1. Dr. Waddah D’emeh

2.  Health Services — specific activities undertaken to maintain or improve health or to prevent decrements of health  Health Systems —formally linked HSOs, possibly including financing arrangements, joined together to provide more coordinated and comprehensive health services

3.  " Any collection of persons, materials, procedures, ideas or facts so managed & ordered that in each case the combination of parts makes a meaningful whole that at achieving organization objectives.”  The process of organization implies the arrangement of human & nonhuman resources in an orderly fashion to make a meaningful whole that accomplishes organizational objectives.

4.  Health Services Organizations — entities that provide the organizational structure within which the delivery of health services is made directly to consumers, whether the purpose of the services is preventive, acute, chronic, restorative, or palliative

5.  Management : The act of any individual who guides others through a series of routines, procedures, or practice guidelines.  The manipulation of people, the environment, money, time, and other resources to reach organizational goals  To forecast and plan, to organize and to command, to coordinate, and to control

6.  “Health System Management is defined as purposeful & efficient use of health system resources and to get members of the health team coordinated to work harmoniously in order to achieve the desired common Goals and Objectives.”

7.  Four main elements of management:  It is a process or a set of interactive and interrelated ongoing functions and activities  It occurs in a formal organizational setting (either a single organization or a system)  It involves accomplishing organizational objectives  It involves achieving these objectives through people and the use of other resources

8.  Managers:  Are formally appointed to positions of authority in organizations or systems  Enable others to do their direct or support work effectively  Have responsibility for resource use  Are accountable for work results  The variety of managers in these settings can be identified by the level of the organization at which they work  Classification schemes typically identify managers as senior-level, middle-level, and supervisory or first- level  The primary differences between levels of managers are the degree of authority and scope of responsibility

9.  Following : is a complementary set of actions taken by individuals that contribute to problem solving, task attainment, and evaluation using healthy and assertive behaviors to support those who are leading or managing.

10.  Leadership : Using individual traits and personal power to interact constructively to resolve problems.  Leadership is the art of getting work done through others willingly.  Leaders are in the front, moving forward, taking risks and challenging the status quo.  Not a job title but person behavior.

11.  Leader: Anyone who uses interpersonal skills to influence others to accomplish a specific goal  Manager: An employee who is responsible and accountable for efficiently accomplishing the goals of the organization

12.  Clarify the organizational structure  Choose the means to achieve goals  Assign and coordinate tasks  Evaluate outcomes and provide feedback

13.  Achieve consensus within the group about goals  Maintain structure that facilitates accomplishing goals  Supply information that helps provide direction and clarification  Maintain group satisfaction, cohesion, and performance

14. Six distinguishing traits of integrated leader– managers: 1. They think longer term. 2. They look outward, toward the larger organization. 3. They influence others beyond their own group. 4. They emphasize vision, values, and motivation. 5. They are politically of good judgment. 6. They think in terms of change and renewal.

15.  Communication and relationship management  Knowledge of the health care environment  Leadership  Professionalism  Business skills

17.  First-level manager  Middle-level manager  Top-level manager

18.  Organizational culture — the pattern of shared values and beliefs, along with associated behaviors, symbols, and rituals, that is acquired over time by members of HSOs/HSs  Organizational philosophy —an HSO’s/HS’s explicit and implicit view of itself and what it is  Provide services that are unique in society  Humanitarian in nature 18

19.  The set of social and technical functions inherent in the management process. Includes:  Planning  Deciding prospectively what to do to achieve organizational missions and objectives  Organizing  Managers must design an organization that is capable of achieving plans  Staffing  Involves a wide range of centralized activities, programs, and policies related to acquisitions, retention, and maintenance of human resources 19

20.  Directing  Social-behavioral in nature and focuses on initiating action in the organization or system  Controlling  Involves gathering information and monitoring activities and performance, comparing actual results with expected results to take corrective action  Decision-Making Function  Intertwined with all other functions

22. 3. 2. 4. 1. 5. ORGANISING PLANNING DIRECTING STAFFING DECISION MAKING CONTROLLING

23.  Three types of skills:  Technical skills — abilities to use the methods, processes, and techniques of managing, includes planning for a new service or facility, devising and operating an incentive-based compensation program, arranging the financing of long-term debt, etc.  Interpersonal skills — abilities to get along well with others, to understand them, and to motivate and lead them in the workplace, knowing how to communicate visions and preferences, how to handle negotiations, and how to manage conflicts  Conceptual skills — abilities to visualize the complex interrelationships in a workplace—relationships between people, between departments or units, between various organizations in a system, and even between an organization or system and its external environment, allows managers to envision the places and roles of their organizations or systems in the larger society 23

24.  Political Competence — dual abilities to accurately assess the impact of public policies on the performance of the senior-level managers domain of responsibility and to influence public policy making  Commercial Competence — ability of managers to establish and operate value-creating situations in which economic exchanges between buyers and sellers occur  Governance Competence — includes ability to establish a clear vision for the organization or system, to foster a culture that supports the realization of the vision, to assemble and effectively allocate the resources to realize the vision, to lead the organization through various challenges, and to ensure proper accountability to multiple stakeholders 24

25.  Henry Mintzberg concluded that management work can be described meaningfully in terms of three roles that all managers play:  Interpersonal Roles — figurehead, leader, and liaison  Informational Roles — monitor, disseminator, and spokesperson  Decisional Roles — entrepreneur, disturbance handler, resource allocator, and negotiator  All of Mintzberg’s managerial roles are integrated, with the manager practicing a combination of these roles according to their level, responsibilities and work environment 25

26.  Designer Role —managers establish intentional patterns of relationships  Strategist Role — managers participate with governing bodies to establish missions and organization-wide or system-wide objectives and then develop and implement suitable strategies capable of achieving the missions and objectives  Leader Role — only effective leadership will encourage and help staff be motivated to fulfill established missions and accomplish objectives 26

27.  The set of skills and knowledge that managers need in order to do their management work  National Center for Healthcare Leadership Competency Model  Applies to first, middle, and senior-level managers  Contains 26 specific leadership competencies organized by three domains of transformation, execution, and people  The importance of specific competencies varies with the manager’s position in the organizational hierarchy; degree of authority; scope of responsibility; and number, types, and skills of subordinates 27

29.  The study of leadership has followed several paths, but it has not yet produced a definitive theory of effective leadership  Theories of leadership can be classified into one of three basic approaches: 1. Inherent traits, skills, abilities, or characteristics explain why some people are better leaders 2. Particular behaviors might be associated with successful leaders 3. An integrative approach that focuses on how leaders, followers, and the situations in which they find themselves interact and work 29

30. The skills are multiple and intersecting each other. Developing self awareness Managing Stress Solving Problems creatively

31. *Coaching*Self awareness *Counseling* Gaining power *Listening*Empowering others *Identifying cause *Diagnosing poor *Appropriate strategies performances *Resolving conflicts*creative environment *Solving problems creatively *Rewarding/accomplishment Communicating supportively Motivating Others Managing Conflict Gaining Power & Influences

32.  Management science like any other professions develops a theory base from many disciplines, such as business, psychology, sociology, and anthropology.  The father of scientific management called Frederick W. Taylor was a mechanical engineer in the Midrale and Bethleheim Steel Plants in Pennsylvania in the late 1800s. Frustrated with what he called "systematic Soldiering" where workers achieved minimum standards doing the least amount of work possible,  Taylor postulated that if workers could be taught the "one best way to accomplish a task," productivity would increase.

33.  Traditional "role of thumb" means of organizing work must be replaced with scientific methods.  In other words, by using time and motion studies and the expertise of experienced workers, work could be scientifically designed to promote greatest efficiency of time and energy.  A scientific personnel system must be established so workers can be hired and promoted based on their technical competence and abilities.

34.  Workers should be able to view how they fit into the organization and how they contribute to overall organizational productivity. Could be accomplished by the use of financial incentives as a reward for work accomplished.  The relationship between managers and workers should be cooperative and interdependent, and the work should be shared equally.  Note: The result of scientific management was productivity and profits rose dramatically.

35.  Henri Fayol (1925) first identifies the management functions of planning, organization, command, coordination, and control.  Luther Gulick (1937) expanded on Fayol's management functions in his introduction of the "seven activates of management;" planning, organizing, staffing, directing, coordinating, reporting, and budgeting.

36.  Mary Parker Follett, the first theorist to suggest basic principles of what today would be called "participative decision making, or participative management." In her essay "the giving of orders" (1926), Follett espoused her belief that managers should have authority with, rather than over employees. Follett stated that to do so, a need existed for collective decision making.

37.  1960, Douglas McCregor theorizing that managerial attitudes about employees (how managers treat those employees) can be directly correlated with employee satisfaction. He labeled this theory X and theory Y. Theory X managers believe that their employees are basically lazy, need constant supervision and direction, and are indifferent to organizational needs. Theory Y managers believe that their workers enjoy their work, are self-motivated, and are willing to work hard to meet personal and organizational goals.

38.  Management can be conceptualized as an input-conversion- output process  Inputs— human and physical resources and technology ( Manpower, Money, Materials, Minutes (Time), Knowledge, Techniques, Skills)  Outputs — missions and objectives  HSOs/HSs are formal organizational settings where outputs are produced (mission fulfilled and objectives accomplished) through conversion of inputs (resources)  Managers and the management work that they perform are the catalyst that converts inputs to outputs  HSOs/HSs and their managers interact with their external environments; this makes HSOs/HSs open systems because inputs are obtained from their external environment and outputs go into that environment 38

40. Labor Material Machines Management Capital Goods or Services OUTPUT INPUT Transformation Process Feedback

42.  Integration of Health Programs/Departments.  Overload of work & Distribution of work.  Changing Health needs/Health Demands.  Improvement of health care delivery system by applying modern management methods and techniques.

43.  A process of deciding how the future should be better than present.  For proper utilization of health system resources.  For improvement of health services.  National Health Planning defines health problems, identifies unmet needs, surveys resources, establishes priority goals which are realistic & feasible, projects administrative action for accomplishment.

44.  A blueprint for any action: (What, How, When, Who to do?)  5 Components:  Identification & Prioritization of Health Problems.  Policies Formulation.  Objectives establishing.  Budget allocation.  Time frame.

45. Planning (P) Implementation (I) Evaluation (E)

46. Step-1. Analysis of the Health Situation.  Collection, assessment, interpretation of information and Demographic data through surveillance.  Epidemiology of diseases, Mortality and Morbidity data  Medical Care Facilities, Technical Manpower, Training facilities.  KABP of population about disease prevention and cure.

47. Step-2. Establishing Objectives & Goals.  Reduces haphazard activities, uneconomical use of funds, poor performances.  General Objectives/procedures at upper level become more specified and detailed at lower levels.  Resources are directed properly taking into nature of objectives (Short Term/Long Term).  Input-Output analysis are being used for defining goals, objectives and targets.

48. Step-3. Assessment of Resources  In terms of men, money, material, time, knowledge, techniques and skills.  A balance is maintained what is required, what is available and how to be utilized.

49. Step-4.Fixing Priorities  Prioritizing objectives/activities in order of importance/ magnitude.  A Good Health manager is a PAPA(Plans well, Analyses critically, Prioritizes Activities and Act timely/promptly).  Formulation of alternate plans.

50. Step-5. Writing of formulated Plan  Preparation of detailed plans.  Working guidance to all those responsible for execution eg. Health Care Providers.

51. Step-6. Programming and Implementation.  Effective organization like staffing, coordination, communication etc.  A standard operating procedures for specific tasks and roles.  Selection, training, motivation, supervision and monitoring of the manpower  Proper management functions are required here.

52. Step-7. Monitoring: “Tracking the tract”.  Following the activities during their implementation whether they are proceeding according to predefined schedule or not.  Keeping the track of the course of activities and taking corrective action before gross failure/deviation occurs.

53. Step-8.Evaluation: To assess/measure the degree of achievements of the stated objectives and targets.  Assessment of adequacy, efficiency, effectiveness etc of final outcomes of a health activity.  Important for feed-back, opportunity for correction of deficiency and gaps during phase of implementation.

54. Implement Integrated Programs Operate & Monitor Programs Selection of Best Program Collect date for Evaluation Formulation of Health Problems Prioritization of Health Problems Establishing Objectives & Goals Train & Orient personnel Designing alternative programs with solutions Integrate best programs and develop plans Formulation of Individual Solutions YES Evaluate degree of achievements in TOG(Satisfactory?) NO

55. Operate & Monitor Programs(Execution) Assessment of Resources Collect date for Evaluation Assessment of Health Situation & Problems (Analysis of Health Data) Establishing Objectives & Goals Designing Time Frame Prioritization of Health Problems (Felt Needs) YES Evaluate degree of achievements in TOG(Satisfactory?) NO