem solving from internal and external
experts so that the solution will be based on current knowledge
IV. Approach problems in relaxed fashion and avoid solving problems
under stress.
V. After appropriate consideration, select and implement the best
solutions without rumination. (do not agonize over selecting a solution)
it is impossible to expect 100% accuracy in diagnosing and resolving
problems
Decision making

Definition:
• Decision making is a complex, cognitive process often defined as
choosing a particular course of action.
• “the process of making choices or reaching conclusions
• Choice made from at least two alternatives
Rational decision making process
The primary steps of decision making process are similar to those of
problem solving.
I. Define the problem/issue and diagnose the problem.
II. Collect relevant data
III. Develop alternative solutions
IV. Assess consequences
V. Select optimum solution
VI. Implement solution
VII. Measure and monitor
DELEGATION

It is the process by which responsibility and authority for performing a

task (function, activity, decision is transferred to another individual who
accepts that authority and responsibility. The delegator remains
accountable and responsible for the tasks
Principles for effective delegation:
• I. Grant proper amount of authority: Responsibility should not be less
than authority delegated.
II. Define the results expected: Delegation must define results
expected (don’t give ambiguous instructions).
III. Consider the capabilities of the subordinates: While delegating
consider the background, experience, intelligence, training and the
limitations of the delegate
IV. Make sure authority is clearly stated: Authority relationships should be
clearly defined not only to the subordinate but also to others concerned as
well. Everyone must know who is in charge and where authority rests.
V. Modify authority whenever necessary: Authority is always revocable or
subject to modification and can be increased or decreased or even
withdrawn altogether (depending on situations and also environment).
VI. Follow unit of command/chain of command: Authority should flow
from the highest manager to all subordinates (each individual reports to
one superior except in matrix organizations (according to functional areas).
VII. Develop a willingness to delegate: Managers lack confidence in
their staff, fear to loose control. Let go and let others make mistakes if
delegation is to work.
VIII. Create a supportive climate. Give moral and material support.
Provide advice and encouragement continuously
IX. Develop effective communication system. There should be free
flow of communication between superior and subordinates for
subordinates to seek clarification and guidance from superior.
X. Establish an effective control system: Controls consent that
authority delegated is used properly. Superior should set performance
standards and evaluate subordinate periodically and help them
improve.
XI. Appropriate incentives: Suitable financial and non-financial
incentives should be provided to reward subordinates for successful
assumption of authority and completion of responsibility
Delegation is a process and therefore
follows several steps.
1. Decide what to delegate: Delegate only an aspect of your work for which you have
responsibility and authority. You need to define the nature of the task. In defining the
nature of the work you need to ask yourself the following questions
a) Does it involve technical skills or special knowledge
b) Are specific qualifications necessary?
c) Is the delegation of this task restricted by scope of practice, standards or job
descriptions?
d) How complex is the task.
e) Is training or education required?
f) Is the task required to be done in a particular way or is there room for creativity.
g) Would a change in circumstance affect who could perform the task.
2. Decide on the delegate: Match tasks to the individual. Analyze the
person’s abilities to perform various tasks to be delegated and
determine . Delegate to the person next in the hierarchy who has the
requisite capabilities and who is legally allowed to do the task and also
by organizational policy.
3. Define the task/communicate : Clearly define your expectations to
the delegate. Plan your meeting with the delegate .Provide enough
time to describe the task and your expectations and to entertain
questions. Communication should be clear and complete.
4. Reach agreement: After outline your expectation you must be sure
that the delegate agrees to accept responsibility and authority for the
task.
5. Monitor performance and provide feedback: monitoring
performance provides mechanism for feedback and control that
ensures that delegated tasks are carried out as agreed
Benefits of Delegation:
To the delegator
devote more time to these tasks that cannot be delegated. With
more time,
develop more skills and abilities facilitating the opportunity for career
advancement.
Improve interpersonal relationship with subordinates,
Provides continuity of work in the delegator’s absence and offers
ready replacement.
To the delegatee,
gains new skills and abilities that can facilitate upward mobility.
Delegation also brings trust and support thereby building self-esteem
and confidence.
 Job satisfaction and motivation are also enhanced as individuals feel
stimulated by new challenges.
Morale improves a sense of pride, develops greater awareness of
responsibility and individuals feel more appreciated and learn to
appreciate the roles and responsibilities of others
To the Organization:
 organization is able to achieve its goals more efficiently due to team
work,
overtime and absences decrease and productivity increases and at
the same time organization’s financial position may improve.
As delegation increases efficiency, the quality of care improves and
hence patient’s satisfaction
Centralization and decentralization
• Centralization is the degree to which authority is retained by higher
level managers with an organization rather than being delegated. If a
limited amount of authority is delegated , the
• organization is usually characterized as being centralized. If significant
amount of authority is delegated to lower managers, the organization is
described as being decentralized.
Assignment
Read and make notes on advantages of centralization and
decentralization
Time management
• Def. :- act or process of exercising conscious control over amount of
time spent on specific activities in order to increase efficiency and
effectiveness
Time management skills
Set goals – realistic and achievable
Prioritize work – make a list of task
Delegate task – to your subordinates as per their skills
Avoid distractors - i.e. email face book politics
Organize your time - identify when you waste time and reduce
Break down tasks – so as to accomplish one step at a time
Set deadlines – set realistic deadlines for task and stick to it
challenge your self and meet the deadline ,reward your self for meeting
difficult tasks
Avoid stress – stress occurs when we accept more than our abilities
resulting into tiredness and loss of productivity ,delegate tasks and
leave time for relaxation
HUMAN RESOURCE DEVELOPMENT
• Training: Training is the planned process of modifying employee
behavior, attitude, and skill through learning in order to increase the
probability of goal achievement.
• Development
This usually suggests a broader view of knowledge and skills acquisition
than training. It is less job oriented than career oriented. It is concerned
more with employee potential than with immediate skills. It sees the
employees as adaptable resources
Training and development cycle
• The primary objective of training is to reduce the gap between what
employees know and what they should know. Systematic training is
initiated by the organization’s policy and sustained by its training
organization
Training involves five steps
• Needs analysis/identifying training needs: The first priority is to
establish what the training and development needs of the organization
are. A training need is any shortfall terms of employee knowledge,
understanding, skill, and attitudes against what is required by the job or
the demands of organizational change. This will involve use of job
descriptions, employee’s appraisal records and any other data that may
indicate such needs.
• Plan training required; The next step is to plan the training required to
the needs identified. This involves such matters as setting budgets and
timetables, and deciding on the objectives, content and methods of
training to be employed
• Implementation/carry out the training: This is training the targeted
employee/ group. The implementation of plan is a joint affair
between the training specialist and their line and functional
colleagues.
• Evaluation and follow up: Management assesses the programme
success. This is by evaluating the results so that subsequent changes
can be made if necessary. Then the cycle starts again.
NB: Read and draw the systematic training basic cycle
• Methods of training
• 1. On the job training
• 2. Apprenticeship training ( combination of classroom ,institutions
and on the job training
• 3. Vestibule training: This is an internal off the job training method in
which the environment of the actual work place is simulated. Used by
organizations where specific skills are needed before actual job
performance
4. Job Rotation; In this training method the employee is moved from
one job to another. It gives the employee a chance to use a variety of
skills and abilities.
5. In coaching/mentoring: A senior experienced manager takes charge
of training and development of a new incumbent. The mentor/trainer
helps the employee to adjust both to the organizational culture and
work setting
JOB ANALYSIS
• Job analysis is the procedure through which you determine the duties
of positions to be staffed in an organization and the characteristics of
the people to hire for them.
• Job analysis produces information used for writing Job descriptions (a
list of what the Job entails) and Job specification ( what kind of people
to hire for the Job). The following types of information is gathered
during Job analysis
1.Work activities: identifying the tasks involved in the Job e.g giving
medications, monitoring vital sign etc.
2. Human behavior: Included here is information regarding Job
demands such as lifting weights or walking long distances
3. Machines, tool equipment's and work aids:
4. Performance standards: This is the Jobs performance standards in
terms of quality or quantity level of each Job duty. (The standards will
be used to appraise the employees
5. Job context: This includes physical working conditions, work
schedule number of people with whom the employee wound normally
interact, information about incentives etc.
6. Human requirements: This is the job related knowledge or skills
(education, training, work experience) and the required personal
attribute (attitudes, physical characteristics personality interest)
Job description
• This is a written statement of what the worker actually does, how he
or she does it, and what the jobs working conditions are.
• A job description set out the purpose of the job, where it fits in the
organization structure, the context within which the job holder
functions and the principal accountabilities of job holder(s) or the
main tasks they have to carry out.
Sections of job description
A job description mainly contains the following sections.
• Job identification; This contains the job title e.g. manager, etc. It also
contains the date that the job description was written, who prepared it, who
approval the job description and the location of the job e.g. hospital in
charge
• Job summary: This describes the general nature of the job and includes only
it major functions or activities e.g. plan, directs, co-ordinates hospital
activities.
• Relationships: This shows the job holders relationship with others inside
and outside the organization e.g. reports to, supervises who? Works with
etc.
• Responsibilities and duties: This section presents the jobs main
responsibilities and duties. e.g. conducting performance appraisal,
giving medication to patients etc.
• Standards of performance and working conditions: This lists the
standards the employee is expected to achieve under each of the job
description duties and responsibilities.
• Job specifications: It shows what kind of a person to and for what
qualities that person should be tested e.g. the skills, knowledge,
experience, attitudes etc.
COMMODITY AND SUPPLIES
MANAGEMENT
• Commodity management is a set of activities and procedures that
ensure that health commodities are available, accessible and of high
quality.
• Importance of commodity management
This is to ensure consistent availability of and access to medicines,
laboratory reagents and other medical supplies.
Some of the supplies also have a short shelf-life and are costly and hence
needs to management effectively.
The other importance is to improve quality of life patients and to
increase the consumer confidence in the healthcare system
• Commodity management cycle
• Commodity management can be described as a cycle made up of
various components. These components are product selection,
procurement, inventory management (with storage & distribution)
and use
• Product Selection: Selection is the process of identifying which
commodity should be made available as per the national guidelines.
Appropriate selection ensures that the effective medicines and
related commodities for are selected. It also ensures that right dose,
dosage form, preparation are selected and the most affordable
commodities are made available
• Procurement: This is the process of obtaining the required medicines
and supplies through purchase, donations or manufacturing. Key
components of procurement includes quantification which is the need
to know how much to buy. It also includes supplier selection where
who to buy from and how to buy is identified. In procurement also
quality assurance in order to ensure quality of the products you buy
• Distribution: This is transferring commodities from a storage
facility/supplier to a point of use or from one point of use to another,
including appropriate storage and inventory control. It involves
moving stocks from national stores, to district stores or central sites. It
also includes distribution from District stores or central sites to
facilities and finally from the facility store to user points.
• Use: Refers to practices that include dispensing the prescribed
medicines to patients, patient adherence and follow up and also
issuing other commodities to points of use.
• Types of Records used in commodity management
• Stock keeping cards: These keep information about commodities in
storage at the facility
• Transaction records: Keep information about commodities being
moved from one facility to another or within a facility.
• Consumption records: Keep information about quantities of each
commodity dispensed on daily basis to patients
• The Procurement
• Procurement means the purchasing, hiring or obtaining by any other
contractual goods, construction and services. Public Procurement
means procuring by public funds. Procurement also means acquiring
affordable commodities of good quality, either by purchase or from
donations
Procurement cycle
Procurement follows a series of steps
• Select the commodity / Review the selection
• Forecast & quantify the quantities needed
• Reconcile the needs and the funds available
• Choose the procurement method
• Locate and select suppliers
• Specify terms of supply
• Monitor supply order progress
• Receive and check supplies
• Make payment to suppliers
• Distribute the commodities
• Collect consumption data
Procurement Methods
In Kenya, procurement in the public sector is governed by the Public
Procurement Act. Let us briefly look at the methods used in procuring
health commodities:
• Open tender: This is a formal procurement process in which local or
international suppliers (or their representatives) are invited to submit
bids for the supply of commodities under the terms and conditions
stipulated in the tender. This method allows for the widest selection
of potential suppliers. However it is a time-consuming and
bureaucratic method
• Closed or Restricted tender: Similar to open tender but here the
bidding is limited to suppliers meeting certain conditions, e.g.
suppliers of a certain financial capacity, suppliers producing drugs of a
certified quality. These suppliers are short-listed using a pre-
qualification procedure. It assists by reducing the potentially large
number of suppliers who may bid, as compared to the open tender.
• Competitive negotiation: Here, the buyer selects a small number of
suppliers and negotiates prices with them directly. It is useful for bulk
procurements or for emergency supplies.
• Direct purchase: The product is purchased directly from one supplier.
This is the simplest method but usually very expensive since the buyer
does not seek better value by checking out other suppliers. It’s useful
for small procurements or for emergency supplies
• Ethical and legal implications in commodity and supplies
management
• Public procurement in Kenya should be based on core principles and
pillars. Some of these principles include:
• Transparency and Accountability: Procuring entities should ensure
there is openness and clarity on procurement policy and its delivery.
• Efficiency: This encompasses the performance of the procurement
process as cost effectively as possible and in a timely manner.
• Consistency: The application of the procurement process should be
the same across all procuring entities.
• Open and Effective Competition: Provision of ample and equal
opportunities for participation by interested and qualified suppliers of
goods, works or services.
• Ethics and Fair Dealing: Under the Public Officers and Ethics Act
(2003), it is an offence for those employed by contracting authorities
in their official capacity to accept any gift or consideration as an
incentive or reward for acting in a manner showing favor or disfavor
for any person or entity
Legal Framework The legal framework for public procurement
includes:
I. Public Procurement and Disposal Act, 2005
II. Public Procurement and Disposal Regulations 2006 and 2009
III. Public Procurement and Disposal Regulations (Public Private
Partnerships) 2009
IV. Supplies Practitioners Management Act, 2007.