Academic Courses
FACULTY OF NURSING
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Topic One:Definitions
Topic Objectives
By end of this topic, you 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
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Topic 1: 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.
- 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 and Effectiveness
- 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.
Management versus Administration
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Topic 1: What is management? [Cont'd]
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.
- 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
- 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.
1. First level management:
- The first level managers are also referred as first line managers 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 supervise 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
3. 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
- 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
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Topic 1: 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 improves job satisfaction)
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)
ATTRIBUTES AND QUALITIES OF A MANAGER
• Technical competence
• Social & human skills
• Conceptual ability
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Topic One: Further Reading
Reference Material
1. Barton E. et al (1980) On Being InCharge. Geneva: World Health Organization.
2. Basavanthappa, B. P. (2000). Nursing Administration. New Delhi, Jaypee Brothers Medical Publishers Ltd.
3. Bennet, R. (2004) Management. Essex: Pearson Education Ltd.
4. Cole, G. A. (1996) Management - Theory and Practice. London: Martins the Printers.
5. Tappen, R. M. (2001) Nursing Leadership and Management 4th F.A Davis, Philadelphia.
Further Reading Resources
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Topic Two: Historical Development of Management
Management has been developed through the following periods:
i) The classical theories
ii) Neo classical theories
SCIENTIFIC / CLASSICAL APPROACH
1910’s
Described management as a science
– focused on formal structure, technical requirements of the organisation and general sets of principles
-Listed duties of a manager
HUMAN RELATIONS APPROACH
– focused on the informal organisation and the psychological & social needs of people at work
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
NB. Classical/scientific managers relied on their experience. They advocated for what worked.
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Topic Two: 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:
He studied;
- Interaction of human characteristics
- Social environment
- Tasks
- Physical environment
- Capacity
- Speed
- Durability cost
FAYOL’S 6 ACTIVITIES OF INDUSTRIAL UNDERTAKING
1. Technical e.g. production
2. Commercial e.g. buying and selling
3. Financial activities e.g. securing capital
4. Security e.g. safeguarding property
5. Accounting e.g. providing financial information
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
F. W TAYLOR’S ACHIEVEMENTS
1. Raised productivity of shovellers from 16 to 59 tons/day i.e. 4 fold
2. Reduced no. of yard laborers from 500- 140
3. Revolutionarised the art of cutting metals
4. Doubled speed at which fine steelwork was done
5. Increased production in one instance by 369% and increased the wages by 60%%= extra profit!!!
was nicknamed "Speedy" Taylor for his reputation as an efficiency expert.
FAILURES OF F. W TAYLOR’S
1. He dehumanized management theory
2. The aspect of management which the laws of science did not as yet apply were to be subject to collective bargaining e.g. class interests
3. Taylor was hated by unions
4. Laws were passed to keep his methods out of military arsenal . The federal government (the military, actually) thought his ideas were dangerous, and scientific management was banned by federal law from ever being implemented in that sector
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Topic Two: 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.
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Topic Two: Administrative theory [Cont'd]
H. FAYOL’S 14 PRINCIPLES OF MANAGEMENT
1. Specialization or division of labor
- Reduces span of attention or effort for any one person or group.
- Develops practice and familiarity
- Specializing encourages continuous improvement in skills and the development of improvements in methods.
2. AUTHORITY
- Rights to give order
- Should be accompanied by responsibility
- The right to give orders and the power to exact obedience.
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.
- outward mark of respect accordance with formal or informal agreement between firm and employees
- No slacking, bending of rules.
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
- One man, one superior -Each employee has one and only one boss.
5.Unity of direction.
According to this principle, each ground of activities having the same objective must have one head and one plan.
- One head, one person (director) and one plan for a group of activities with one objective. A single mind generates a single plan and all play their part in that 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.
- Interest of one individual or one group should be subordinate( not prevail over the general good (total workgroup)
- When at work, only work things should be pursued or thought about.
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 pay should be fair to both employee and the firm.
- Employees receive fair payment for services, not what the company can get away with.
8.Centralization;
- The degree of concentration of authority should be based upon optimum utilization of all faculties of the personnel.
- Depending on size of company and quality of managers.
- Consolidation of management functions.
- Decisions are made from the top.
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. There should be an unbroken chain of authority extending from top executive to lowest level worker.
- Formal chain of command running from top to bottom of the organization, like military
10.Order.
- All materials and personnel have a prescribed place, and they must remain there. The right man should be in the right place. A place for everything &everything in its own place, the right man in the right place.
- All materials and personnel have a prescribed place, and they must remain there.
11.Equity.
- This means that employees should be treated with justice and kindness. Managers should be fair and impartial in their dealings with subordinates Treat every employee with equity &justice.
- A combination of justice and kindliness towards employees.
- Equality of treatment (but not necessarily identical treatment)
- Employees cannot work efficiently unless job security is assured of them.
- Employees need time to settle into their jobs,
- This may be lengthy times.
- Limited turnover of personnel.
- Lifetime employment for good workers.
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.
Thinking out a plan and do what it takes to make it happen within levels of authority and responsibility all staff should be encouraged to show initiative i.e. new ways of doing things.
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
Harmony is a great strength to organizations
Team work should be encouraged.
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Topic Two: MAX WEBER
- ''Bureau' (French, borrowed into German) is a desk, or by extension an office (as in 'I will be at the office tomorrow'; 'I work
at the Bureau of Statistics'). - 'Bureaucracy' is rule conducted from a desk or office, i.e. by the preparation and dispatch of written documents - or, these days, their electronic equivalent.
- Max Weber, a sociologist who began to study the new forms of organization being developed for managing large numbers of people in far-flung and complex activities.
- Germany had been an early leader in developing a civil service. At the same time, German industry was beginning to adopt the organizational methods developed in the United States.
- Surveying this scene, Weber attempted to isolate the elements common to all of these new organizations
- Weber concluded that all these new large-scale organizations were similar.
- Each was a bureaucracy.
- Today many of us regard bureaucracy as a dirty word, suggesting red tape, inefficiency, and officiousness
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 labor: 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
FEATURES DEVELOPED TO MAKE BUREAUCRACIES RATIONAL
(1) functional specialization
(2) clear lines of hierarchical authority,
(3) expert training of managers,
(4) decision making based on rules and tactics developed to guarantee consistent and effective pursuit of organizational goals.
RATIONAL BUREAUCRACY
Weber noted additional features of rational bureaucracies that are simple extensions of the four just outlined,
1. To ensure expert management, appointment and promotion are based on merit rather than favoritism, and those appointed treat their positions as full-time, primary careers.
2. To ensure order in decision making, business is conducted primarily through written rules records, and communications
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Topic Two: Summary
CONCLUSION & NOTE ON SCIENTIFIC MANAGEMENT
There is a best machine for each job, so there is a best working method by which people should undertake their jobs
All job processes should be analysed into discrete tasks & via this management find the ‘one best’ way to perform each task
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Topic Two: Further Reading
Reference Material
1. Barton E. et al (1980) On Being InCharge. Geneva: World Health Organization.
2. Basavanthappa, B. P. (2000). Nursing Administration. New Delhi, Jaypee Brothers Medical Publishers Ltd.
3. Bennet, R. (2004) Management. Essex: Pearson Education Ltd.
4. Cole, G. A. (1996) Management - Theory and Practice. London: Martins the Printers.
5. Tappen, R. M. (2001) Nursing Leadership and Management 4th F.A Davis, Philadelphia.
Further Reading Material
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Topic 3: 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.
Definitions of Motivation
- “Motivation takes place when people expect that a course of action is likely to lead to the attainment of a goal - a valued reward that satisfies their particular needs”. (Armstrong:1997).
- “The willingness to exert high levels of effort toward organisational goals, conditioned by the effort’s ability to satisfy some individual needs”. (Robbins:1998).
Concept of Motivation
- The underlying concept of motivation is some driving force within individuals by which they attempt to achieve some goal in order to fulfil some need or expectation.
- Peoples behaviour is determined by what motivates them. Their performance is a product of both ability level and motivation.
- Performance = function (ability X motivation)
Types of Motivation Theories
- Content Theories
- Process Theories
CONTENT THEORIES
- These theories attempt to explain those specific things which actually motivate the individual at work.
- These theories are concerned with identifying peoples needs and their relative strengths, and the goals they pursue in order to satisfy these needs.
- Content theories place emphasis on what motivates human behavior i.e. the wants and needs that people are trying to satisfy
Content Models
- The Hierarchy of Needs Theory (Maslow:1943).
- The ERG Theory (Alderfer:1972).
- The Acquired Needs Theory/Achievement Motivation Theory(McClelland:1961).
- The Dual-Factor Theory (Herzberg:1968
PROCESS THEORIES
- Process theories- These seek to explain specific actions focusing on the thought process that people experience prior to behaving in a particular manner e.g H. Vroom
Process Models
- Theory X, Theory Y (McGregor:1960)
- Expectancy Theory (Vroom:1964 and Porter & Lawler:1968)
- Equity Theory (Adams:1965)
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Topic 3: 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)
- Individuals cannot be treated in isolation, but must be members of a group
- The need to belong to a group and have status within it is more important than monetary incentives or good physical working conditions
- Informal (or unofficial) groups at work exercise strong influence over the behavior of workers
- 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.
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Topic 3: Maslow Hierarchy of Needs
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 the adjacent diagram- Basic proposition is that people are wanting beings, they always want more, and what they want depends on what they already have.
- Hierarchy ranges through 5 levels and is displayed in the form of a pyramid implying a thinning out of needs as people progress up the hierarchy.
- Ascending order implies that it is the next unachieved level that acts as the motivator.
Maslow’s Hierarchy of needs
- 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.
- 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.
- Social needs- Social needs include the need for love, affection, care, belongingness, and friendship.
- 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).
- 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
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Topic 3: Herzberg’s Dual-Factor Theory
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Herzberg’s original study consisted of interviews with 203 accountants and engineers. - The object of the research being to design jobs that provided job satisfaction, thereby encouraging higher levels of performance.
- This process developed into job enrichment.
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/Growth Factors (satisfiers)
- These factors, if present, serve to motivate the individual to superior effort and performance.
- These factors are related to the job content of the work itself.
- The strength of these factors will affect feelings of satisfaction or no satisfaction, but not dissatisfaction.
They include;
- Achievement for performing a task
- Recognition and praise
- Work itself
- Responsibility for one’s work
- Advancement: through promotion
Hygiene factors/Maintenance Factors (disatisfiers)
- These are the factors, which if absent, cause dissatisfaction.
- They are related to the job context and concerned with the job environment.
- They serve to prevent dissatisfaction.
- They act as a ‘platform’ upon with the satisfaction factors can be built.
- 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
They include;
- Company policy and administration
- Supervision – the technical aspects
- Salary
- Interpersonal relationships – supervision
- Working conditions
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Topic 3: McGregor’s Theory X, Theory Y
McGregor put forward two suppositions about human nature and behaviour at work. - He argues that the style of management adopted is a function of the managers attitudes towards people and assumptions about human nature and behaviour.
- 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 (McGregor)
- Theory X represents the assumptions on which traditional organisations are based, and was widely accepted and practised before the development of the human relations approach.
- The central principle is direction and control through a centralised system of organisation and the exercise of authority
Theory X assumptions
- Human beings are lazy, dislike work and avoid it as far as possible
- Since human beings dislike work they must be coerced, controlled or threatened with punishment to achieve goals
- Human beings will avoid responsibility, and want to be directed whenever possible
- Human beings place security above all other factors associated with work and will display little ambition
THEORY Y (McGregor)
- Theory Y represents the assumptions consistent with current research knowledge.
- The central principle is the integration of the individual and organisation goals.
- It is recognised as the best way to elicit co-operation from workers
Theory Y assumptions
- For most people work is as natural as play or rest.
- People will exercise self-direction and self-control in the service of objectives to which they are committed.
- Commitment to objectives is a function of rewards associated with their achievement.
- Given the right conditions the average worker can learn to accept and to seek responsibility.
- The capacity for creativity in solving organisational problems is distributed.
- The intellectual potential of the average person is only partially utilised.
- Motivation occurs at all of Maslow’s levels
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Topic 3: Expectancy Theory
Vroom’s expectancy theory(1964) maintains that employees behave in ways they expect will produce positive outcomes.- The model suggest that the persons level of effort or force (motivation) is not simply a function of rewards.
- It is a measure of the strength of a particular outcome has for the individual
Vrooms expectancy theory is:
F = Sum (E * V) where,
F = Force - the motivation or the force used to achieve it.
E = Expectancy - the possibility of achieving a certain outcome through certain actions.
V = Valency - the preference an individual has for a particular outcome, the worth placed on a particular result.
- Porter and Lawler (1968) develop Vroom’s expectancy theory by suggesting that there are two factors determining the effort people put into their jobs.
- The value of the reward to individuals in so far as they satisfy their need for security, social esteem, autonomy and self-actualisation.
- The probability that reward depends on effort, as perceived by individuals - in other words their expectations of the relationship between effort and reward.
- Thus the greater the value of a set of rewards and the higher the probability that receiving each of these rewards depends upon effort, the greater the effort that will be made in a given situation.
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Topic 3: Adams Equity Theory
Equity theory focuses on peoples feelings of how fairly they feel they have been treated in comparison with the treatment received by others.- It is based on exchange theory.
- People expect certain outcomes in exchange for certain inputs or contributions.
- Adams states that people will be better motivated if they are treated equitably.
- The exchange variables are:
- • Inputs - what the individual brings to their employment in terms of effort, experience and skills.
- • Outcomes - the range of factors the employee receives in return for their inputs i.e. all the financial and non-financial rewards.
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Topic 3: Alderfer’s ERG Theory
This is a modified need hierarchy model and it condenses Maslow's five levels of need into only three levels based on the core needs of:- • Existence
- • Relatedness
- • Growth
- Existence needs are concerned with sustaining human existence and survival and cover physiological and safety needs of a material nature.
- Relatedness needs are concerned with relationships to the social environment and cover love or belonging, affiliation and meaningful interpersonal relations of a safety or esteem nature.
- Growth needs are concerned with the development of potential and cover self-esteem and self-actualisation.
- More than one need can be activated at the same time - a frustration-regression process e.g. if an individual is continually
- frustrated in an attempt to satisfy growth needs, relatedness needs may reassume most importance.
- ERG theory states that an individual is motivated to satisfy one or more basic sets of needs.
- If a persons needs at a particular level are blocked then attention should be focused on the satisfaction of needs at the other levels.
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Topic 3: LYNDALL URWICK’S 10 PRINCIPLES OF ORGANISATION
- Objective- every org or part must have an expression of purpose, otherwise it is meaningless and therefore redundant.
- Specialization-activities confined to a single function.
- Co-ordination- facilitate co-ordination: unity of effort
- Authority-a supreme authority must rest somewhere, a clear line of authority to every individual in a group.
- Responsibility-of superior for acts of subordinates is absolute
- Definition-content of @position, duties involved, authority, responsibilities and relationship with others must be clearly defined in writing and published to all concerned!!
- Correspondence- in every position, responsibility and authority should correspond.
- Span of control-no persons should supervise more than 5 or at most 6 direct subordinates whose work interlocks!!
- Balance- various units of org’n must be kept in balance.
- Continuity-reorganization is a continuous process, in every undertaking specific provision should be made.
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Topic 3: Further Reading
Reference Material
1. Barton E. et al (1980) On Being InCharge. Geneva: World Health Organization.
2. Basavanthappa, B. P. (2000). Nursing Administration. New Delhi, Jaypee Brothers Medical Publishers Ltd.
3. Bennet, R. (2004) Management. Essex: Pearson Education Ltd.
4. Cole, G. A. (1996) Management - Theory and Practice. London: Martins the Printers.
5. Tappen, R. M. (2001) Nursing Leadership and Management 4th F.A Davis, Philadelphia.
Further Reading Material
Click here to watch
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Topic 4: 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
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Topic 4: 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
- 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.
- 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
- Autocratic leaders – have little trust in employees and exclude them in decision making.
- Benevolent leaders – Are kind to employees but still do not involve them in decision making.
- Consultative leaders – Seek employee’s advice about decisions.
- 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
- Impoverished – Low concern for both production and people.
- Authority compliance – high concern for production and low concern for people.
- Middle of the road – moderate concern for production and people.
- Country club – High concern for people and low concern for production.
- Team – High concern for both production and people.
- 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.
- 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
- The quantum leadership: A leadership style based on the concept of chaos theory
- Shared leadership, an organizational structure in which several individuals share the responsibility for achieving the organization’s goals.
- Servant leadership; the premise that leadership originates from a desire to serve; a leader emerges when others’ needs take priority.
- 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.
- The traditional manager, concerned with the day to day operations was termed as Transactional Leader.
- 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 Leader |
|---|---|
| Focuses on management tasks. | Identifies common values. |
| Is caretaker (takes care of tasks | Is committed (extramile) |
| 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 |
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Topic 4: 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
- Quantity of work output
- Quality of output
- Time use
- Conservation of resources
- Assistance to co-workers
- 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.
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Topic 4: 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
- Quantity of work output
- Quality of output
- Time use
- Conservation of resources
- Assistance to co-workers
- 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.
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Topic 4: How Leaders Influence Others
Leadership, the foundation of the management function of leading, and a critical element of the health systems management building blocks is the process of influencing others toward the achievement of health care organizational goals (better health outcomes).- Power is the capacity to affect the behavior of others.
- Effective leaders develop and use power, or the ability to influence others.
- Legitimate, reward, and coercive are all forms of power used by managers to change employee behavior.
Legitimate power
- Legitimate power stems from a formal management position in an organization and the authority granted to it. Subordinates accept this as a legitimate source of power and comply with it.
Reward power
- Reward power stems from the authority to reward others. Managers can give formal rewards, such as pay increases or promotions, and may also use praise, attention, and recognition to influence behavior.
Coercive power
- Coercive power is the opposite of reward power and stems from the authority to punish or to recommend punishment. Managers have coercive power when they have the right to fire or demote employees, criticize them, withhold pay increases, give reprimands, make negative entries in employee files, and so on.
Expert power
- Expert power results from a leader's special knowledge or skills regarding the tasks performed by followers. When a leader is a true expert, subordinates tend to go along quickly with his or her recommendations.
Referent power
Referent power results from leadership characteristics that command identification, respect, and admiration from subordinates who then desire to emulate the leader. When workers admire a supervisor because of the way he or she deals with them, the influence is based on referent power. Referent power depends on a leader's personal characteristics rather than on his or her formal title or position, and is most visible in the area of charismatic leadership
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Topic 4: Functions of Management
Management has been described as a social process involving responsibility for economical and effective planning and regulation of operation of an enterprise in the fulfilment of given purposes- 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 Where
- ✔ P – planning
- ✔O – organizing
- ✔S – staffing
- ✔D – directing
- ✔Co – coordinating
- ✔R – reporting
- ✔B – budgeting
- It bridges the gap from where we are and we want to be. A plan is future course of action.
- It is an exercise in problem solving and decision making .planning is determination of course of action to achieve desired goals .
- Planning is important to ensure proper utilization of human and non human resources
- According to Henry Fayol to organize a business is to provide it with everything useful or its functioning i.e. raw materials tools capital and personnel
- Organization involves
- identification of activities
- Classification of grouping of activities
- Assignment of duties
- Delegation of duties and creation of responsibilities
- Coordinating authority and responsibility relationship
- Manpower planning
- Recruitment ,selection and placement
- Training and development
- Performance appraisal
- Promotion and transfer
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Topic 4: Functions of Management
Directing has the following elements
- Supervision - implies overseeing the work of subordinates by their superiors .it is the act of watching and directing work and workers
- Motivating- means inspiring ,stimulating or encouraging the subordinates with zeal to work .positive ,negative ,monetary ,non monetary incentives may be used
Leadership -is a process by which manager guides and influences the work of the subordinates in desired direction
Communication - is the process of passing information ,experience opinion from one person to another .it is a bridge of understanding
It implies measurement of accomplishment against the standards and correction of deviation if any to ensure achievement of organizational goal. The purpose is to ensure that everything occurs in conformity with the standards. Controlling is the measurement and correction of performance activities of subordinates in order to make sure that the goals and objectives are achieved. Controlling has the following steps
- Establishment of standard performance
- Measurement of actual performance
- Comparison of actual performance with standards
- Corrective action
- Coordinating through planning
- Coordinating through organizing
- Coordinating through staffing
- Coordinating through directing
- Coordinating through controlling
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Topic 4: Further Reading
Reference Material
1. Barton E. et al (1980) On Being InCharge. Geneva: World Health Organization.
2. Basavanthappa, B. P. (2000). Nursing Administration. New Delhi, Jaypee Brothers Medical Publishers Ltd.
3. Bennet, R. (2004) Management. Essex: Pearson Education Ltd.
4. Cole, G. A. (1996) Management - Theory and Practice. London: Martins the Printers.
5. Tappen, R. M. (2001) Nursing Leadership and Management 4th F.A Davis, Philadelphia.
Further Reading Material
https://blog.smarp.com/what-are-the-top-leadership-skills-that-make-a-great-leader
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Topic 5: Planning
1. PLANNING
• OBJECTIVES
By the end of this lecture, you should be able to
- Explain planning and planning process.
- Describe the purposes of planning.
- Describe strategic planning and its importance in organizations
In our day to day living, we are involved in planning activities and programs. What plans did you make today before commencing work?
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Topic 5: Planning
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
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
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.
Are plans that define specific action or non-action. Rules describe situations that allow only one choice of action.
TYPES OF PLANNING
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
- 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
Planning Process- • - Assessment
- • - Setting goals
- • - Implementation
- • - Evaluation
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Topic 5: 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
- 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
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
- 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/tactical 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.
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Topic 5: Purposes of Planning (Significance)
- Contributes to a purposeful organization.
- Reduces costs. Efforts will be better directed toward desired results
- Provides for integration and coordination of activities.
- Haphazard approaches can be minimized and duplications avoided.
- Provides for consistency of action which is necessary so that both internal and external people can anticipate the organizations
- Plans tend to be slow when joint efforts of several individuals are needed.
- There is friction as people bring together their ideas to make a decision.
- Differences in perception of objectives.
- Communication problems.
- Persuasive ability of the impressive individual.
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Topic 5: Further Reading
Reference Material
1. Barton E. et al (1980) On Being InCharge. Geneva: World Health Organization.
2. Basavanthappa, B. P. (2000). Nursing Administration. New Delhi, Jaypee Brothers Medical Publishers Ltd.
3. Bennet, R. (2004) Management. Essex: Pearson Education Ltd.
4. Cole, G. A. (1996) Management - Theory and Practice. London: Martins the Printers.
5. Tappen, R. M. (2001) Nursing Leadership and Management 4th F.A Davis, Philadelphia.
Further Reading Material
https://www.toppr.com/guides/business-studies/planning/planning-process/
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Topic 1: Definition of Organizing
- It is the process of grouping the necessary responsibilities and activities into workable units, determining the lines of authority, communication, developing patterns of coordinating and giving feedback.
- By organizing we are attempting to answer the question:
To answer the question the manager must define, group and assign duties. There are certain basic issues to consider. These include:
- Setting up structure – structured aspects of the organization must be sure up which indicate the activities to be performed and lines of responsibility and authority.
- Developing procedures and policies.
- Determining organizational requirements and deciding how duties will be performed
1. Formal – Those organizations whose membership and activities are governed by certain specified rules and procedures which determine the degree of authority and behavior of each participating member e.g government ministries, non-profit making organization, business companies.
When designing the departmental organizational structure, the manager should plan for an ideal organization
2. Informal – These are social groups or “cliques” which develop within formal organizations in order to fulfill individual social needs e.g according to social interests like welfare society.
No formal organization will operate efficiently without an accompanying informal organization
Types of formal organization structures
1. Formal
Line Organizations
- It is the oldest and simplest type of formal organization structure.
- Pure line structure is straight forward and has direct chain of command pattern that emphasizes superior subordinate relationships
Functional Structures
- Employees are grouped in departments by specialty with similar tasks being performed by the same group. Similar departments reporting to the same manager are grouped together
- Service integrated structure/product line
- All functions need to produce a product or services are grouped together, in self contained units. units are based on product, service, geographical location, or type of customer.
Hybrid Structure
- As organization grows it typically organizes both self-contained units and functional units resulting into a hybrid structure
Matrix
- Integrates both product and functional structures into one overlapping structure. Different managers are responsible for function and product
2. Informal
Organizational structure refers to how work is organized, where decisions are made and the authority and responsibility of workers. Structure is a map of communication and decision making paths. Organization structure is an important tool through which managers can increase organization efficiency
- It depicts the expression of responsibility relationships among people and jobs. The organizational structure is graphically portrayed by the organizational chart. This is a pattern to show how parts are put together to accomplish a particular purpose.
- Individual positions are shown as rectangular boxes each representing a job. The chart shows:
- Areas of responsibility.
- To whom and for whom each person is accountable.
- Major channels of formal communication.
- Interdepartmental relationships.
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Topic 1: Elements and Purposes of an Organisational Structure
Elements of an Organisational Structure
In drawing up an organizational chart determine the purpose of the plan considering administrative control, Planning and policy making and relationships with other departments and agencies.
Review departmental functions and determine what activities are needed in order to carry out the functions. Avoid duplication of activities and include all-important ones.
Classify the functions and activities and draw up job specifications and descriptions. Find out where the responsibility for decision making should be placed and allow for delegation.
Review relationship with other departments in the hospital or organization.
Purposes of Organizational Structure
The following are the main purposes of organizational structure are:
- To have the right people taking right decision at the right time.
- To establish who is accountable for what and who reports to whom.
- To facilitate easy flow of information -channels of communication.
- To depict interdepartmental relationships.
- To integrate and coordinate activities.
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Topic 1: Health Care Organisations
The health care organizations make up the health care system which provides total services offered by all health disciplines. Today many types of health care organizations exist. These differ in terms of: Ownership, Role or services offered, activity and size
TYPES OF HEALTH CARE ORGANIZATIONS
Hospitals: These are institutions whose purpose is to serve the whole community, sick or well. Hospitals play a significant role and the services provided include:- preventive, curative, rehabilitative, promotive, education and research.
- Hospitals are classified into:-
- - Acute care: This is a facility in which average length of stay is less than 30 days.
- - Chronic or long term hospitals: These are designated to care for patients whose average length of stay is longer than 30 days.
Ambulatory-based organization
This is the second type of health care organization. Many health services are provided on ambulatory basis. It is the care mainly given by private physicians or in hospitals as out-patient care. The goal is to focus on out of hospital preventive care and illness follow up care. It also reduces the cost of expensive acute hospital care.
Health Managed Organization (HMO)
The other type of health care organizations are the HMO's. This is a newer concept in our country which is catching up quickly. This is where an organization gets people to enroll and pay a fixed periodic fee to the organization which determines the amount of services used. The HMO company offers hospital and outpatient services. Examples of these include insurance companies who cover medical expenses.
Home Health Care Organization
The last type of health care organizations is home-based. The services in this case are offered at home. The care is given by professional with expert skills in assessing patients self-care abilities and identifying resources to overcome problems and meet patients needs. These include patients' requiring palliative care, chronically ill, disabled or elderly.
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Topic 1: The Kenya National Health System
The health system in Kenya include the
- National system and the County Health System,
- National and county governments institutions engaged in health service delivery,
- Research for health, health financing institution,
- Health regulations,
- All health workers both in the public and private sectors,traditional,
- Complementary and alternative health care providers,and all institutions
- Professional societies ( like the Kenya Medical Association) who are involved in ensuring the promotion, prevention, control and treatment of illness, care and or rehabilitation of health.
Structure of the health care system in Kenya
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Topic 1: Public sector health service Delivery
The health sector comprises the public system, with major players including the MOH, Parastatal organization and the
private sector, which includes private for –profit, non-governmental organization (NGOs) and faith-based organization(FBO) facilities.
Health services are provided through a network of health facilities countrywide, with the public sector system accounting for about 50 percent of these facilities. The public sector health service delivery is organized on a six level tier system as outlined below.
Public Sector Health Service Delivery System
This is the foundation of the health services delivery priorities. Through engagement
with health workers, communities define their own priorities and thereby
develop ownership and commitment to health services. Health behavior change
activities through public health information sharing and skills enhancement. Dispensaries and clinics primarily handle promotive and preventive care. They
are the health system’s first line of contact with patients, but in some areas,
health centers or even sub-county hospitals are effectively the first points of
contact. They are staffed by enrolled nurses, public health technicians. Services - Curative, rehabilitative, preventive, and promotive services,
health census of the population in catchment area, record-keeping and reporting
activities, coordinating information flow from facilities in catchment area. The network of health centers
provides many of the ambulatory health services. They generally offer
preventive and curative services, mostly adapted to local needs. Health centers
are staffed with midwives, nurses, clinical officers, and occasionally by doctors.
They provide a wider range of services, such as basic curative and preventive services
for adults and children, as well as reproductive health services. They also
provide minor surgical services such as incision and drainage. They augment
their services coverage with outreach service, and refer severe and complicated
conditions to the appropriate level, such as the county hospital. 4: Primary hospital (Sub-county
hospital) Sub-county hospitals provide the
first referral level. They form an integral part of the county health systems.
They provide: 1. Curative and rehabilitative
services 2. Clinical supportive and
supervision, health behaviour change, referral services, logistical support to lower
facilities. 3. Coordination of collection and dissemination
of health information flow. Facilities provide referral services
at the county level. They include: 1. Provide specialized care, involving
skills and competence not available at lower level hospitals. 2. Oversee the implementation of
health policy at the county level, maintain quality standards, and coordinate
and control all county health activities. 3. Provide training services and
internship for health workers, referral for curative and specialized care
services, management and coordination support to lower level facilities. 6: Tertiary hospital (National
referral) National referral hospitals: There are
two referral hospitals in the country: Kenyatta national hospital and Moi
Referral and Teaching Hospital in Eldoret. The equivalent private referral
hospitals are Nairobi Hospital and Aga Khan University hospital Specialized Hospitals (Psychiatric
and Rehabilitation Hospitals): These facilities render specialist psychiatric
and rehabilitation hospital services.
Level
Activities
1: Community
2: Dispensary Clinic
3: Health Centre, maternity home, nursing home
5: Secondary hospital (County referral hospital)
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Topic 1: Linkages and responsibilities in the health care system
The constitution of Kenya (2010) assigns the larger potion of delivery of health services to the counties with the exception being the national referral services. Counties bear overall responsibilities for planning, financing, coordinating delivery and monitoring of health services towards the fulfillment or right to ‘the highest attainable standard of health’.
Responsibilities for health services are exercised at three levels
- The Ministry of Health ( National Directorate for health)
- County Health Management Teams(CHMT)
- County Health Facility Management Teams
The Ministry of Health
Under the devolved system of government, the National Government through the Ministry of Health is responsible for
provision of overall direction through
- Policy formulation,
- National strategic planning,
- Priority setting,
- Budgeting and resource mobilization,
- Regulating,
- Setting standards
- Formulating guidelines,
- Monitoring and evaluation,
- and provision of technical backup to the county level
Key mandates of the MOH:
- Development of national policy.
- Provision of technical support at all levels.
- Monitoring quality and standards in health services provision;
- Provision of guidelines on tariffs for health services;
- Conducting studies required for administrative or management purposes
- The chief Technical Officer of the Ministry of Health is the Director of Medical Services (DMS).The role of the MOH is to provide strategic direction through national health planning, development of services and quality standards, health financing, HRH planning, monitoring and evaluation.
- These national functions are distributed amongst six directorates namely
- Administrative Services;
- Health Standards ,Quality Assurance and Regulations;
- Curative and Rehabilitative Services;
- Policy Planning and Health Care Financing;
- Preventive and Promotive Services;
- National Quality Control Laboratory.
- The role of the National Directorates for Health is to provide overall direction- policy formulation, national strategic planning, priority setting, budgeting and resource mobilization, regulating, setting standards, formulating guidelines monitoring and evaluation and provision of technical backup to the county level.
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Topic 1: County Government
- At county level ,the Kenya Health Policy 2012-2030 proposes the formation of county health departments whose role will be to create and provide an enabling institutional and management structure responsible for ‘coordinating and managing the delivery of health care
- mandates and services at the county level’. In addition to the county health departments, the policy calls for the formation of county health management teams. These will provide ‘professional and technical management structure’’ in each county to coordinate the delivery of health services through health facilities available in each county.
- The role of the county government is to provide strategic and operational leadership and stewardship for overall health management in the county, including provision of health services, resource mobilization, creation of linkages with national level referral health services, monitoring and evaluation, coordination and collaboration with state and non-state and non-state stakeholders at the county level.
- Within each county, the Health Facility Management Teams are charged with the responsibility of providing health services, developing and implementing facility health plans, coordinating and collaborating with stakeholders through county Health Stakeholder Forums, supervising,continuosly monitoring and evaluating health services provision and implementing health policies
SERVICES PROVIDED IN VARIOUS LEVELS OF HEALTH FACILITIES
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Topic 1: County Government [Cont'd]
Job descriptions
- Job descriptions state the principal duties and responsibilities of the various jobs and the scope of authority. They may be based on information obtained from employees who hold positions and supervisors, as they perceive the jobs.
- Generally they describe function elements of a position in relation to duties and responsibilities.
Job Specifications
- This refers to human qualities or personal specifications which are necessary to perform a job adequately.
- It includes the details of the knowledge, skills and abilities and behavior required to perform a job.
- Most organization manuals combine jobs specifications as part of each job description.
Tools Used By Manager
1. Organizational manuals
- These provide in comprehensive written form, the decisions which have been made concerning the organizational structure.
- The manual should clearly specify: The responsibilities of each supervisory position and how they are related to other positions.
- They should state the objectives of the organization and each department.
- Manuals should have major policies of the organization particularly relating to personnel e.g Human resource issues, disciplinary policy, terms and conditions of service, training and development, leave.
Policy
- A policy is a guide which clearly spells out responsibilities and prescribes actions to be taken under a given set of circumstances.
- It provides general direction for decision making so that action can be taken within the framework of organizations beliefs and principles.
Procedure
- This prescribes steps that should be followed in order to conform or carry out a policy.
Standards
- These coordinate and articulate the operations of organizations.
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Topic 1: Organisational Communication
In your communication course, you discussed the principles and importance of communication.
- There is no organization that can exist without communication. Communication is referred to as the lifeblood of an organization.
- Communication is the need of creating common understanding. It is therefore the process of transmitting ideas and information from one person (sender) to another or group of people (receivers).
- Organizational communication is the exchange of information within the organization. While employees’ communications are the responsibilities of the managers, the managers work may be supplemented through already established means of communication within an organization.
In any organization, there exists both formal and informal communication
- The formal communication system mainly used is based on the chain of command from the top of the organization to the bottom. This is used for all official messages including directives, procedures, policies, job instructions etc.
- The informal communication – System is usually oral and not crucial to the functioning of the organization. It generates from informal groupings e.g associations or welfare. In most cases, messages are transmitted through “grapevine” or rumors and sometimes the communication is distorted or groundless. Since it can cause fear and anxiety among staff, the manager should be aware of them to reinforce the formal system.
- The role of the manager is to use positive informal communication to the maximum for the benefit of organization. He/she must discourage any which may not work in the interest of organization success. There is need to establish proper formal channels and use them for all information that employees need to know
Flow of Communication in an Organization
The Manager is responsible for passing information through vertical channels of communication which includes both downward and upward flow of communication.
1. Vertical Flow: The Manager is responsible for passing information through vertical channels of communication which includes both downward and upward flow of communication
a) Downward Communication:
Most information within organizations move from top downward, that is, top management to employees. This may be through face to face, written materials e.g memos or circulars. The purpose is mainly to inform employees of their job responsibilities, commitment to the objectives and any other relevant information.
Some barriers to this include:
- Manager may withhold information.
- The employee may fail to understand the message.
- Employee may get information not relevant to their needs and do
- not get information they need.
b) Upward Communication:
This is the flow of information from bottom – up or subordinates to supervisor. Ideally information should pass freely up the chain of command so that management gets the feedback needed to evaluate results and initiate improvements. Barriers to upward communication may include:
- If employees feel management is not interested in their ideas, they will not offer them.
- Sometimes, bad news get blocked and is not communicated to the top management.
- Delays in relying messages
2. Horizontal Flow
This is the flow of information where managers communicate with each other at a professional level or employees of equal rank exchange information including opinions or news.
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Topic One: Further Reading
Reference Material
1. Barton E. et al (1980) On Being InCharge. Geneva: World Health Organization.
2. Basavanthappa, B. P. (2000). Nursing Administration. New Delhi, Jaypee Brothers Medical Publishers Ltd.
3. Bennet, R. (2004) Management. Essex: Pearson Education Ltd.
4. Cole, G. A. (1996) Management - Theory and Practice. London: Martins the Printers.
5. Tappen, R. M. (2001) Nursing Leadership and Management 4th F.A Davis, Philadelphia.
Further Reading Resources
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Topic Two: Staffing
Allocating human resources is one of the many responsibilities and a challenge to the manager.
This topic will introduce you to the managerial function of staffing
including staffing process, scheduling and factors affecting staffing
OBJECTIVES
By the end of this topic, you should be able to:
- Explain staffing process
- Describe factors affecting staffing
- Describe scheduling and different types of scheduling
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Topic Two: Definition of Staffing
This is the process of balancing the quantity of staff available with the quantity and mix of staff needed by the organization.
Objectives of Staffing
The following are the main objectives of staffing:
- To provide appropriate numbers and mix of staff to meet patient needs
- To provide continuous quality care to patients
- To periodically evaluate staffing practices in order to determine the scope of staffing problems.
- To utilize the talents and skills of each level of STAFF to their fullest
- To provide new employees with an adequate orientation period.
- To establish staff conditions of employment and adjust as needed to current practices.
- To utilize centralized or decentralized staffing as means of scheduling
- To establish a master-staffing plan for allocating personnel based on assessment of patients needs.
- To maintain records pertinent to staff data.
STAFFING PROCESS
The process of staffing involves: Recruitment, Selection, Induction and Scheduling
Let us examine the meaning of each of the above terms:
Recruitment
- This is the first part of the process and it involves filling a vacancy. It is the drafting or revision of the job specification for the vacant position, outlining the qualifications, experience, skills and the responsibilities involved.
- The vacancy is then advertised to source suitable candidates. The sources could be internal, that is, from within the organization or external.
Selection
- Selecting is the next stage which involves matching the requirements of the job with the attributes of the candidate. The process includes assessing the candidate by various means eg. Interviewing and screening. The purpose of this is to obtain information. Selection testing including achievement, aptitude, intelligence and personality may also be used. These are followed by offer of employment
Induction
- This is the process of receiving employees when they begin work, introducing them to the organization and to their colleagues and informing them of the activities, and the culture of the organization. This may be regarded as the orientation or beginning of training
Scheduling(Duty Roster)
- After induction is given, the employee is assigned the tasks to be performed. The schedules for work and time off should meet organizational goals with fairness and equality among personnel. A schedule should adhere to following:
- Policies, standards and practices of the organization on the use of professional and paraprofessional personnel (Supportive staff).
- Appropriate ratio or balance between professional and supportive staff. This is in order to deliver continuity of services nursing care.
- Approved budget. The manager should consider the financial resources within the organization.
- Consideration of vacations and consideration of allowance of adjustment in case of illness, emergencies or changes in patient care needs.
Factors Affecting Staffing
- Patient factors e.g Unpredictability of the patient census, variety of patient conditions, patient population, and care needs.
- Staff factors including, experiences and expectations of the organization, job descriptions, education level and personnel requirements.
- Health care organization factors e.g. policies and procedures, resources available and number of beds per unit
- Since each setting is unique, there is no guide that can stipulate the correct number of personnel needed to provide quality care but systems have been developed for guidance e.g.. patient classification system which is a method of grouping patients according to the amount and complexity of their nursing care requirements. In this case patients are grouped according to the nursing time, effort and ability required to provide care.