Health Service Management

for 3rd Year Environmental Health Students

Credit Hours =3

Mezgebu Yitayal (MPH)

Department of Health Management and Health Economics
School of Public Health
College of Medicine and Health Sciences
University of Gondar

October 2010
 Course Description
This Health Service Management course for undergraduate
medical and health science students is designed to prepare
competent health managers/health service providers to plan,
implement, and evaluate health service programs and
activities effectively and efficiently with special emphasis on
public health important diseases.
 Course Objectives
After completion of this course, medical and health sciences
students will able to:
 plan health service programs;
 organize tasks and resources;
 lead organizations; and
 monitor, supervise and evaluate predetermined health service
program goals.
 Learning Objectives
At the end of the course, the student will be able to:
 Understand the meaning and scope of management
 Know contemporary organizational structures, functions and
behaviors.
 Identify concepts and principles of health service
management
 Discuss the socio-economic impact of public health problems
(HIV/AIDS, TB and Malaria)
 Make appraisal of the health policy, strategy and structure of
the Ethiopia health system.
 Cont….
 Acquire skill in planning, implementing and evaluating health
programs.
 Perform situational analysis
 Prioritize public health problems (HIV/AIDS, TB, Malaria)
 Identify potential obstacles and limitations
 Design strategies
 Effectively manage health institutions
 Collaborate with communities and other stakeholders
 Understand the principles of human resource management
 Cont….
 Identify possibilities of mainstreaming of HIV/AIDS
 Identify equity and equality issues
 Make rational use of the available scarce resource
 Identify principles of monitoring and evaluation
 Discuss National Health Management Information System
 Design Health service programs/projects
 Course Pre-requisite
 No course pre-requisite
 Course Logistics
 Location: Class room ___, Science Amba
 Period: __________________
 Semester: I Year: III_
 Project work: University of Gondar Hospital, North Gondar
Health Department, Gondar Zuria District Health Office,
Health Centers
 Teaching-Learning Methods
 Lectures
 Discussions
 Guest speakers
 Case study
 Teaching-Learning Materials
 Printed materials (Textbooks, Handouts)
 Non-projected materials ( writing board)
 Projected materials (LCD, Overhead projector)
 Course Assignments
 Project work on program evaluation
 Assessment Methods
 Drills, quizzes and written exercises
 Case studies
 Project work
 Objective written examinations
 Observation and checklist
 Attendance Criteria
 Because this course will involve numerous discussions and
class activities, students are expected to attend all classes.
 Absence from class will lead to disqualification from sitting
for examination.
Course Content
Cont…
Cont…
Cont...
Cont…
Cont…
Cont…
 Some References
1. Lecture Notes on Health Service Management. Chalie Jirra,
Amsalu Feleke And Getnet Mitkie.
2. Essentials of Health Care Management. Stephen M. Shorell,
Arnold D. Kaluziny, 1997, USA.
3. On Being in Charge, 1992, WHO.
4. Management, Stoner
 Organization and Management
Organization
 Two or more people who work together in a structured way
to achieve a specific goal or set of goals.
 formal and informal
 In both people are kept together
 believing there is a benefit working together to achieve a
common goal

What does goal mean ?

Goals
The purpose that organization strives to achieve.
Goal is the fundamental element of an organization. Why?
 Goal is the reason to exist and
 An organization cannot exist without goal
 More than one goal

What do all organizations need to achieve goals?

To achieve goals all organizations should
 have a method and
 have to acquire and
 allocate resources

Thus the need for management.

What is management?
Management
 Is a process of reaching organizational goals by working with
and through people and other organizational resources
 Is a process of utilizing efficiently the available resource to
achieve organizational goals.
 Is the practice of consciously and continually shaping
organizations.
 Is the process of planning, organizing, staffing, leading, and
controlling the work of organization members and of using all
available organizational resources to reach stated
organizational goals.
 Cont…
The definition of management is based on two principles:
 Commitment to achievement
 The importance of people and other resources

This means that people are the most important resource for
getting things done
 Cont…

 The process of planning, organizing, staffing, leading, and

controlling the work of organization members and of using
all available organizational resources to reach stated
organizational goals.
In formal or informal organizations managers are BASIC.
 Who are the managers?
 Why are they basic?
 Cont…

 In all organizations managers are essential. Because they are:

 People responsible for directing the effort’s aimed at
helping organizations achieve their goals
 People responsible for helping organization members set
and reach goals.
 Management and Administration

Administration
 Implementing policy decisions
 Regulating the day-to-day activity (office)

Three views regarding management and administration:

 Management and Administration are the same:
administration is used for higher executives functions for
government circles while the term management is used for
the same functions in the business world.

29
 Cont…
 Administration is above management: administrative is
determinative while management is executive function
 Administration is part of management: Management is the
general term used for the total process of executive control
while administration is concerned with the installation and
following of procedures

30
 Why do we study organizations and management?

We study organizations and management because

1. Living in the Present, Building the Future and Remembering
the Past :

 Living in the Present

 organizations has a role on the standard of living
 We rely on organizations daily for food, clothing, medical
care, etc.
 Building the Future:
 Organizations work or moving to the desirable future;
 new treatment for diseases, new practices, new products,
new management, etc
 Positive/Negative impact
 Cont…

Remembering the Past :

 Connections to the past history.
 Patterns of human relationship
 People define themselves in terms of the organization they
have been a part of.
 Keeping record and value own history and keeping traditions
alive.

How would history be important?

Give some examples of organizations and their history.
 Cont…
2. Management as a specialty in time and human relationships
 Management deals with time:
 Time Management is to create a desirable future.
 Management is either practiced or is a reflection of a
particular historical era.
 Management produces effects that emerge over time.
 Cont…

 Management as a specialty in human relationships

 Management deals with human relationships
 Managers act in relationships : two-way streets.

Influence on both sides

 Managers act in relationships that have spillover

effects for other people. Better or worse

 Managers juggle multiple simultaneous relationships.
 Cont…

 Management as a specialty in time and human

relationships
 Management deals with time and human relationships

Organizations, managers and other individuals deals with time:

 think about future human relationships
 new relationship and modify existing ones.
 Management Thoughts/Schools
 They are theoretical frameworks for the study of management.

 Each of the schools of management thought are based on

somewhat different assumptions about human beings and the
organizations for which they work.

 Disagreement exists as to the exact number of management

schools.

 Different writers have identified as few as three and as many as

twelve.
 Cont…
The five major schools of management thought are:
 The classical school,
 The behavioral school,
 The quantitative or management science school,
 The systems school, and
 The contingency school.
The formal study of management is largely a twentieth-century
phenomenon, and to some degree the relatively large number of
management schools of thought reflect a lack of consensus
among management scholars about basic questions of theory
and practice.
Management Thoughts/Theories
 Importance of Management
 Management is universal and necessary function
 It is essential for all kinds of organizations. This is because
every organization requires:
 the making of decisions,
 The coordinating of activities,
 The handling of people, and
 Evaluating the performance directed toward its objectives.
Leaders
 help identify dragons nest but do not eliminate dragons by
themselves
 they design the appropriate climate, create the right tools and
enable others to act.
 create new knowledge
 Shape organizational climate and structures.
 steward that is looks after everyone's welfare
 Nurture values and learning
 Enabler
Characteristics of managers versus leaders

Manager Leader

Administers Innovates
A copy An original
Maintains Develops
Focuses on systems & structure Focuses on people
Relies on control Inspires trust
Short- range view Long-range perspective
Asks how and when Asks what and why
Eye on the bottom line Eye on the horizon
Imitates Originates
Accepts the status Challenges the status
Classic good soldier Own person
Does things right Does the right thing
 Managers and organizational performance

 Management is a major and PRICIPAL activity that is

responsible to make a difference how the organization
 is doing, affecting and affected by people.
 Thus a need for measuring Managers and organizational
performance.
Managerial performance measures:
 How efficient and effective a manager is.
 How well a manager determines and achieves organizational
objectives.
Organizational performance measures:
 How efficient & effective an organization is.
 How well it achieves objectives.
 What do efficiency and effectiveness refer to?

Efficiency:
 The ability to minimize the use of resources in achieving
organizational objectives.
 Doing things right.

Effectiveness:
 the ability to meet organizational objectives.
 the ability to determine appropriate objectives.
 Doing the right thing.

Which one is the best for managers / organizations, efficiency or

effectiveness?
 Names for Manager

Different names of manager include:

 Executive Administrator, Leader. Boss
 Principal. Chief, Supervisor
 Senior Manager
 Superintendent
 Commissioner,
 Overseer, Officer, Coach,
 President, Executive, Prime Minister, etc.
What are the Attributes common to all managers regardless of
title or level?

Attributes common to all regardless of title or level

 formally appointed to positions of authority by the
organization
 directing work efforts of others subordinates and non
subordinates
 responsible utilization of organizational resources
 accountable to superiors for work results
 Non-Managers

Are non-managers
 responsible for utilization of organizational resources?
 accountable to superiors for work results?

If both are responsible,

 What is the difference between managers and non-managers?

The non-managers are not formally appointed to positions of

authority by the organization for directing work efforts of
others.
 Functional and General Managers

Classification based on scope of activities

 Function: Refers to a group of similar activities in an
organization, such as marketing, production, finance, etc.
 Functional Manager: Responsible for one organizational
functional area/activity e.g. finance
 General Manager: Responsible for all functional activities
e.g. a company

Is it possible to have more than one general manager in an

organization?
Do both functional and general managers perform the four
management functions?
 Cont…

Yes, the difference is in the scope of activities they oversee.

 The primary differentiation between levels of managers is the
degree of authority and scope of responsibility and
organizational activity.
 Types of managers and their functions
A. Classification by management level
1. Traditional by level / hierarchy

 First-line /low level , Supervisory

mangers:

 Middle managers: Middle level

 Top/ senior managers : high level

 2. Other classification
 Policy level
 Administrative or coordinating level
 Operations level
1. First-line / low level ,Supervisory Mangers:
 Responsible for the work of operating and do not
supervise other managers
 Direct non management employees
 have authority and responsibility
 First or lowest level of managers in the

organizational hierarchy.
2. Middle Managers:
 Managers in the midrange of the organizational hierarchy
 They are responsible for other managers and sometimes for
some operating employees
 They report to more senior managers
3.Top Managers / Senior
 Mangers responsible for the overall management of the
organization
 They establish operating policies.
 Guide the organization’s interaction with its environment.
 Small in number
 What are the Attributes common to all managers
regardless of title or level ?
 formally appointed to the authority.

 directing work efforts to others.

 subordinates
 non-subordinates
 responsible for utilization of resources.

 accountable to superiors for work

results.
 Skills for Managers

Which skill is needed by all managers?

 Because the common denominator are people at all levels, an
inability to work with people, not a lack of technical skills, is
the main reason some managers fail to reach their full potential.

A manager with Human skill:

 knows weaknesses and strengths,
 knows how feelings hurt others.
 chooses either people have to be controlled versus self
discipline
 does not make wrong judgments about people without studying
contents of information.
 Managerial Skills and Management Level

Degree Of Skill Requirements

Top Mgt

Conceptual
Middle Mgt Technical Skills
Human Skill
Skill
First Line Mgt
 Management Level and Skills
Three basic types of skills for successful management

1.Technical skill:
 the ability to use:
 procedures,
 techniques
 knowledge of a specialized field
 using specialized knowledge and expertise in executing
work related techniques and procedures.
 Related to things :process or physical objects
 Cont…
2. Human skill :
 the ability to work with,
 understand
 motivate other people as individuals.
 builds cooperation among the team.
 Working with people : Attitude,
 communication.
 Cont…
3.Conceptual skill:
 Ability to see the organization as a whole
 ability how various functions of the organization
complement one another.
 The relationship of the organization to its environment.
 How changes in one part of the organization affect the rest
of the organization
 Managerial Roles

Decisional role Intrapersonal roles

 Entrepreneur  Figurehead
 Disturbance  Leader
handler  Liaison
 Resource
allocator
 Negotiator

Informational role
 Monitor
 Disseminator
 Spokesperson
1.Interpersonal Roles:
There are three interpersonal roles
A. Figurehead: - they engage in activities that are:
 symbolic in nature
 as a symbol of legal authority,
 attending ceremonies,
 signing documents, etc.
 Cont…
B. Liaison role:
 involves formal/ informal contacts beyond the vertical
chain of command (inside and outside).
 links in horizontal/vertical chain of communications

C. Leader role:
 leadership.

 accountable,

 responsible, and motivator

 2.Informational Roles
There are three informational roles:
A. Monitor:
 Constantly looking for useful information.
 filter,
 evaluate and choose to act or react to that information.

B. Disseminator:
 involves choosing to disseminate the information.
 communicating selected information

C. Spokesperson:
 represent and speak on behalf of the organization.
 communicating selected information to outsiders
3. Decision-Making Roles
There are four decision maker roles:
A. Entrepreneur/ Change agent:
 designing

 initiating changes within the organization

B. Disturbance Handler:
 They handle both internal and external
disturbances.
 They anticipate disturbances and resolve conflicts.
 Cont…
C. Resource allocator:
 managers decide who gets what based on priority

setting.

D. Negotiator: managers choose how to interact with their:

 superiors,
 peers,
 subordinates.
 negotiating with other parties
representing organizational interests
 Organizations and Environments
 Organizations are neither self sufficient nor self contained
 Dependent for input and out put
 Management performs all the functions of management in
interaction with its environment

Management through its functions (planning, implementation

and evaluation) and in interaction with the environment
converts inputs (materials, technology, information, finance,
human resource, time, etc) into outputs (products, services)
External environment:
 All elements outside an organization that are relevant to its
operation
 It includes the direct-action and the indirect.
1) Direct-action elements: directly influence an organization’s
activities.
 Individuals/groups
 Examples: stakeholders.
 Cont…
Indirect-action elements:
 Social variables: demographics, lifestyles
 Technological variables: new developments in products,
processes and materials.
 Economic variables: national income, per capita income,
employment, etc.
 Political variables: policies, laws and regulations
 Components of External Environment
Political
 Policy
 Political institution/organization
 Government officials/institutions

Economic and Business Communities

 Suppliers
 Clients
 Farmers
 Merchants
 Other stakeholders
 Cont…
Social
 Community
 Leaders
 Man in the street
 Others

Technological
 Medical equipment
 Strategies

National and International Issues

 Change in national and international situations
 Concepts of Management
Effectiveness
 It is the degree to which stated objective is being achieved.

Efficiency
 It is concerned with the balanced use of resources in relation
to outcome.

Economy of Scarce Resources

 Some and often many resources are scarce and costly thus we
have to economize.
 Cont…
Work Relations
 Work activities should be designed and structured so as to
support each other towards the achievement of objectives

Information
 Management needs information if it is to make the right
decision. Information should be:
 the right type/kind
 at the right time
 at the right place and
 in the right hands
 Principles of Management
1. Division of Labor: The more people specialize, the more
efficiently they can perform their work.
 Effort and attention are focused on special portion of the task.
 Work specialization is the best way to use human resource.
 This principle is observed by the modern assembly line.

2. Authority: Managers must give orders so that they can get

things done.
 Authority and responsibility should be closely related.
 Cont…

3. Discipline: Members in an organization need to respect the

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

4. Unity of Command: Each employee must receive instructions

from only one person.
 reporting to more than one manager, conflicts in
instructions and confusion of authority
 Cont…
5. Unity of Direction: The entire organization should be moving
toward a common objective in a common direction.

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

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

7. Remuneration: Consideration of variables such as cost of

living ,success of the organization etc. to determine rate of
payment. to both employees and employers.
 Cont…
8. Centralization: Decreasing the role of subordinates in decision
making is centralization;
 increasing their role in decentralization.
 Fayol believed that managers should retain final
responsibility,
 but should at the same time give their subordinates enough
authority to do their jobs properly.
 The problem is to find the proper degree of centralization in
each case.
 Cont…

9. Hierarchy: Lower line managers should always inform upper

level managers.

10. Order: To increase efficiency and coordination ,materials and

people should be in the right place at the right time.
 People, in particular, should be in the jobs or positions they are
most suited to.

11. Equity: All employees should be treated equally.

12. Stability of Staff: Retaining productive employees should

always be a high priority of management.
A high employee turnover rate undermines the efficient
functioning of an organization.
 Cont…

13. Initiative: Subordinates should be given the freedom to

conceive and carry out their plans, even though some mistakes
may result.
Encourage employees to do do through self direction.

14. Espirit de Corps: Promoting harmony and team spirit among

members to give the organization a sense of unity. Small
factors should help to develop the spirit .
 For example, the use of verbal communications instead of
formal, written communication whenever possible.
 Functions of Management
 Planning
 Organizing
 Directing
 Controlling

It can also be called as PIE (Planning, Implementing and

Evaluation).
 Decision making and communication are key processes in
management.
 Planning
Plan : A specific action proposed to help organization achieve
objectives.

 a statement of recommended action.

 managers need to plan in order to cope with an uncertain

environment.

Planning: is the process of establishing goals and suitable

course of action for achieving these goals.
 Cont…
Goal: Is the purpose that an organization strives
to achieve.
Importance of goals
 Provide a sense of direction
 Focus our efforts
 Guide our plans and decisions
 Help us evaluate our progress

Objectives
 The objectives are clearer statements of the specific activities
required to achieve the goals
 Cont…
Objectives should be:
1. specific
2. measurable,
3. realistic,
4. focused on key result areas,
5. cover a specific time period
 Attributes of planning
1.Futuristic
 anticipate the future
 what is required
 how it will be accomplished

2.Decision making
 determines what is to be done: when, where, how, and for
what purpose.
 choosing among the alternatives.
 Resource allocation.
 Cont…
3.Continuous and dynamic
 planned activities are affected by internal and external factors.

 need for environment scanning and adaptive changes.

4.Taproot for the other elements of management process

 Vision
 Clear description of the future that all stake holders want to
create .
 a concrete picture of the future that we wish to create

Benefits of Visioning:
 Breaks the manager out of boundary thinking.
 Provides continuity of actions.
 Identifies direction and purpose.
 Cont…
 Alerts stakeholders to needed change.
 Promotes interest and commitment.
 Encourages openness to unique and creative solutions.
 Encourages and builds confidence.
 Builds loyalty through involvement (ownership).
 Results in efficiency and productivity.
 Vision Killers
 Tradition
 Fear of ridicule
 anxiety/contentment of some stakeholders
 Fatigued leaders
 Short-term thinking
 Mission Statements
 are brief written descriptions of the purpose of the
organization.

 mission statements vary in nature from very brief to quite

comprehensive, and including having a specific purpose
statement that is part of the overall mission statement.
 Environmental Scan
 develops a common perception.
 identifies strengths, weaknesses, trends and conditions.
 draws on internal and external information.
 is a key on-going process for internal and external honesty and
openness to changing conditions.
SWOT Analysis: A Frame Work for Selecting Strategies
SWOT Matrix
Internal External

Positive Strengths Opportunities

Negative Weakness Threats

 The Planning Process
Step 1: goal formulation (what do we want?)
 Review/understand organization’s mission
 Translate mission into concrete terms

Step 2: identification of current objectives and strategy

 Cont…
Step 3: environmental analysis (what is out there that needs
doing?)
 Assess the direct-action and indirect-action elements of the
environment.

Step 4: Resource analysis (what are we able to do better or

worse than anyone else?)
 Cont…
 Based on the existing goals and strategy
 Identify the organization’s competitive advantages and
disadvantages
 Strengths and weaknesses of the organization
 Includes assessment of existing infra-structure/resources and
additional resource needs
 Cont…
Step 5: Identification of strategic opportunities and threats
(what can we do that needs doing?)
 Situations that are favoring and problems existing or predicted

 Analysis of the environment and resources

Step 6: Determination of the extent of required strategic change

 Performance gaps (objectives established in the goal formation
versus the results likely to be achieved)
 Cont…
Step 7: Strategic decision-making- Identify, select and evaluate
alternatives

Step 8: Strategy implementation- Incorporate into daily

operations of the organization

Step 9: Measurement and control progress

 Check progress at periodic intervals
 Measure success
 Management By Objective (MBO)
 an approach to planning and controlling, based on measurable
and jointly set objectives.

MBO consists of four steps:

1. setting objectives jointly.
2. developing action plans,
3. periodically re-evaluating objectives and plans and monitoring
performance
4. conducting annual performance appraisals.
 The steps of health planning
 Situational analysis
 Priority setting
 Option appraisal
 Programming and budgeting
 Implementation and monitoring
 Evaluation
 Tips
Characteristics of Planning
 Closely associated with the goals of the organization
 Primary concerned with forecasting
 Involves the selection of the best alternatives
 Comprehensive
 Flexible
 Nature of Planning
 Contribution to purpose and objectives
 Primacy of planning
 Pervasiveness of planning
 Efficiency of planning
 Importance of Planning
 To off-set uncertainty and change
 To focus attention on objectives
 To help in coordination
 To gain economy in operation
 To help in control
 To increase organizational effectiveness
 Types of Plans
Plans can be classified on different bases or dimensions. The
important ones are:
Repetitiveness
Time dimension, and
Scope/breadth dimension
Classification of Plans Based on Repetitiveness
1. Standing Plans
2. Single-use Plans

1. Standing Plans
 That can be used again and again
 That are followed each time a given situation encountered
 Include mission or purpose, goal or objective, strategy,
policy, procedure, method, and rule.
 Cont…
Purpose or Mission
 The terms can be used interchangeably
 Identify the basic function of organization

Objectives or goals
 The terms can be used interchangeably
 The ends toward which activity is aimed
 The end point of planning
 The end point of organizing, staffing, leading, and controlling
are aimed
 Cont…
Policies
 General statements or understandings that guide or channel
thinking in decision making
 Define an area within which a decision is to be made
 Help decide issues before they become problems
 Many types of policies

 Often interpreted as “ ten commandments” – no room for

discretion
 Cont…
Strategies
 Ways and means to achieve objectives
 Major course of action
 Every objective should have at least one strategy

Procedures
 Show the sequence of activities
 Guides to action
 Help in the implementation of policies
 Cont…
Methods
 More detailed
 Only concerned with the single operation

Rules
 Spell out specific required actions or non-actions, allowing no
discretion
 Rules, procedures and methods by their very nature, are
designed to repress thinking; we should use them only when we
do not want people use their discretion
 Cont…
2. Single-use Plans
 Are those plans that are not used up once the objective is
accomplished
 Used only once
 Include programs, projects and budgets

Programs
 Complex of goals, policies, procedures, rules, task
assignments, steps to be taken, resources to be employed, and
other elements necessary
 Supported by budgets
 May call for many supporting programs
 Cont…
Budgets
 Statement of expected results expressed in numerical terms
 Fundamental planning instrument

Project
 Part of general program
 Can be handled by itself
 Classification of Plans Based on Time
1. Long-range planning
 the time may range usually from 5-10 years
 Distant future
 The development of a plan for accomplishing a goal over a
period of several years.

Assumption: current knowledge about future conditions is

sufficiently reliable to ensure the plan's reliability over the
duration of its implementation.
 Cont…
2. Short-range planning
 Complementary of long- range plans
 Constitute the steps towards the implementation of long-
range plans
 Generally 1 year, sometimes up to 2 years

3. Intermediate-range planning
 Ranges between long and short- range plans
Classification of Plans Based on Scope/Breadth
1. Strategic Planning
2. Tactical Planning
3. Operational Planning
 Cont…
1. Strategic Planning
 process of analyzing and deciding on the organization's
mission, objectives, major strategies, major resource
allocation
 Strategic planning is:
 performed by top level mangers
 mostly long range in its time frame
 expressed in relatively non-specific terms
 type of planning that provide general direction
 Cont…
 designed to meet an organization’s broad goals
 focus on environmental assessment and addresses objective
and strategy.
 That an organization must be responsive to a dynamic,
changing environment.

Assumption: the environment is indeed changeable, often in

unpredictable ways.
 Cont…
Being strategic means
 clear about the organization's objectives,
 aware of the organization's resources, and
 responsive to a dynamic environment.

Strategic thinking: "Are we doing the right thing?"

1. a definite purpose be in mind
2. understanding of the environment
3. creativity in developing effective responses to those forces.
 Cont…
2. Tactical Planning
 Refers to the process of developing action plans through
which strategies are executed
 Departmental managers in organizations are often involved in
tactical planning. Examples are:
 Developing annual budget
 Choosing specific means of implementing strategic plans
 Deciding on course of action
 Cont…
1.3 Operational Planning
 Most specific and detailed
 Concerned with day-to-day activities
 Short-range and more specific and more detailed.
 Contains details for carrying out or implementing, those plans
in day-to-day activities.
 Strategic Plan vs. Operational Plan
1.Time Horizon: long time versus short time

2.Scope: wide range of goals versus narrow range operations.

3.Degree of Detail: simplistic and general versus detail and

specific activities.
 Limitations of Planning
 Lack of accurate information
 Problems of change
 Failure of people
 Internal inflexibilities
 External inflexibilities
 Rigidity in planning
 Time and cost factors
 Decision Making and Creative Problem Solving
 Decision making is a major part of management because
 When planning, organizing, staffing, leading, and
controlling, managers make decisions on a daily basis.
 it requires choosing among alternative courses of action.

 Decisions must be made at many levels in an organization

from executive decisions on the goals to the day to day
repetitive operations performed by lower level managers.
 Cont…
 Decision is a choice made from two or more alternatives.

 Many decisions are made in order to solve problems

What is a problem?
The difference between actual and desired states of affairs
 Gap where one is and wants to be
 the definition put managers in a better position to create more
effective and efficient solutions i.e. problem solving
 Depending on the situation, problems can be resolved ,

solved, or dissolved
 Cont…
Problem solving
 conscious process of closing the gap between actual and
desired situations.

Creativity
 the reorganization of experience into new configuration.
 It is a function of knowledge leads imagination and evaluation
 more knowledge: more ideas patterns combination
 knowledge must lead to imagination new ideas and then the
idea must be evaluated and developed into usable idea.
 Cont…
Problem Identification
Is problem finding an easy task?

The problem finding process originate from:

Deviation from past experience
Deviation from a set of plans
 Pitfalls of managers in problem identification
 False expectation

 False association of events

 False self-perception and social image

During decision making and problem solving
 Need to cope with accelerating change,
 face the challenges of dealing with

 complexity,

 uncertainty,

 the need for flexible thinking,

 decision traps.
 Factors contributing to decision complexity
 risk and uncertainty,
 long-term implications,
 interdisciplinary input,
 pooled decision making, and
 value judgments.
 Managers can respond to a condition of risk by
 calculating objective or subjective probabilities.

Objective probabilities: derived mathematically from reliable

historical data
subjective probabilities: are based from experience and
judgment.

 A condition of uncertainty exists when little or no reliable

factual information is available.
 7 Steps Formal Decision Making Process
1. Defining the problem or opportunity
2. Identifying limiting factors
3. Developing potential alternatives
4. Analyzing the alternatives
5. Selecting the best alternative
6. Implementing the decision
7. Establishing a control and evaluation system
 Cont…
 Limiting factors help rule out many possible choices. Time
and resources are usually major limiting factors to possible
decisions.

 Alternatives are the potential solutions that can be identified

after considering the limiting factors.

 Analyzing the alternatives identifies the consequences, the

advantages and disadvantages for each possible choice.
 Cont…
 Selecting the best alternative is making the choice that offers
the most advantages and the fewest disadvantages.

 Implementing the decision requires taking action to get results.

This includes

 communicating the decision to appropriate personnel

 putting plans, programs, and procedures into effect.

 Cont…
 Establishing a control and evaluation system provides a
feedback mechanism for tracking
 the implementation of the decision allows for modifications
or adjustments to be made as necessary
 Types of Decisions
1. Programmed decisions
2. Non-programmed decisions

1. Programmed decisions
 Elements of some decisions which are similar and made so
often
 Repetitive and routine
 Includes procedures, rules and manuals

E.g. patient admission, scheduling, inventory and supply ordering

 Factors influencing decision making process
 The internal environment such as
 superiors,
 colleagues,
 subordinates, and
 organizational system

 The external environment such as

 customers,

 The manager’s personal style often influences their choice of

one of the decision-making approaches.
 Cont…
A. Rational/ Logical (the 7-step decision model described
earlier)
B. Intuitive (gut-level decisions or hunch),

C. Predisposed (tendency to re-use previous decisions, regardless

of new information)

A number of other factors need to be considered as part of the

decision making process.
 Cont…
Some of these include:
 being able to set priorities,
 timing,
 avoiding tunnel vision or narrow thinking,
 being able to "let-go" of previous decisions if necessary,
 the ability to be creative and innovative in problem solving
("thinking outside the box").
 Cont…
2. Non-programmed decisions
 are unique and non-routine and may have unclear
implications for the organization, requiring
 creative problem solving because they are unfamiliar,
Unique and non-routine
 E.g. decision to expand, add or closes services
 Cont…
Helpful environment
 Providing adequate time for decisions to be made
 Having self-confidence
 Encouraging others to make decisions
 Learning from past decisions
 Recognizing the differing nature of decisions
 Recognizing the importance of quality information
 Making the tough decisions
 Knowing when to hold-off
 Being ready to try (new) things
 Knowing when to ask for help
 Organizing Principles and organization
Organizing Function :
 next step after planning.
 structuring the work of the organization.
 The purpose is
 to make the best use of the organization's resources to achieve
organizational goals.
 to make the organization a stable place for employees
 Cont…
Organizing
 deciding what work needs to be done,
 deals with formal assignment of tasks and authority and
coordination.
 arranging them into a decision-making framework.
 Cont…
The steps in the organizing process include:
1. review plans
2. list all tasks to be accomplished
3. divide tasks into groups
4. group related jobs together
5. assign work to individuals
6. delegate authority to establish relationships between jobs and
groups of jobs
 Cont…
Organizations:
 A pattern of relationship through which people pursue to
achieve common goals.
 are groups of people, with ideas and resources, working
toward common goals.
 Characteristics of organizations
Whatever their purpose, all organizations have four characteristics:
(1) coordination of effort
(2) common goal or purpose
(3) division of labor
(4) hierarchy of authority.
 Organizational Design
 The determination of the organizational structure
 most appropriate for the strategy, people, technology and
tasks of the organization.
 Matching goals ,strategic plan, capabilities with environment.
 Organizational Structure
 The way, in which an organization’s activities are divided,
organized and coordinated.

 Is the formal decision-making framework by which job tasks

are divided, grouped, and coordinated.
 Organization Chart
 The formal organization can be seen and represented in chart
form.

 displays the organizational structure and shows job titles, lines

of authority, and relationships between departments.

 Is helpful for managers as it is an organizational blue print for

deploying human resource.
 Cont…
Dimensions of Organization charts
 Representing the organization's structural skeleton,
organization charts have dimensions representing:
 vertical hierarchy
 horizontal specialization.
 Cont….
A clear organizational structure:
 clarifies the work environment
 creates a coordinated environment
 achieves a unity of direction
 establishes a chain of command
 Functional Steps in Organizing
The four building blocks:
 Division of work
 Departmentalization
 Hierarchy
 Coordination
 Cont…
1. Division of work / Division of labour/
 the degree to which tasks in an organization are divided into
separate jobs.
 breaking of a complex task into components
 Individuals are responsible for a limited set of activities
instead of the entire task.

2. Departmentalization
 Once work activities are divided in to jobs
 jobs have been classified through work specialization,
 they are grouped and common tasks can be coordinated and
logically connected.
 the basis on which work or individuals are grouped into
manageable units.
 Cont…
3.Hierarchy
 Concept is how many could be effectively handled
 A pattern of multiple levels of an organizational structure
 At the top the senior-ranking manager
 Bottom - low-ranking managers located at various levels

4.Coordination
 The integration of activities of separate parts of an organization
for accomplishing the organizational goals.
Integration: the degree to which various departments work in a
unified manner
 Leading (Leadership)
The management function of influencing, motivating, and
directing human resources towards the achievement of
organizational goals.

Motivation: The psychological process that gives behavior

purpose and direction.

Theories of Motivation
1. Maslow’s needs hierarchy theory
2. Hertzberg's two-factor theory
3. Expectancy theory
4. Goal-setting theory
 Motivation Theories
Maslow’s Needs Hierarchy Theory
 People have needs, and when one need is relatively fulfilled,
other emerge in predictable sequence to take its place.

Maslow’s hierarchy of needs:

 Physiological needs: food, water, sleep, and sex.

 Safety needs: safety from the elements and enemies.

 Love needs: desire for love, affection, and belonging.

 Esteem needs: self-perception as a worthwhile person.

 Self-actualization: becoming all that one can become.

Maslow’s Hierarchy of Needs Theory
 Hertzberg's Two-Factor Theory A
theory of motivation based on job satisfaction.
 A satisfied employee is motivated from within to work
harder.
 A dissatisfied worker is not self-motivated to work.
 Conclusion: Enriched jobs are the key to self-motivation.

Dissatisfiers - factors associated with the job context or work

environment.

Satisfiers: factors associated with the nature of the task itself (job
content).
 Cont…
Implications of Herzberg’s Theory
 Satisfaction is not the opposite of dissatisfaction.
 There is a need to think carefully about what motivates
employees.
 Meaningful, interesting, and challenging (enriched) work
is needed to satisfy and motivate employees.
 Problems with theory
 Assumption of job performance improving with
satisfaction not strong support.
 One person’s dissatisfier is another person’s satisfier.
 Expectancy Theory
 A model that assumes motivational strength is determined by
perceived probabilities of success.

Relevance of Expectancy Theory to Managers

 Employee expectations can be influenced by managerial
actions and organizational experience.
 Training increases employee confidence in their efforts to
perform.
 Listening provides managers with insights into employees’
perceived performance-reward probabilities.
 Goal-Setting Theory
Goal setting: the process of improving performance with
objectives, deadlines, or quality standards.

A General Goal-Setting Model

Properly conceived goals trigger a motivational process that
improves performance.
 Motivation Through Rewards
Extrinsic Rewards
 Payoffs granted to the individual by other rewards.
 Money, employee benefits, promotions, recognition,

status symbols, and praise.

Intrinsic Rewards
 Self-granted and internally experienced payoffs.
 Sense of accomplishment, self-esteem, and self-

actualization.
 Cont…
Improving Performance with Extrinsic Rewards
 Rewards must satisfy individual needs.
 Employees must believe effort will lead to reward.
 Rewards must be equitable.
 Rewards must be linked to performance.
 Group Dynamics and Teamwork
What Is a Group?
 Two or more freely interacting individuals who share a
common identity and purpose.

Types of Groups:
Informal groups: a collection of people seeking friendship and
acceptance that satisfies esteem needs.

Formal groups: a collection of people created to do something

productive that contributes to the success of the larger
organization.
 Cont…
What Does It Take to Make a Group?
 Two or more people
 Free interaction among members
 Common characteristics
 Common purpose
 Management of Health Team
What is a Team?
 A team is a small number of consistent people committed to a
relevant shared performance goal.
 The heart of a true Team:
 Respect each other
 Flexibility
 Communication
 Trust
 Cont…
Team
 It is a special type of group
 Preferably2-8 people,
 Interacting and influencing each other
 The members have attitudes of willingness to work and active
participation,
 The members stimulate each other, are independent and show
no domination of one member over another
 Cont…
 There is continuous coordination and collaboration among team
members
 The members have a shared approach to common goals and are
trustworthy and honest,
 The success of the team is more important than individual
achievement and
 Consistent people committed to a relevant shared performance
goal/ work for a common goal
Characteristics of an Effective Functioning Team
A clear, understandable and elevating goal,
 driven by the result of their efforts
 Competent members
 Unified commitment: strong, urgent and personal
commitment to reach the goal.
 A collaborative climate: helps to increase trust, honesty,
openness, consistency, respect
 Standards of merit,
 External support and recognition, and
 Principal leadership: the leader
 Stages of Team Development
1. Forming
 Development acceptable to the group.
 Period of orientation or acclimation

2. Storming
 Members oppose the formation of the structure.
 Become hostile and fight to the ground rules.

3. Norming
 Conflicts are addressed and resolved.
 Group unity emerges.
 Cont…
4. Performing
 Structural issues resolved.
 Structure supports group dynamics and performance.
 Structure used for task accomplishment.

5. Adjourning
 For temporary groups (task force): the group wraps up activities
 A highly cohesive team is characterized by
 Team versus Group
Team Group

Common goal Self interest, individual goals

Defined responsibilities No role definitions

Works together Act independently

Has a leader Does/does not have a leader

Communicates continuously Communicates if necessary

Takes responsibility Blames others

Relies on one another Relies on self

 Cont…
What Makes Workplace Teams Effective?
 Innovative ideas
 Goals accomplished
 Adaptability to change
 High person/team commitment
 Being rated highly by upper management
 Team, Teamwork, and Trust
Trust: A Key to Team Effectiveness
 a belief in the integrity, character, or ability of others.
 The primary responsibility for creating a climate of trust
falls on the manager.
 Trust is the key to establishing productive interpersonal
relationships.
 Trust encourages self-control, reduces the need for direct
supervision, and expands managerial control.
 Cont…
Six Ways to Build Trust
1. Communication: keep people informed.
2. Support: be an approachable person.
3. Respect: delegate important duties and listen.
4. Fairness: evaluate fairly and objectively.
5. Predictability: be dependable and consistent.
6. Competence: be a good role model.
 Communication
Communication
 The interpersonal transfer of information and understanding
from one person to another.
 A linked social process of sender, encoding, medium,
decoding, receiver, and feedback.
The Basic Communication Process
 Cont…
Upward Communication
 The process of encouraging employees to share their
feelings and ideas with management.
 Options for improving upward communication
 Formal criticism procedures

 Employee attitude and opinion surveys

 Suggestion systems

 Open-book policy

 Informal meetings

 Internet chat rooms

 Exit interviews
 Communication Problems
Barriers to Communication
1.Process barriers
 Sender barrier

 Encoding barrier

 Medium barrier

 Decoding barrier

 Receiver barrier

 Feedback barrier

2. Physical barriers
 Devices and distance
 Cont…
3.Semantic Barriers
 Misinterpretation of the meaning of words and phrases

by individuals.
 Specialized occupational languages can create
communication problems with outsiders.

4. Psychosocial Barriers
 Differing backgrounds, perceptions, values, biases,

needs, and expectations of individuals can block

communications.
 Becoming a Better Communicator
Effective Listening
 Tolerate silence; keep listening.
 Ask stimulating, open-ended questions.
 Encourage the speaker with attentive eye contact, alert
posture, and verbal encouragers.
 Paraphrase what you have just heard.
 Show emotion to show your sympathy with speaker.
 Know your biases and prejudices.
 Avoid premature judgments.
 Summarize by reiterating what the speaker said.
 Cont…
Effective Writing
1. Keep words simple.
2. Don’t sacrifice communication to rules of composition.
3. Write concisely.
4. Be specific.
 Cont…
Running Meetings
 Prepare ahead of time.
 Have a reason for the meeting.
 Distribute an agenda.
 Give participants at least a day’s notice.
 Limit attendance and designate a leader.
 Have a specific start and end time.
 Encourage participation but keep to the agenda.
 Use visual aids.
 Follow up.
 Conflict Management
Definition
Conflict management is the use of strategies and tactics to
move all parties toward resolution, or at least containment of
dispute, in a manner that avoids escalation and the
destruction of relationships. (Carol A. Aschenbrener, MD)

Antecedent Conditions
 Competition for resources, Task interdependence
 Jurisdictional (role) ambiguity, Status struggles
 Out-of-role actions. Communication barriers
 Values, beliefs, biases and expectations
 Habits and habitual practices
 Frames of reference/past experience
 Cont…
Conflict Resolution
 Conflict is when two or more values, perspectives and
opinions are contradictory in nature and haven't been aligned
or agreed.
or
 It is the perceived incompatible differences that result in
interference or opposition.
 Conflict exists in situations where goals, interests or values of
people are incompatible and they block other’s efforts to
achieve their goals.
 It is natural and inevitably arise
 Cont….
Conflict is often needed.:
 Helps to raise and address problems.
 Energizes work to be on the most appropriate issues.
 Helps people "be real", for example, it motivates them to
participate.
 Helps people learn how to recognize and benefit from their
differences.
 Cont….

 The conflict isn't the problem - it is when conflict is poorly

managed that is the problem.
 Conflict is a problem when it
 Hampers productivity.
 Lowers morale.
 Causes more and continued conflicts.
 Causes inappropriate behaviors.
 Cont…
Types of Conflict

Conflict
Conflict

Inter-
Inter-
Interpersonal
Interpersonal Intragroup
Intragroup Intregroup
Intregroup organizational
organizational
 Cont….

1. Interpersonal Conflict: between individuals based on

differing goals or values.
2. Intragroup Conflict: occurs within a group or team.
3. Intergroup Conflict: occurs between 2 or more teams or
groups.
 Managers play a key role in resolution of this conflict

4. Interorganizational Conflict: occurs across organizations.

 Managers in one firm may feel another is not behaving

ethically.
 Cont…
Sources of Conflict

Different
Differentgoals
goals
&
&time
timehorizons
horizons
Status
Status Overlapping
Overlapping
inconsistency
inconsistency Authority
Authority

Conflict
Conflict

Scarce
Scarce Task
Task
Resources
Resources Incompatible Interdependency
Interdependency
Incompatible
evaluation
evaluation&
&
Reward
Reward
 Cont…

1. Different goals and time horizons: different groups have

differing goals.
 Production focuses on efficiency; Marketing on sales.

2. Overlapping authority: two or more managers claim

authority for the same activities.
3. Task Interdependencies: one member of a group fails to
finish a task that another depends on.
 This makes the worker that is waiting fall behind.

4. Incompatible Evaluation or reward system: workers are

evaluated for one thing, but are told to do something
different.
 Cont…

5. Scarce Resources: managers can conflict with scarce allocation

of resources.
6. Status inconsistencies: some groups have higher status than
others.
 Leads to managers feeling others are favored.
 Cont…
Conflict Resolution Approaches
Has various approaches
1. Avoid differences - select people from workers and do
compromise
2. Repress or delay differences
 The manager can emphasize harmony and team work
or bring dispute parties together only under highly
controlled circumstances
3. Problem solving - bring the disputing parties together
,getting them a chance to air their differences or act as a
mediator
4. Traditional approach - people selected outside institute
 Cont…
Modern Approach
I. Win - Lose method
 Is based on force
 Personal goals are satisfied at anther experience through
the use of authorities
II. Lose – Lose method
 Neither party being truly satisfied
 With no clear winner

III. Win - Win method

 The most constructive resolution but most difficult to reach
 Finally settle the most mutually beneficial solution
 Cont…
Strategy for conflict resolution
1. Problem analysis -To determine the basic issues
2. Select the problem
3. Identify the steps to attaining the goal
4. Depersonalize the Goal
5. Search for solution
 Cont…
Styles of conflict resolution
1.Avioder/withdrawal/: Low assertiveness and social interaction
“ It is ok, I will sit alone in the dark’’

Avoiding or Inaction: The goal is to do nothing or delay

• Denial of the existence of conflict or unwillingness to deal with
the issues
• “No way’’
You may be using this style if you:
1. Avoid situations that create tension
2. Avoid controversy
3. Avoid open discussions of issues or concerns
4. Postpone difficult negotiations
 Cont…
2. Accommodator: Low assertiveness but high social interaction
“Let’s all sit together in the dark’’

Accommodating or Obliging: The goal is to let the other party

win
• Giving the other side what they ask or demand
• “Your way”
You may be using this style if you:
1. Focus on other parties concerns more than your
own
2. Trying to help the other party even when it
means giving something up
3. Trying to keep the other party happy
4. Trying not to hurt the other parties feelings
 Cont…
3. Collaborator/problem solving: High assertiveness and high
social interaction
“ Let’s change the light bulb together’’
Collaborating or Integrating: The goal is to find a win/win
solution
• An open problem-solving approach to meet everyone’s
interests to greatest extent possible
• “Our way”
You are negotiating with a collaborating style if you:
1. Bring issues into the open.
2. Issues are important to both parties.
3. Looking for creative solutions.
4. Seek to build trust and satisfy both parties.
5. Exchange information and ideas freely
 Cont…
4. Competitor: High assertiveness and low concern for
social acceptance
“ My room is better, let them yours’’
5. Compromiser/ Sharing: Combines qualities of the above
“ Today we will sit in the dark, tomorrow we will sit in the
light ”
 Cont…
Compromising: The goal is to find a middle ground
• A pragmatic approach of trading concessions to make a deal
• “Half way”
You may be using this style if you are:
1. Splitting the difference.
2. Giving up something for something in return.
3. Taking an intermediate position
4. Engaging in give and take
 Cont…
Conclusions
 Conflict is a normative expression of human diversity and is a
necessary component of team and programmatic function.
 The ultimate goal of health care teams is the care of patients.
Focussing on common values and frameworks, as opposed to
imposing diverse perspectives brought to the table, and
committed and skilled leadership are key elements to effective
team function and delivery of care.
 It is essential that lessons learnt from the application of
organised conflict management in industry be applied in health
care.
 Organisational commitment to problem solving has the
potential to increase the level of service at lower cost.
 To that end it is crucial that health care systems actively
recognise the need for, and build in conflict management skills
and systems.
 Controlling/Organizational Control
Control
Taking preventive or corrective action to keep things on
track.

 Checking, testing, regulation, verification, or adjustment.

 Objectives are benchmark for measuring actual
performance.
Purpose of the control function
 Get the job done despite:

 environmental
 organizational
 behavioral obstacles and uncertainties.
Functions of Control
 Establish standards of performance
 Gather information and Measure current performance
 Compare performance with standard
 Taking corrective action
 Rewarding
 The primary aim of control is to improve performance
 Ensuring that resources are more effectively deployed and
those mistakes are rectified.
Feedback in the Control Process
 An essential element in the control process.
 Any feedback system must have a number of characteristics.
 Timely
 Reliable
 Precise
 Right
Forms of Management Control
There are three basic forms of management control:
1. Monitoring,
2. Supervision
3. Evaluation.
 Monitoring
 Monitoring is the day-to-day watch on
 Continuous follow-up of on going activities
 Carried out through observation
 It is regularly checking to see that program activities are
being done as planned.
 To assess reactions of people receiving the services or
involved in the project.
Goals of monitoring
 To identify problems early.
 To solve without delaying the progress of the program
How to monitor a program?
Program managers should follow four steps when monitoring an
intervention:
1.Establish data sources (in practice, limitations of time and
resources may require giving priority to one set of information
needs over the other).
2.Collect data on program implementation and outcome.
3.Compare program outcomes with prior or expected outcomes.
4.Assist in making policy and management decisions.
2. Supervision
 Continuous processes to be conducted by the management
in line with controlling.
 The three main styles of supervision are autocratic,
anarchic and democratic.
 Autocratic and anarchic supervisions tend to humiliate
people, make them irresponsible and mostly one way.
 It may dry up the initiative of colleagues.
Cont…
 Democratic supervision helps people to grow,
 become responsible for their own work to show initiative
 Follows two-ways communication.
 People like to be consulted.
 Most people prefer to work under a democratic
leadership.
3. Evaluation
 It is the methodical process of determining the worth of a
system, project, course of action campaign, etc.
 It involves the comparison of the actual performance of the
system
 It is also defined as a systemic way of learning from
experience
 using the lessons learned to improve current activities
 Promote better planning by careful selection of alternatives
for future action or asking, “Did we achieve what we set out to
do?”
Cont…
 Comparing the present situation with the past in order to find
out to what extent organizing purposes have been achieved.
 It is carried out mainly as a way of looking at:
 program activities,
 human resources,
 material resources,
 information, facts and figures.
 Steps in evaluation
1. Assess the evaluation situation
 Determine the evaluation goal
 Clarify what is at stake e.g. change in policy, etc.
 Specify how much confidence and reliability

2. How to choose the evaluation design appropriate to the

evaluation situation
 Assess feasibility of achieving
 Assess potential threats to internal validity
 Choosing the evaluation design appropriate to the
situation
 Assessment of evaluation criteria
Cont…
3. How to develop evaluation indicators and instruments.
4. How to plan your approach for analyzing data.
5. How to plan for optimal use of results for learning and action
Cont…
The results of evaluation are expected to show:
 What a program has been trying to do;
 What actually happened;
 Where there are differences/gaps between plans and what
happened
 The reasons for the difference/gaps, and
 What needs to be done about them?
Types of Evaluation
Some authors use the terms
 Input, Process, output ,Outcome and Impacts to determine the
value of a program

Others use the term

 Formative/diagnostic evaluation is done to evaluate Input;
 Progressive Evaluation is performed during implementation to
evaluate Process;
 Summative or Terminal Evaluation to evaluate output and it is
done at the conclusion of the program.
 Managing Resources
Resource Management
 The performance of daily activities requires that many elements
–people, time, equipment, material, drugs, etc. - are brought
together to carry out the work.
 The successful performance of activities and the achievement of
objectives depend upon resources management.
1.Managing Equipment (expendable & non-
expendable) including drugs.
Purpose- for wise use and avoid wasting.
Common reasons for wasting:-
1. Overusing (in amount and variety)
2. Using expensive ones for no additional benefits
3. Overstocking
4. Inappropriate storage (temperature, ventilation, radiation...)
5. Issuing too much at a time
Four main procedures in the management of equipment
1. Ordering (obtaining equipment from stores or shops)
 Requires the following skills:
 Listing requirements, from a knowledge of past use and
estimates of present use type & quantities, economically.
 Balancing requirements with available resources and
making cost estimates, and prioritization.
Cont…
 Use of a catalogue (list of articles for purchase) from

shops/ distributors.
 Completion of order – forms or requisition forms to the

appropriate source. Note the exact item number

description & price carefully. In case of drugs avoid
brands names.
2.Storing equipment (recording, labeling and holding
equipment in a stock or store room)
Main reserve Vs on the site.
 Dry, cool, and protected from light, arrange systematically,
label them.
 Use double shelf system of stock control for extremely
important supplies.
 The second shelf will complement the supply time and
purchasing intervals (the time between sending an ordering and
receiving, and the time between the arrivals of successive dug
orders, usually three or six months)
The following skills are required
1.Recording the receipt of new articles and the issue of articles.
Compare with invoice (a statement of the cost of the article).
or the delivery note.
2. Keeping a stock- book or ledger in balance.
 Use separate page for each item stocked
 the date in which the item was received
Cont…
 the reference number of the item (from the catalogue) and the
place of purchase

 Every time an item is delivered, the quantity received is added

to the total stock; each time an item is issued, the quantity is
subtracted from the total stock.
3.Issuing equipment
 Giving out, recording the issue and the balance of remaining
stock, and receiving a signed issue voucher to the appropriate
department.

Three steps:
 A ledger record (writing the issue in the stock ledger) - to
make balance, to order new below a certain level
 Issue of a voucher which must be signed (date, what how
much, page in the ledger, to which department, by whom,
signature).
 An inventory record of the section receiving and using the
equipment.
4). Controlling and maintaining equipment

To avoid wastage Skills needed:

 Cleaning and keeping equipments in order after use
 Inspection (using checklist and schedule)
 Repairing of damaged non expendable equipments.
II. Managing time -a non- renewable resource
1.Finding out how staff use time
 Keep a daily diary for a few days to identify how much
time is spent in performing actual tasks, how much on
correspondence, how much on talking to other staff, how
much on walking around
 To make the best use of time avoid unnecessary wasting.
Cont…
2.Planning time arrangements for work
 what will be done (list of activities,), where it will be done
(place), who will do it, and when it will occur?
 Time table: - is used for weekly regular recurring events.

 Schedule: - for intermittent, irregular or variable events,

including details of where the events take place.

 Roster: - for duties planned for different staff members, for

different times in turn.
 Make it fairly distributed among the appropriate staffs.
Cont…
 Program: - for long term arrangements of several different
events or activities of which the time plan is only one part.

 Year calendar: - acts as a reminder of definite important

events, usually out of one’s control.. In addition it shows where
it is possible to fit in new events such as special meetings or
periods of travel
III. Managing Space
1.Arranging work-space to ease for staff. Could this space be
arranged in another way that would make the work easier and
suit the customers better?

2.Arranging work-flow. Work flow is an arrangement in which a

series of work functions are coordinated in space and time so
that delays are minimal.
Cont…
 The greatest obstacle to the organization of work flow is
attitude. Prevent congestion and queues- they are not
indicators of how busy and hard working you are.

 Avoid delays (provide service with only a very short

waiting time)

 It is essential to examine the whole process- removing a

queue from one stage may result only in creating a queue at
another (for example if the position at the examination
room is improved, patients may have to wait at the
pharmacy for their drugs).
Example in a health care facility

 Separate rooms for new and repeat visitors. Give

identification numbers usable during return. Simplified
filing system...
 Label every door
 Establish a brief assessment room for preliminary
treatment, and resorting of patients.
Cont…
 Daily returning patients should go directly.
 Appointments with busy officials should be made
carefully.
 In the pharmacy prepackage routine courses of drugs.
 Keep a stock of written instructions to patients on how to
take routine course of drugs.
Wherever possible organize a family health service

 In which a number of families from a district or a village are

assigned to a health center worker who is responsible for their
health care.

 Advantages of family health service

 Avoids unnecessary journeys

 Much more job satisfaction for the staff
Cont…
 The family is seen as a total unit, and a health problem can be
seen in is entirety.

 Enables less skilled health workers better screen patients.

 Work is more efficient because time and other resources are

used better
Cont…
 Define the catchments area where the health unit is meant to
give a complete health to all people and communities
 Use maps in district health work.

Advantages:
 To show distances to various health units and villages.
 To plan routes
 To decide on traveling methods
Cont…
 To learn the population distribution, density and different
types of community in an area.
 To obtain information about the topography and
environmental features of the community
 To show strategic places such as markets, community halls
 IV. Managing Paper Work
Its quality and efficiency plays an important part in the
effectiveness of the health care activities and programme
It is useful for :
 Monitor and control of clinical and community health care
work,
 Correspondence (referrals, reports),
 Memory system of a health service,
Cont…
 Staff management,
 Administration of funds and equipment.
 Arrange space for office work- give time for office activities.
 Set up a filling system-arrange and index. to allow any paper
to be found any time it is needed
V. Managing Human Resource
Definition: HRM is the management function that deals with:
 recruitment,
 selection,
 placement,
 training, and
 development of organization members

This is the management function (is the process of an ongoing

procedure) that tries to keep the organization supplied with
the right people in the right position, when they are needed.
 Cont..
It includes seven basic activities.
1. Human resource planning
2. Recruitment
3. Selection
4. Socialization (Orientation)
5. Training and Development
6. Performance Appraisal
7. Promotions, Transfers, Demotions, and Separations.
 Cont…
HRM is the process of accomplishing organizational objectives by:
 Acquiring
 Retaining
 Developing
 And properly using human recourses in the organization

Purpose
The purpose of HRM is to improve productive contribution of
people to the organization in an ethical and socially responsible
way.
 Cont…

Basic Activities:
 Human Resource Planning
 Recruitment,
 Selection,
 Socialization,
 Training and Development
 Performance Appraisal, and
 Promotion, Transfers, Demotions and Separation
1. Planning procedures
 Planning for future needs
 Planning for future balance (number needed versus present)
 Planning for recruiting
 Planning for the development of employees
2. Recruitment
Recruitment includes:

Job Description
 Job,
 Covering Title,
 Responsibility,
 Location on the organization chart.

Job (Hiring) Specification:

 Written description of the education,
 Experience and skills needed to perform a job or fill a position
effectively.
Methods of Recruitment:
 Peer recruiter (advantage: well informed, person is identified)
 Within the organization (Advantage: familiar, inspiring, less
expensive)
 Outside the organization (e.g. colleges, graduate schools, other
organizations)
 Formal announcement (mass media)
3. Selection
 It is the process of choosing individuals who can
successfully perform a job from available candidates
 It is a crucial process in management and requires constant
attention, interest and concern of management.
 The three sources of information used in selection are
application forms, pre-employment interviews and
testing
4. Introduction (Socialization) and Orientation
 When the candidates or the best applicant is selected and offered
a job, it is necessary to introduce the new employee to the
philosophy, rules and polices, etc. of the organization.
 Thus, before the employee begins his her work, he/she should be
assimilated to job and organizational environment.
 It is a program designed to help employees to fit into the
organization smoothly
These HRM activities include:
 Appraising each employee’s job performance
 Moving employees within the organization through promotion,
demotion and transfer, disciplinary counseling and separation,
when necessary administrating compensation and benefit.
 Provide employee assistance and career counseling, and
 Ensuring a healthful work place and personal safety
5. Training and development
 Training begins the very first day, which is designed to
improve the person’s skills and knowledge to do the current
job at high level.
 Development refers to the organizations efforts to help
employee’s acquire knowledge, skills and behavior that
improve their ability to meet changes in job requirements
and customer needs.
Approaches to training

On-the-job training
 Job rotation: variety
 Internship: Combined classroom teaching
 Apprenticeship: training under guidance of skilled co-worker

Off- the-job training

 Vestibule training: training on realistic job setting or equipment
 Behaviorally experienced training: simulation exercises, cases,
games, role-playing (done outside the organization)
6. Performance Appraisal
 It is the process through which a manager measures
employees’ activities and output against organizations
objectives.
 It involves measuring actual performance of an employee
and providing information about his/her strengths and
weakness
Purpose:
 To give feedback,
 To recognize outstanding performance,
 To locate the need for additional training
 To identify candidates for promotion
7. Promotion, Transfer, Demotion and Separation
Promotion
 Moving to a higher position and responsibility
 Recognize outstanding performance
 Should be fair (merit-based)

Problems: Some may be by passed

 Moral decreased
 Resentfulness
 Discrimination may occur: sex, race, age, and minority
 Cont…
Transfer
Shift to other positions
 For experience
 To fill gap
 To keep promotion ladders open
 To keep individuals interested in the job sometimes, for those
with inadequate performance
Problem: some employees refuse transfers (family problem)
 Cont…
Discipline, Demotion and Separation
When the organization’s policy is violated.

Steps:
 Warning
 Admonishment
 Probation
 Suspension
 Disciplinary transfer
 Discharge
Health Management Information System (HMIS)
Management:
Management is the planning and control of the uses of resources
(physical, fiscal, human, etc.) toward accomplishing specific
organizational objectives. Management involves proactive and
reactive decisions which plan for new actions and evaluate
past actions.

Data or Information:
Data: Facts that describe entities such as objects or activities.
They can be either qualitative or quantitative, categorical or
continuous.
Cont…
Information: Data that have been organized and presented in
such a manner that they facilitate decision making.

 Information consists of facts or data which are organized in a

form which allows conclusions to be drawn or knowledge to
be gained. Inherent in the concept of information is that it be
represented in a way that is useful for a specific purpose.

System:
A system is any collection of components that work together to
achieve a common objective. Typically, a system takes inputs
and processes or transforms them into desired outputs.
Cont…
Health Management Information System:
A set of components and procedures organized with the objective
of generating information which will improve health care
management decisions at all levels of the health system.
Relation Ship Between MIS and the Management Cycle
MIS, Information Needs and the Management Cycle
Indicators
Indicators are variables that help to measure changes, directly or
indirectly (WHO 1981)

Qualities of Good Indicators

 Action-oriented
 Relevant
 Easily generated, measured
 Valid: Sensitive & Specific
 Reliable
 Representative
 Understandable
 Timely
Checklist for Designing a Good Report
 Keep it brief and to the point

 Consider the Decision Makers’ Needs

 Consider the Organisation and Presentation of the Information

 Ensure the Report Permits Comparison

Presentation Techniques
 Bar Graph
 Line Graph (regular or cumulative)
 Pie Chart
 Area chart
 Maps/geographic distribution
 Text
 Others?
Historical Development of Health Services Policies in
Ethiopia.
 Modern medicine was introduced in to Ethiopia in the 16th
century.
 The foundation for formalized health services in Ethiopia goes
back to 1908 G.C (when offices dealing with created in
ministry of interior).
 World War II Italian occupation 1935 -41 G.C. no marked
events has taken places during this period.
 Post World War II:
Cont…
 The first health legislation established in 1947, which
guarantees the creation of separate ministry.
 Ministry of health (MOH) established 1948 G.C.
 1952 E.C (1960 G.C) Ethiopian government began to develop
basic health services with health centers as backbone.
 1954 E.C (1962 G.C) GCPH established.
Cont…
 Three nursing schools were established between 1949 and
1951

 In 1966 the first medical school was opened in A.A.

 Ministry of health did not formulate national policy and

strategy for definite health services until 1955E.C (1963 G.C)
when the second five years development plan was launched.
THE 5 YEAR DEVELOPMENT PLAN-1966-1971
(1974-1979G.C)
 Re-emphasized the importance of public health services
 It set target to raise the health services coverage from 15-30%
at the end of the 5 Year plan period.
 The five-year draft proposal to be launched in 1966 E.C did
not materialize due to social upheaval and change of
government.
Structure and Development of Health Care System
Since the Revolution of Derg Era (1974)
 When health condition was assessed health service distribution
was highly skewed in favor of a few urban centers
 43% of health budget allocated for 3 big cities
 By 1974 there were
 6474 health personnel of all categories
 650 health stations
 93 health centers
 84 hospitals with 8624 beds. These made possible health
service coverage of 15% of the total population
Change in Health Policy
The Socialist Ethiopian Government revised the health policy: to
place more emphasis on
 primary health care,
 rural health services, prevention and control of communicable
diseases,
 self reliance and
 community participation in health activities through its
declaration of National Democratic Revolutionary Programme
in 1976 and its adoption in 1978 G.C of the Alma-Ata
Declaration of Health for All (HFA) by the year 2000.
Specific Aspect of Policy Emphasis
 Community involvement in development activities including:
 Health Coordinate efforts.
 The gradual integration of programme .
 The delivery of essential health care at the cost affordable
by the community
 Developments of a 6 tiered health service with levels of
increasing technical complexity to facilitate management
referral support and training
Six-Tiered National Health Care System
 Community Health Services (Health Posts)
 Health Stations (Clinics)
 Health Centers,
 Rural Hospitals,
 Regional Hospitals, and
 Central Referral and Teaching Hospitals
 The Ten-Year Heath Sector Plan (1977-1986)
The plan is part of the over all process to achieve the goal of
health for all by the year 2000 for the Ethiopian people based
on the principles of PHC:
 through promotion of health
 prevention of disease
 reduction of morbidity
 reduction of mortality
Main Objectives of the Plan
 To foster full and active community involvement in health
activities
 To ensure multi-sectoral collaboration and coordination in all
health actions
 Extend health services to where the broad masses live and
work
 Put under control all major communicable diseases
 Expand EPI Services to ensure a wide coverage of the
population
 Ensure the provision of comprehensive health services to
special population.
 To extend medical service to 80% of the population
 The Health Policy of Transitional Government of Ethiopia
 Democratization and decentralization of the health service
system.
 Development of the preventive and promotive components of
health care
 Development of an equitable & acceptable standard of health
service system
 Promoting and strengthening of inter-sectoral activities
Cont…
 Promotion of attitudes and practices conducive to the
strengthening of national self-reliance.
 Assurance of accessibility of health care for all segments of
the population
 Working closely with neighboring countries.
 Development of appropriate capacity building based on
assessed needs
 Provision of health care for the special population.
 Promotion of participation of the private sector and NGOs
 Primary Health Care
Definition
 The international conference on PHC held At ALMA-ATA in
1978 defines as follows:
 Essential Health Care based on:

 Practical,

 scientifically sound, and

 Socially acceptable methods and technology made universally

accessible to individual and families in the community through
their full participation, and
Cost…
 Cost that the community and country can afford to maintain at
every stage of their development in the spirit of self-reliance
and self-determination

 It forms the first level of contact of individual, the family and

the community with the national health system, brining health
care as close as possible to where people live.
Historical Development of Primary Health Care
 WHO, established in 1948, has always had as a major objective
the attainment by all people of the highest possible level of
health.

 Health according to the WHO definition is "a state of complete

physical, mental and social well being and not merely the
absence of disease or infirmity".

 However, due to political and socio-economic factors the

various health care approaches implemented in different
countries between 1948 and 1978 did not enable WHO to meet
the stated objective.
Cont…
 In the 1950s, the vertical health service strategy implemented.

 However, the delivery of vertical programmes found to be

expensive and unsuccessful.

 Later in the mid 1950s, the concept/ strategy of basic health

Service came into being.

 This approach gave more attention to rural areas through

construction of health centres and health station providing both
preventive and curative care
Cont…
 In the early 1970s, integration of the specialized disease control
programmes with the basic health services emphasized.

 All these approaches were disease oriented and ultimately failed

to reach the desired goal.

 Especially in developing countries where their health problems

required emphasizing health promotion and preventive care.
Cont…
 Organized limited health institutions failed to meet the
demands of those most in need who are usually too poor or
geographically or socially remote to benefit from such
facilities.

 The health services often created in isolation neglecting other

sectors such as education, agriculture, water, communication
etc., which are relevant for improvement and development of
health.
Cont…
 Health institutions stressed curative services with insufficient
priority to preventive, Promotive and rehabilitative care.

 The communities have rarely been given the opportunity to play

an active role.

 These situations called for WHO and UNICEF in the early 70s to
seriously and critically re-evaluate and re-examine existing
policies, approaches and options in health.
Cont…
 Predominantly curative -pre-world war II

 Predominantly vertical programmes 1950s - 1960s

 The transition from vertical programme to integrated PHC 1970

- to the present
 PHC Principles
The following principles underline the concept of PHC :
 Inter-Sectoral collaboration
 Community participation
 Appropriate technology
 Equity
 Focus on prevention and health promotion
 Decentralization
 The PHC Philosophy
1. Equity and Justice
 Equitable distribution of services, resources and health care.
 Effective PHC makes an important contribution to greater
social justice and equity by reducing the gap between the
"have's and the "have not's".
 It tries to achieve more equitable distribution of resources
and attain a level of health for all the citizens of the world
that will permit them to lead a socially and economically
productive life.
Cont…
 If not all can be served, those most in need should have
priority.

 Equity must be ensured through the development of a

sound PHC infrastructure.

 Equity must be ensured in the allocation of funds,

materials, and human power.
Cont…
 For better equity in the distribution of health human power,
an incentive system must be developed to encourage health
personnel to work in rural areas.

 There should be equity in training opportunities for health

workers.

 Health services should be accessible and affordable

2. Individual and community self-reliance
 Personal responsibility for their own and their
families’ health
3. Inter-relationship of health and development
Development: - Definition is multi-dimensional process
involving changes in structures, attitude and institutions as
well as the acceleration of economic growth, reduction of
inequality and eradication of total poverty.

Role of Health in Development

 Health makes a fundamental contribution to a country's
economy
 Better health among adults means an improved work force
 As health improves productivity increases.
 The PHC strategy
1. Change in the Health Care System
 Total coverage with essential health care
 Integrated systems
 Involvement of communities
 Use and control of resources
 Redistribution of existing resources
 Reorientation of health human resources
 Legislative changes
 Design, Planning & management of health system
Cont…
2. Individual and Collective Responsibility for Health
First aspect- is a political issue
 Decentralization of decision-making

Second aspect - self-realization

 Personal responsibility for their own and their families’ health.

For both aspects it is important to have Informed and motivated

public
Cont…
3. Inter-sectoral Action for Health
Practical Action for this is:
 Attention of over all economic development.
 More consciously and directly towards the maximization of
health.
 Sharpening awareness at the community level, District,
Regional etc.
 The Components/Elements of PHC
 Health Education
 Provision of Essential Drugs
 Immunization
 MCH/FP
 Treatment of Common Diseases & Injuries
 Adequate Supply of Safe Water & Basic Sanitation
 Communicable Disease Control
 Food Supply And Proper Nutrition
Additional Elements Incorporated after Alma-Ata
 Oral Health
 Mental Health
 The use of traditional Medicine
 Occupational Health
 HIV/AIDS
 ARI
 PHC in Ethiopia
PHC activities in Ethiopia, which formally began in 1980s,
include the following:
 Education on the prevailing health problems and methods of
preventing and controlling them.

 Locally endemic diseases prevention and control.

 Expanded program on Immunization

Cont…
 Maternal and child health including family planning

 Essential drugs provision

 Nutrition promotion of food supply

 Treatment of common diseases and injuries

 Sanitation and safe water supply

Major problems in the implementation of PHC in
Ethiopia
 Absence of infrastructure at the district level.
 Difficulty in achieving inter-sectoral collaboration.
 Inadequate health service coverage and mal-distribution for
available health services.
 Inadequate resource allocation.
 Absence of clear guidelines on how to implement PHC
 Presence of culturally dictated harmful traditional practices
 Unscientific beliefs and practices in Ethiopia.
Cont…
 Absence of sound legal rules to support environmental health
activities.
 Weak community involvement in health
 The future of PHC will depend on our ability to alleviate most
of the problems mentioned above unless we provide viable
solutions to the obvious problems of the past we can never be
sure of the future.
Millennium Development Goals (MDGs)
 In the United Nations Millennium Summit in 2000, 147
countries adopted MDGs
 Eradicate extreme poverty and hunger by half relative to
1990
 Achieve universal primary education
 Promote gender equality and empower women
 Ensure environmental sustainability
 Reduce child mortality by two thirds relative to 1990
 Improve maternal health, including reducing maternal
mortality by three quarters relative to 1990
 Prevent the spread of HIV/ AIDS, malaria and other
diseases
 Develop a global partnership for development
Goal 1 Eradicate extreme poverty & hunger
Target 1: Halve, between 1990 and 2015, the proportion of
people whose income is less than $1 a day

Target 2: Achieve full and productive employment and decent

work for all, including women and young people

Target 3: Halve, between 1990 and 2015, the proportion of

people who suffer from hunger
Goal 2: Achieve Universal Primary Education

Target: Ensure that, by 2015, children everywhere, boys and girls

alike, will be able to complete a full course of primary
schooling

Goal 3: Promote Gender Equality and Empower Women

Target: Eliminate gender disparity in primary and secondary
education, preferably by 2005, and in all levels of education
no later than 2015
Goal 4: Reduce Child Mortality

Target: Reduce by two thirds, between 1990 and 2015, the under-
five mortality rate

Goal 5: Improve Maternal Health

Target 1: Reduce by three quarters, between 1990 and 2015, the
maternal mortality ratio
Target 2: Achieve, by 2015, universal access to reproductive
health
Goal 6: Combat HIV/AIDS, Malaria and Other Diseases

Target 1: Have halted by 2015 and begun to reverse the spread of

HIV/AIDS
Target 2: Have halted by 2015 and begun to reverse the incidence
of malaria and other major diseases

Goal 7: Ensure Environmental Sustainability

Target 1: Integrate the principles of sustainable development into
country policies and programmes and reverse the loss of
environmental resources
Target 2: Reduce biodiversity loss, achieving, by 2010, a
significant reduction in the rate of loss
Cont…
Target 3: Halve, by 2015, the proportion of the population
without sustainable access to safe drinking water and basic
sanitation
Target 4: By 2020, to have achieved a significant improvement
in the lives of at least 100 million slum dwellers

Goal 8: Develop a Global Partnership for Development

Target 2: Address the special needs of the least developed
countries, landlocked countries and small island developing
states
Target 2: Develop further an open, rule-based, predictable,
non-discriminatory trading and financial system
Cont…

Target 3: Deal comprehensively with developing countries’ debt

Target 4: In cooperation with pharmaceutical companies, provide
access to affordable essential drugs in developing countries
Target 5: In cooperation with the private sector, make available
the benefits of new technologies, especially information and
communications
The Millennium Development Goals with Health-Related
Indicators
The Millennium Development Goals with Health-Related
Indicators

Goal 1: Eradicate extreme poverty and hunger

 Prevalence of underweight children under five years of age

Goal 4: Reduce child mortality

 Under-five mortality rate
 Infant mortality rate
 Proportion of 1-year-old children immunized against measles

Goal 5: Improve maternal health

 Maternal mortality rate
 Proportion of births attended by skilled health personnel
Cont…
Goal 6: Combat HIV/AIDS, malaria and other diseases
 HIV/AIDS prevalence among young people aged 15 to 24
 Condom use rate of the contraceptive prevalence rate
 Number of children orphaned by HIV/AIDS
 Prevalence and death rates associated with malaria
 Proportion of population in malaria risk areas using effective malaria
prevention and treatment measures
 Prevalence and death rates associated with tuberculosis
 · Proportion of tuberculosis cases detected and cured
 under Directly Observed Treatment, Short course (DOTS)
Cont…
Goal 7: Ensure environmental sustainability
 Proportion of population using solid fuels
 Proportion of population with sustainable access to
improved water source, urban and rural
 Proportion of urban population with access to improved
sanitation

Goal 8: Develop global partnerships for development

 Proportion of population with access to affordable essential
drugs on a sustainable basis
The Twenty-Year Health Sector Development Plan
(HSDP)- (1996-2015)
The focus will be on preventive and promotive aspects of care
with:
 Health Education,
 Reproductive Health Care,
 Immunization,
 Better Nutrition
 Environmental Health and Sanitation receiving prominence.
Cont…
 The six-tier health delivery system will be changed into four
tiers.
 The administration is decentralized, democratized and
participatory.
 At the base of the pyramid will be the primary health care
units, serving a population of about 25,000 with five satellites
community health posts (CHP) and a series of gradual referral
hospitals at the top.
Four-Tier Health Delivery System
 Primary Health Care Units
 District Hospital
 Regional Hospital
 Specialized/Teaching Hospital
Cont…
 The expected outcome of the intervention is the reduction of
the burden of disease
 The health sector programme is designed for a period of 20
years.
 Its main goals are the building of basic infrastructure for the
provision of standard facilities
 supplies the development and deployment of an appropriate
health human power for a realistic and equitable PHC delivery
system are the grass root level
 Components of HSDP
1. Service Delivery and Quality of Care
2. Health Facility Rehabilitation and Expansion
3. Human Resource Development
4. Pharmaceutical Services
5. Information Education & Communication (IEC)
6. Health Sector Management & MIS
7. Monitoring and Evaluation
8. Health Care Financing
 Health Policy of Ethiopia
 uses decentralization and democratization as a tool to address
the problem of under privileged rural people

 has been realized after formulation of health sector

development program
 HSDP I (1997/8 -2002)
 HSP II (2003 -2005)
 HSDP III (2005/6 -2009/10)

 Health Extension Program (HEP) has been implemented

almost through HSDP-III

310
 Health Extension Program
 defined package of basic and essential promotive, preventive
and selected high impact curative health services

 introduced in recognition of failure of essential services to

reach communities in remote areas.

 have been customized to meet the needs, demands and

expectations of the pastoralist, agrarian and urban population.

 most important institutional framework for achieving MDGs

311
 Principles and Concepts of HEP
 is based on the concept and principles of PHC.

 It is designed to improve the health status of families,

 with their full participation, using local technologies and the
community's skill and wisdom.

 is similar to PHC in concept and principle,

 except HEP focuses on households at the community level, and it
involves fewer facility-based services.

312
 Philosophy of HEP
 The philosophy of HEP is that if the right knowledge and skill
is transferred to households they can take responsibility for
producing and maintaining their own health.

 HEP is the main vehicle for bringing key maternal, neonatal

and child health interventions to the community.

313
 Objectives of HEP
 shifting health care resources from predominantly urban to
rural areas,

 improving access and equity of essential health services at the

village and household levels,

 ensuring ownership and participation among community

members,

314
 Cont…
 promoting gender equality,

 improving the utilization of peripheral health services

 by bridging the gap between communities and health facilities
through Health Extension Workers (HEWs), and

 reducing maternal and child mortality and to promote an

overall healthy lifestyle.

315
 Health Extension Workers (HEWs)
 are cadres responsible for implementation of HEP packages

 are deployed to health post to serve every 5000 people.

 every health post is being staffed by two female HEWs

 who provide 16 major packages under four components

316
 Components of HEP

1. Disease Prevention and Control

 HIV/AIDS and other sexually transmitted infections (STIs) and TB
prevention and control,
 Malaria prevention and control, and
 First Aid emergency measures

2. Family Health
 Maternal and child health,
 Family planning,
 Immunization,
 Nutrition, and
 Adolescent reproductive health
317
 Cont…

3. Hygiene and Environmental Sanitation

 Excreta disposal,
 Solid and liquid waste disposal,
 Water supply and safety measures,
 Food hygiene and safety measures,
 Healthy home environment,
 Control of insects and rodents, and
 Personal hygiene

4. Health Education and Communication

 Health education and communication

318
 HEALTH CARE FINANCING
Health Care Financing: - refers to mechanisms of raising resources
for health care services.

Sources of Health Care Finance

 Public and Quasi-Public
 Private
 International Organizations

Public and Quasi-Public Sources

 General taxation
 Deficit financing
 Earmarked taxes
 Social insurance
 Lotteries and betting
Cont…
Private Sources
 Private health insurance
 Employer-finance schemes
 Charity and voluntary contribution
 Community-financing and self-help
 Direct household expenditure
 User fees/changes
 Co-payments
 Excess payments

International Organizations
 WHO
 UNICEF
 UNFPA etc.
A Glimpse of Financial Regulations and Fiscal Practices in
Ethiopia
Ethiopian Fiscal or Budget year
 Begins Hamle 1 (July), and budgetary allocations must be
used within the budget year period after which any leftover, if
any, is required to be returned to local finance Department.
Prominent Government Bodies in Administration at finance
in Ethiopia
 Ministry of Finance (MDF)
 National Committee for central planning, presently called
Ministry for Economic Development and Cooperation
Cont…
Ethiopian Budget Cycle
 Budget preparation (proposals)
 Budget compiling and approval
 Budget execution
 Budget Audit (closing)

Types of Budgets
 Revenue Budget (from surpluses, takes, etc)
 Expenditure Budget
 Capital Budget
 Recurrent Budget
Cont…
Types of Budgeting
 Line-item budgeting
 Programme budgeting

Government Bodies in Budgeting

 Ministries, Authorities, Commissions, Corporation, etc
 Ministry of finance
 National committee for Central Planning (NOW MEDAC)
 Council of Ministers
 Council of representatives (formerly called parliament,
recently shengo)
Line-Item Budgeting in Ethiopia
Ethiopian government prepares its revenue and expenditure
budgets using Line item budgeting. In line-item budgeting a
fixed amount of money is allocated to a given item and
expenditure above the allocation or transfer of allocation,
whole or in part, from item to another is impossible without
prior request and authorization from government.

There are three major line of item:

 1000: Revenue items
 6000: Items for recurrent budget
 8000: Item for capital budget
Six Major Items of Recurrent Budget
6000: Recurrent Budget
6100: Expenditure for social service
6200: Non-social contract based service
6300: Expendable (consumable) goods and equipment
6400: Support and contribution
6500: Purchase of vehicles and machines
6600: Military construction works and equipment
Cont…
8000: Capital Budget
8100: Surveying, surveillance, Design and Engineering works
8101: Preliminary studies and surveillance
8102: Engineering works and technical designs
8200: Building construction and related works:
8201: Residential Buildings
8205: Transport equipment (vehicles. etc)
8300: Labor and running expenses:
8301: Management and Control
8304: Financial expenses:
8400: Capital Transfer:
8401
8403
Some of Important items of expenditure (selected)
6100:
6101 Salary for civil workers
6102 Allowance for civil workers
6200:
6201 Public utilities (electric, postage, water, etc)
6202 Travel, transport, and per diem
6203 Printing and Information
6204 Campus repair and security
6205 Vehicle repair and maintenance
6206 Rent
6210 Various contracts services
Cont…
6300:
6301 Food
6302 Medical and Pharmaceutical equipment's
6303 Teaching equipment and stationery
6304 Clothes bed and matters (uniforms)
6305 Fuel and oil
6306 Expendable office supplies
6307 Other consumable goods
6500:
6501 Motor vehicle purchase
6502 Purchase of various equipment
Forms Involved in Government Financial and Fiscal
Activities
Budgetary Forms:
Ñ/uT/1 : Are used for preparation of budget proposals
Ñ/uT/2 :
Ñ/uT/3/1: Announcement of budgetary allocation for recurrent
expenditure
Ñ/uT/3/2: Announcement of budgetary allocation for capital
expenditure
Ñ/uT/4: Form used for transfer of budget
Ñ/uT/5: Request form additional budgetary allocation
Cont…
Ñ/uT/6: Announcement of budgetary allocation for regional
branch offices.

Accounting forms:
Ñ/uT/11/1: Payment request from budgetary allocation (salary
and allowances)
Ñ/uT/11/2: Request for payment (recurrent expenditures)
Ñ/uT/11/3: Request for payment (capital expenditure)
 Models Dealing with Property and Finance
 Model 6: Payment voucher for unsettled advance
 Model 19: Model for confirming delivery of items/drugs
 Model 20: Model for requesting items/drugs
 Model 21: Model for approving item delivery by person in
authority
 Model 22: Model for issuing items/drugs
 Model 30: Official receipt for collecting money
 Model 33: Model used to request and pay salary of staff
Line Item for Budget
Once approved-money can not be transferred from one category
of item to another
61 Item for salaries
6101: Salary for civil servants
62 Line item for different services (Budget)
6201: Item for postage, water, telephone and electric bill
6202: Transport and per diem
6203: Information advertisement and publication
6204: Equipment, building and fence repair and maintenance
6205: Repair and maintenance of vehicles
6206: For rent
63 Line item for expendable items
6301: For food
Cont…
6302: Drugs and equipment
6304: For clothing
6305: Fuel for cars
6306: For stationers
6307: Contingency fund for which item not set for
64 Item for supportive fund
6401: For individual support
6402: For organization support
6403: For international organization support
65 Line item for non-expendable items
6501: For parches of cars
6502: For parches of other equipment including animal
 Hospital Management
The word Hospital is derived from the Latin word hospitium,
which means a place where guests are received. Hospitals are
important part of the health system.
 Provide complex curative care,
 Act as a first, second, or last referral level,
 Centre for transfer of knowledge and skill,
 Constitute essential source of health information, and
 Use more than half of the national health resource in terms of
budget and highly skilled manpower.
Types of Hospitals
General hospital: provides a wide range of acute-care services
for all age groups.

Special Hospital: provides care for those in specific age groups,

e.g. children, those with a specific disease, e.g. TB, cancer &
those of one sex, and obstetrics.
 Hospitals can also categorized by level of services provided.
These different levels are based on the following criteria:
 Case mix i.e. type of patients seen.
 Technical capacity i.e. availability of technology.
 Availability of skills i.e. type and number of staff.
Cont…
Tertiary hospital
 Complex problems are dealt with.
 More than ten clinical specialties.
 Most specialized staff and technical equipment.
 Bed size ranges from 300 to 1500 depending on the population
to be served.
Regional hospital
 Five to ten clinical specialties.
 Bed size ranging from 200 to 800.
 Intermediate number of specialized staff and technical
equipment.
Cont…
District hospital
 Less than five specialties or in some countries only GPs.
 Limited laboratory services.
 Bed sizes from 50 to 300.
Strengthening the Various Units of the Hospital
Clinical Units

OPD: This is the most important unit of the hospital. Its proper
functioning is an indicator of the performance of the hospital.
Public image of the hospital is influenced by the OPD. The
OPD should be strengthened in the following way:

 The provision of adequate supports services such as pharmacy,

x-ray and laboratory facilities.

 It should be staffed with adequate skilled and experienced

specialists, doctors and nurses.
Cont…
 Continuous supervision to ensure improved quality of care.
 Improved management process to facilitate patient flow.
 Proper organization to facilitate coordination of referrals,
admissions and discharge

Inpatient: It is a place where the healing process is to be

accelerated through improved quality of care. Normally
patients should be admitted only from the medical point of
view. However, at present admission for social reasons is
increasingly becoming a serious problem.
Cont…
The inpatient management should be organized in such a way to
accelerate discharge while at the same time improving the
quality of care. Effort should be done to reduce the length of
stay through:
 Improved diagnosis, treatment and follow up.
 Regular and intensive nursing care.
 Continuous supervision and monitoring of patient condition.
 Increasing the availability, reliability and sensitivity of
laboratory services.
 Improved reliable drug supply.
 Avoiding late admission, observation, diagnosis, treatment and
delayed discharge.
 Initiation strict mechanisms of control and accountability.
 Developing system of continuous in service training.
Cont…
Supporting Service Units
The clinical support service units such as laboratory, pharmacy,
x-ray, pathology and others require professional skills and
equipment. Usually they are under managed or unaccountable.
There is a need for placing strong management in these units.
The other service units such as catering, pottering,
maintenance and security are usually fragmented and in most
case not efficient. The most improperly managed in many
hospitals is the registration office. This unit requires properly
trained staff in data handling and very close supervision is
required
 Improving Quality of Care
 Adopting standard case management guideline for diagnosis
and treatment of common diseases. This assures treatment
according to acceptable scientific standards. It saves cost and
avoids unnecessary treatment.
 Supervision of health workers by senior staff members using
the standard management guideline.
 Improving effectiveness of basic training of health workers.
 Setting up a system of continuing education.
 Developing better communication between providers and
users of service.
 Quality Assurance
There are many models of quality assurance practices in different
countries among these are:
Hospital Accreditation: this is a voluntary scheme where by
independent assessors check compliance with standards and
award grades.
Medical Audit: an examination of medical practice to make sure
it reaches defined standards.
Community Satisfaction: this is community perception the
quality of care.
Total Quality Management: this is a management system, which
tries to insure that all aspect of the work contributes and
reinforces to quality improvement.
Cont…
Every hospital needs to plan for quality assurance.

The following activities are useful:

 Improves hospital service.
 Make effective treatment.
 Improve efficiency by reducing duplication and waste.
 Set standards and guidelines.
 Monitor quality of service.
 Identify and prioritize what can be improved.
 Define problems.
Cont…
 Identify who will work on the problems.
 Analyze and study problems.
 Suggest solutions.
 Decide and implement suggestions.
 See how things have changed and decide what to do next.
 Raise quality assurance awareness among health workers
Technology Assessment
 Technology has an effect on the quality of care provided.

 Technology includes devices, drugs and procedures.

 The choice of hospital technology depends on:

 Appropriateness
 Cost of servicing and maintenance.
 Comparing costs to benefits.
 Hospital Resource
 Problems seen in hospitals are related to the availability and
use of resource.

 Important points are resources allocations this means the

distribution of resources to hospitals in the health sector.

 The allocation of hospitals by type, region and population size.

 The allocation is to be based on equity and cost effectiveness

consideration.
Cont…
Resource Management: the use of resource must be analyzed by
comparing inputs to outputs to make assessment of efficiency.
Several hospitals could be compared to assess efficiency.

Resource Generation: hospital cost is rising rapidly. Despite

large amount is appropriated still additional resource is needed
to finance hospitals. However in setting hospital fee or
increasing in public sector the following points need to be
taken:
 It should not limit access to the poor and the vulnerable
groups.
 It should be linked to quality of service.
Cont…
There are certain recommendations to the pricing principles in
hospitals.
 Regular adjustment of fee levels with inflation is necessary.
 Price should be decentralized according to regional variations
and income levels.
 Hospitals should be allowed to retain some of the fee it
collects and use it to improve the quality of care.
 Patient income should be used as criteria for exemption from
payment.
 Patients who use services with important externalities such as
treatment of certain communicable diseases e.g. Tb, leprosy
should be exempted from payment so that the use of such
services is encouraged.
 Hospital budget should be flexible to need. Budget
preparation, approval, release and use should be on time.
 Hospital Information
 Hospital data should be collected timely and regularly.
 They should be used for sound decision making.
 Performance should be evaluated using performance
indicators.
 Out patient attendance
 Admissions by age, sex, location and so on
 Discharges by cause and severity of illness.
 Deaths
 Bed days occupied
 Average length of stay
 Turn over interval
Cont…
 No. of major operations
 Delivery admissions
 Laboratory tests
 No. of referrals
 Budget allocation
 Expenditures
 No. and type of manpower
 Requirement for effective hospital function
 National hospital guidelines
 Training of competent health professionals
Cont…
 Training in hospital management of hospital administrators,
medical directors and matrons
 Rational use of resource and generating adequate finances.
 Effective leadership based on established criteria.
Structure of the Hospital
The Health System Pyramid
A hospital is an important part of the national health system.
 Central Hospital
 Regional Hospital
 District Hospital
 Primary Health Care Units (PHCU)

The criteria for determining which level provides care in based

on epidemiology i.e. frequency and severity of disease and
unit of cost of providing services at each level.
Cont…
 At the bottom of the pyramid should be the most frequently
occurring conditions that are less expensive to treat where as
at the top are the rarest conditions that are most expensive to
treat.
 Normally for economic efficiency and improved quality of
care patients should be encouraged to use lower levels of the
pyramid.
 A hospital should provide the kind of care and support, which
cannot be handled at the lower level.
Cont…
 However it is difficult in poor countries as patients by pass to
over load hospitals. Some of the reasons are as follows:
 Poor health service coverage.
 Very low quality of care provided at the primary level.
 Meagre resource allocation to PHCUs.
 Inadequate laboratory and diagnostic facilities.
 Poor perception of quality of care by the people.
 Hospital competing for resource and patients with PHCUs
 Strengthening PHCUs
 This is the major role of a hospital .
 A hospital is to be organized in such a way it supports the
lower health units instead of becoming an obstacle to its
development by competing for resources, patients and health
activities.
 Strengthening PHCUs improves quality of care, reduces cost,
and leads to improve economic efficiency.
 Strengthening the lower PHCUs is achieved mainly through:
 Referral
 Training
 Appropriate supervision
 Referral System
Development of the Referral Mechanism
 In this case patients are referred upward for higher level of
care and are referred backward for continuity of care.

 It is a two-way system. Referral has an advantage in

strengthening lower health units in the following way:
 It decreases patient suffering and improves survival.
 It serves as a process of continuous and permanent learning
for the health worker.
 It improves the performance of PHCU by delegating
responsibilities for follow up of cases e.g. Tb. and leprosy
cases.
Cont…
 It increases community confidence in the health service. For a
hospital to serve as a referral unit it must have
 Staff with diagnostic and treatment skills other than those
available at the primary level.
 The technical resources to make full use of the skills of the
hospital staff e.g. adequate laboratory facilities.
 The possibility for hospitalizing referred patients.
 The organizational and management capability.
 Referral should make a difference for the referred patient in
terms of improvement of patient condition. A referral is
useful only if something can be done at the hospital that
cannot be done at the periphery.
Problems in the Development of a Better Referral
 Poor quality of care provided at the lower levels of care.
 Inadequate coverage of health services.
 Inadequate resource allocation to PHCUs.
 Low quality of care perceived by the population.
 Distance and financial inaccessibility.
 Inadequate flow of information between the hospital and the
lower levels.
 Lack of organizational and management links between the
different levels of care.
 Organizational and management weakness at the OPD in
terms of processing and coordinating referrals.
 Improving the Referral System
 The hospital activity should be integrated with the PHCUs.
 Referral policy should develop based on local circumstances.
 Referral criteria should be set. For major disease categories.
 Prepare manuals, information and training.
 Improve hospital facility and management capacity to support
the referral policy.
 Improve reliability and quality of services provided at the
primary level.
 Design referral system in consultation with communities and
local administration.
Cont…
 Building and expanding PHCUs. Constructing large hospitals
with out the required number of PHCUs leads to inefficiency
and lack of effectiveness.
 The tendency to build large hospitals must be seen from the
issue of cost, equity and sustainability.
 Normally the process of follow up of patients is basically the
responsibility of health centers. Hospitals treat the sick and
injured until the patient goes to the health center for follow up
and continuity of care.
 The Hospital Business
Hospital direct services involving physical contact with the
patient such as surgery, bedside nursing, and examinations and
treatments must be performed in the hospital. Conversely
support services such as laundry, food and some housekeeping
and maintenance may be obtained from commercial and other
community or regional sources.

Resources for Patient Care

Available to the manager are the tangible resources of money,
buildings, equipment, materials, and information, the
intangible resource of time, and the human resource.
 Management is applied by people to the other resources so that
they interact to provide patient care.
Cont…
The functions of management have to be applied on the hospital's
diagnostic, treatment, supportive and patients' services areas:
 Medical department
 Nursing department
 Clinical laboratory department
 Radiology department
 Pharmacy department
 Social Service department
 Medical Records department
 Catering department
 Wards
 Obstetrical department
 Rehabilitation department
Cont…
 Surgical department
 Outpatient-Emergency department

Support Services Areas include:

 Personnel department
 Public Relations department
 Business department
 Admissions department
 Purchasing department
 General stores department
 Genera service department
 Engineering and Maintenance department
 Laundry department
 Housekeeping department
 District Health Management
District is taken to be crucial point because it is a meeting point
for top down and bottom up decisions
Definition
District is defined as geographical area that is small enough for
health and related social problems to be properly understood
and appropriate action to be taken and large enough to permit
the deployment of essential technical and managerial skills for
planning and management of programme while awarding over
dispersal of skills.
Advantageous Characteristics of a District
 It is geographically compact and all parts of the area are
usually accessible often within one day
 It is administratively defined unit which is replicated in all
parts of the country
 It is managed by few officers, thus facilitating liaison and
coordination between the local representatives of different
sectors and NGOs
 It is often has one main town which is a focus of
communication and trade with associated roads and transport
services
 It has small enough population to facilitate the co-ordination
and management of health services available
 It is usually a large enough unit to have specialized supporting
technical and managerial staff, with sufficient skills
District Health System
 Based on PHC
 Self-contained segment of national health system
 It comprises well defined population living within a clearly
delineated administrative and geographical area
 It includes all institutions and individuals providing health
care
 Consists of a large variety of interrelated elements that
contribute to health in
 Homes
 Schools
 Work places and
 Communities through Health and other related sectors
 It provide a fully comprehensive range of promotive,
preventive, curative and rehabilitative health activities
Cont…
Essential characteristics of a district health systems based on
PHC are:
 Equity
 Accessibility
 Emphasis on Promotion and Prevention
 Inter-sectoral Action
 Community Involvement
 Decentralization and integration of health programmes
Factors Leading to Development of District Health
Management in Ethiopia
 A major weakness in the provision of adequate support for
local health and health related activities in the absence of a
well established local organization for health.
 A gap in the organizations structure unique to the health
sector. The need to develop and strengthen this center of
decision-making mechanism at district level.
The Woreda Health Management Organization
The woreda health management organization designed to be
responsible to:
 Zonal regional Health office –vertically
 Health committee of the woreda development committee –
horizontally
 The members of the health sub-committee
 Administrator/responsible person for woreda
 Representatives of the Ministry of Agriculture
 Representative of the Ministry of Education
 Representative of the Water Commission
 Community organization chairman
 Peasant Association
 Labour Union
Cont…
 Women’s Association
 Urban Dwellers Association (UDA)
 Health professionals association
 NGO representatives
 Woreda health manager secretary
 Woreda health management team
 Responsible for giving technical guidance to all health
institutions in the woreda
 The team includes:
 The coordinator of the woreda health management
 Heads of hospitals
Cont…
 Heads of health centres
 Representatives of NGO
 The woreda health management coordinators
 Two coordinating offices are established
 Health programs coordinating office
 Training and service coordinating office
BUSINESS PROCESS REENGINEERING (BPR)
     Evolution of Management
Early perspectives
 Management is an integral part of Human's life and has been
with us from time immemorial.
 The concept of management is as old as the human race.

- The activities of hunting safeguard the family from attacks, the

activities of fishing, etc. all subtle ingredients of management
and organization.
 The basic form of management and organization exist since the
beginning of organized human activity.
 Cont…
The era of Industrial Revolution
- Mid - 1700s movement from the cottage industry to the factory
system has developed and this gave birth to the industrial
revolution in Europe (especially in England).
- Mid - 1800s in America shift from agrarian society to industrial
society.
Cont…
Driving Forces
Three forces, separately and in combination, drive the changes.
These are 3C’s : Customer, Competition and Change.

a. Customer
 The dominant force in the seller-customer relationship has
shifted from seller to customer
 A mass market no longer exists in real term.
 Customer has upper hand; Because:
- They have choices.
- The role of technology - access to information.
- Customers (business customers and individual consumers)
know what they want, know what they want to pay for it, how
to get it as their needs and preferences.
Cont…
b. Fierce Competition
 The shift in customer-seller relationship and the technology
changes the nature of competition.
 The phenomenon of mass marketing has broken.
 The traditional competitive strategies: lower price and highest
quality, and best service become standard for almost all
competitors.
Cont…
c. Change
- Change is becoming constant.
- The pace and nature of the change also changing
- The nature of change becomes fast, flexible
-  Today nothing is constant or predictable
- The customer demand, the technology, and the competition.
       Reengineering Revolution
Reengineering is
 Responding to the reality in order to live within today's new
business world.
 The Solution for today's business environment as Adam Smith's
ideas were to the industrial revolution for the last two years.
 Shift from organizing Job around task to process based and
hence job titles and organizational arrangements (departments,
divisions, work units, and so on) cease to matter, instead,
process based managing business overtook.
Reengineering Defined
 The concept of BPR was successfully popularized by two sets of
consultants: Hammer and Champy (1993) and Davenport
(1993).
 Reengineering means
-  Challenging the status quo
-  'Starting over'
-  A 'fresh start', 'blank sheet' start.
It does not mean
- Trying to repair or improve the existing system so that they
work better. But abandoning long established procedures and
looking afresh.
-  Trying to make incremental improvement such as 10%, but
dramatic change such as 10X.
Cont…
Generally, reengineering is creation, reinvention of new way
of doing business, recreation of the different new form
organization. “ The fundamental rethinking and radical redesign
of business processes to achieve dramatic improvement in
critical, contemporary measures of performance, such as cost,
quality, service level, and speed". (Hammer, 1993).
This definition contains four key words.
A.  Fundamental
B.  Radical
C.  Dramatic
D.  Processes
 These are pillars or building blocks of BPR.
A.  Fundamental
 A fresh start, blank sheet review.
 Starts challenging the status quo by asking basic questions
about company and how they operate:-
 Why do we do what we do? And why do we do it the way
we do?
- Reject all rules and assumptions that underlie the
foundation of your organization. Reengineering takes nothing
for granted. It ignores what is and concentrates on what
should be.
-   Reengineering begins with no assumption and given
- You unlearn all rules, assumptions, principles and
techniques that underlie the way your organization is
organized and been conducted, but start afresh.
Cont…
Reengineering first determine what a company must do, then how
issue comes latter
B. Radical
 Radical redesign means getting to the root of things.
 Not improving the existing system to make better.
 Not superficial change, or modification
 Throwing away the old
 Disregarding all existing structures and procedures and
inventing completely new ways of doing work.
 Reengineering is about business reinvention - not business
improvement, business enhancement or business modification. 
 
 C. Dramatic

 Reengineering is not about making marginal or incremental

improvement but about achieving quantum leaps in
performance.

 It is about bringing drastic cost reduction, (e.g. not 10% but

10X) dramatic improvement in quality, speed and service level.
 
D. Processes

 It is only business processes the object of reengineering

 It is processes not the organizations, or parts of it such as
department, or work units to be redesigned in reengineering.
 Organizations: It can not (and should not) reengineer the
department or work unit, but business processes have to be
redesigned.
 Processes mean simply - a set of activities together produce a
result of value to a customer. 
Who Needs BPR?
The experience shows that there are three kinds of companies
/organizations have to undertake reengineering.

First
- Companies that find themselves in deep trouble.
E.g. costs are higher than business sales and competitions;
customers are dissatisfied about the services the company offer
and openly rail against it etc.

Massive public (customer) dissatisfaction about service that the

company is offering
- These organizations (companies) have no choice, no time.
Cont…
Second
 Organizations that are not yet in trouble, but whose management
has the foresight to see trouble coming.

E.g. Even though they are in Healthy financial condition attractive

(good) profitability level, but management see that new
competitors entering the market, changing customer
characteristics, changed regulatory (policy), change in economy
development, the technological advancement etc.
Cont…
Third

 Organizations that are in peak condition.

They have no discernible difficulty, either now or in the horizon,
but their management is ambitious and aggressive.
 They need reengineering as an opportunity to further
their lead over their competition, to keep their position.
 What Reengineering is not?
It is very important to note the following forms and manifesto of
change programs that are different from reengineering

Reengineering is not automation or computerization. It is true

that
-  computerization can speed work up;
- Automation can faster jobs accomplishment.
Cont…
a. Reengineering is not restructuring or downsizing

 Restructuring or downsizing has relevance with reducing

capacity to meet current, lower demand.
 Reduce size to match the demand at time of fewer market.
 It means doing less with less. However, reengineering mean
doing more with less.
-  Downsizing reduce costs by getting rid of people and jobs,
reengineering reducing cost by eliminating non value-adding
activities, non-value adding steps, stages, and hand offs and
non-value adding rules and procedures.
Cont…
b. Reengineering is not reorganizing, delayering or flattering
an organization
- Although, reengineering produces flat organization, simply
delayering or flattening an organization doesn't mean doing
reengineering.
 The key issue here is on process structure, not organizational
structure.
 The problem facing organizations do not result from their
organizational structure, but their process structures.
c. Reengineering is not quality improvement, Total Quality
Management (TQM)
It is true that quality programs and reengineering shares a number
of common themes.
 They both recognize the importance of processes.
 They both start with the needs of the process and customer.

However, the two programs are fundamentally different.

 Quality program work within the framework of the
organization's existing processes to make them better.
 It is incremental improvement to process performance.
 Cont…
Reengineering is:
- Breakthroughs, not enhancing existing process but discarding
them and replacing them with entirely new ones.
- Starting over
- Beginning again with a clean sheet of paper
- Inventing new approaches to process structure.
- Rejecting the assumptions inherent in Adam Smith's industrial
paradigm (division of labor, hierarchical control) and
search for new models of organizing work
- Reengineering is a new beginning.
 TQM Versus BPR
No. Factor TQM BPR
1 Level of change Small incremental Tremendous, radical
2 Staring point Existing process Clean state
3 Frequency of change Continuous/open- One-time/discrete
ended
4 Time required Short Long
5 Participation Bottom-up Top-down
6 Scope Narrow, within Broad, across
functions functions
7 Risk Moderate or none High risk
8 Primary enabler Statistical process Information
control technology
9 Type of change Cultural Cultural/Structural
 Cont…
d. Reengineering is not decentralizing or outsourcing
- The objective of outsourcing is to reduce costs (the market can
perform more efficiently).
- Reengineering have no assumption (old thought); but determining
what the organization need to do and the best way to do it.
- Decentralization has advantage to reduce costs of bureaucracy and
centralization by devolving power and authority so that the
decentralized entity able to make decision, find solution for local
problem by themselves rather than waiting center. However, it
doesn't mean providing breakthrough performance, it entails the
existing system doing better (it exist with old system).
- Decentralizing might mean sending down the inefficient,
problematic... System procedures, rules, etc to let they use of
these. It is pouring soured wine into new bottles'
Cont…
Reengineering is not about incremental change, but dramatic
change

- Reengineering is not about making incremental improvement in

performance (e.g. 5% reduction of cost, 10% sales increment)
but is about achieving quantum leaps in performance (e.g. 5
times cost reduction, 10 times sales growth)
- The hallmark of Reengineering is achieving a dramatic break
through performances in cost reduction, quality, service level,
speed of delivery, etc.
 Cont…
Exercise
1.Using the 3cs, analyze them against your respective
organization. What do they mean to your organization?
2.From the three kinds of companies finding reengineering in
which category do you categorize your organization? Why?
Does your organization need Reengineering? Explain the
reasons why?
3.What experience you get from the kinds of change programs
that are not reengineering (such as automation, down sizing etc)
 Reengineering: the New World of Work Overview
The Basic Characteristics and Common features of Reengineered
Business Processes
 Several jobs are combined into one
 Worker make decisions
 The steps in the process are performed in a natural order.
 Non-value adding activities and handoffs in the process are
eliminated
 Processes have multiple versions
 Work is performed where it makes the most sense
 Checks and Controls are Reduced
Cont…
The Implication of Reengineered Processes on the
Organizational System
 Work units change-from functional departments to process
 Jobs Change-from simple tasks to multi-dimensional work
 People's roles change-from controlled to empowered
 Job preparation changes - from training to education
Cont…
 Focus of performance measures and compensation shifts -
from activity to results
 Advancement /promotion/ criteria change-from performance
to ability
 Values changes - from protective to productive
 Managers change - from supervisors to coaches
 Organizational structures change from hierarchical to flat
 Executives change - from storekeepers to leaders.
 The Business System Diamond
Business Processes

Jobs and Values

Structure and Beliefs

Management and
Measurement System
Cont…
 These all four points on the business system diamond have to
fit together. If they do not fit together, the new form of
reengineered organization does not exist: it will be flawed and
misshapen.
Fundamental Techniques and Tools for Getting Reengineering
to Happen
-   Issues going to be discussed are:-
1.   Who will reengineer?
2.   Rethinking business processes
3.   Redesigning Business Processes
4.   The hardest part of reengineering
5.   The enabling role of Information Technology

These are the key notions in reengineering.

 Who will Reengineer?
 Before coming to enter into the object of reengineering, 'what'
of the reengineering process, it is better to look at 'who' will
reengineer.
 The principle: First "who"... then "what“ - The key route to
success
 How organizations select and organize the people who actually
do the reengineering is key factor to the success to be achieved.
 These are BPR - implementing arrangements.
-   Leader
-   Process owner
-   Reengineering team
-   Core staff (reengineering Czar)
- Steering committee (optional)
Rethinking Business Processes for Redesigning
 Business Process: the object of Reengineering
 It is business processes to be reengineered, not organizations
or parts of it.
 Departments, divisions and units - parts of organization are
not the object of reengineering.
 This is one of the mistakes done in reengineering efforts;
i.e., trying to apply reengineering where it can not fit-what
cannot be reengineering.
 Cont…
è Organizations mistakenly attempt to redesign departments or
basing their reengineering work on existing functional
department such as administration and finance department,
sales department or manufacturing department.
 You cannot reengineer an organization. We cannot and do
not reengineer organizational units - departments divisions
etc..
è Departments, e.g. sales department, are shorthand for a
collection of people. Trying to reengineer this department
(collection of people) means nothing.
 Reengineering is for a business process and nothing else.
It is the work that people are doing in those department
subjects for reengineering: How the work is done, how
outputs are created from inputs.
 Business process
A collection of activities that takes one or more kinds of inputs and
creates an output that is of value to the customer.
 Process mean a group of related tasks that together create value
for a customer.

Making the processes visible for reengineering

Processes are not something that we invent. Every organization
has processes.
 Processes are what companies do
 They correspond to natural business activities, but are
fragmented and obscured by organizational structure.
 They are invisible and unnamed.
 Characteristics of Process
Two main Characteristics

• They have customers /internal or external/

• They cross organizational boundaries. (they normally
occur across or b/n organizational subunits.)
• There are two main types of processes. Core and
support.
Cont…
a. Core processes
 The reason an organization exists.

 Concentrate on satisfying external customers.

 They start with customer request and works towards their

satisfaction.

 They directly add value in a way perceived by the customers of

the business.
Cont…
b. Support process
 Are internally focused, such as the process of recruiting, hiring
and training new employee and making payment

 Enable the mission oriented units to do their work.

The two main types of Business Processes

Management

Support Processes
 Cont…
Exercise
 Who are your organization’s external customer?

 What outputs/products or services does your organization

offers to meet the needs of its external customers?

 Identify and list the core business process of your organization.

 Identify and list main support process of your organization.

 Ways of Making them Visible for Reengineering
 Giving them names that express their beginning and end state
 Using process map
 Choosing the processes to reengineer
 Understanding the current process
-   It needs to know something about the current process.
 What it does?
 Why it does that way.
 How well (or poorly) it performs and the critical
issues that govern its performance.
 Who are the customers? How customers get served?
 The processes inputs, out puts,
Cont…
 Analyzing rather than understanding the most frequently
committed errors in Reengineering.
There two problems with analyzing
 It is a waste of time

è As the objective is not to improve the existing process, what is

the value of creating exhaustive documentation? It is just going
to be thrown away.
 Reengineering means reinventing the way you work.
Cont…
 It can inhibit the change

- Too much time spent on analysis and documentation can

cripple the imagination.
-    You lose sight the forest for the trees.
-  After spending a lot on studying the existing process, it
begins to make sense to you
 It doesn't look so bad.
 Your cognitive processes inevitably adapt to the business
process you are analyzing.
 As a result, you lose your ability to think clearly and
originally.
 And get comfortable with the process; you will be incapable of
proposing radical change to it.
Points to consider when understanding the current process
a.  Begin with customers' need
-   Understand what the process customer need.
- The goal of redesigning a process is to create a business
process that better meets customer needs.
 Therefore, it is critical that the team truly understand the
customers' need.
 This involves
 Identifying the process's customer.
 Studying customers' goals, problems, and how the process
has been serving them.
 Identifying the customers' real problem?
 What problem do they have with the output of the process
(e.g. quality, delivery time)
Cont…
b.  Understand the current process itself
- Once the team understands what the process customer need
about out put of the process, then the next is to understand
what the process currently provides.
- The goal is to understand the what and the why, (not how of
the process).
- Knowing what and why, the team can begin its redesign
with a blank sheet of paper.