Health Services Management Compiled by: Kiddus Yitbarek, 2022

 Every health team must work closely with

Chapter Six
other partners (teachers, leaders and
Implementation others).

Section Two: Leading a Health Team Of all the above essential features of a

At the end of this section, you would be health team, enhancing community

able to: participation and establishing relationship

with the community require rigorous effort
 Define health team and leadership
by all the team members. In majority of the
 Explain the term power and its forms
cases the team must work with the community
 List and distinguish various types of
rather than telling people what to do. To the
leadership theories
extent possible, the health team working in a
 Define motivation
community should help people to identify
 List and distinguish theories of motivation
their own problems and give priority.
Part I: Leading
Good team work is a result of several
Health Team contributing factors. Some of the managerial
measures you can take to improve the quality
A health team is a group of health workers
of your team work are setting and having
composed of different categories and working
objectives with team members, encourage
together to provide health care service to
personal relationships, distribute task,
individuals and families in a community. Its
coordinating activities and apply sound
members include all those working together in
organizational principles.
any health services organization (technical,
support staffs, village health workers etc). Leadership
Depending on the type of team the main
Leadership is a continuous process of
function of a health team is to respond to the
directing and influencing the work related
needs of the community.
activities of group members towards
Types of health team depend on the work and accomplishment of goals in a given situation.
specialty in which the team is engaged. Some
Leader is an individual in a team influencing
common properties of all health teams are:
group activities towards goal formulation and
 A health team usually should have a base. achievement.
 It works in a defined area with an agreed
Influence is the means by which people
frame work (i.e. catchment area).
successfully persuade others to follow their
 A health team must be able to enhance
advice, suggestion, or order.
community participation to achieve its
purposes. Power is the potential to exert influence.

Power

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Health Services Management Compiled by: Kiddus Yitbarek, 2022

Influence is important to the leadership is also largely determined by the position of

process and to the success in the leader role. the leader along the organizational structure.
This implies that the essence of leadership is
D. Expert Power
the ability to influence followers. To have
This power is derived from having knowledge
influence one must have power which
valued by the health services organization or
determines the ability of the leader to
influence his/her followers. Leader’s team, such as expertise in problem solving and
critical tasks. Unlike the above types
effectiveness largely depends on his/her
discussed, this type of power can’t be given
ability to identify the different types of
by the organization.
power they possess and apply them in
appropriate circumstances. E. Referent Power

Major types of power It results when an individual engender

admiration, loyalty and emulation to the
A. Legitimate power (formal power or
extent that he/she gains the power to
authority)
influence others. In this case the team
It is derived from a person’s formal position
members follow the advice, suggestion or
in an organization. It exists because
order of the leader not to offend him/her as
organizations find it advantageous to assign
he/she is identified as ‘good person’. This
certain power to individuals so that they can
power can’t be given by the organization.
do their jobs. Managers at different level
F. Connection Power
have different degree of legitimate power.
For such sort of potential to influence “it is
B. Reward Power
not what you know, it is who you know” that
It is based on the leader’s ability to reward
matters. As the relationship with influential
desirable behaviors. This power stems partly
people can happen both inside and outside the
from the legitimate (position) power granted
organization, connection power cannot fully be
to the leader within the formal organizational
granted by the formal structure alone. So, a
structure. Rewards include pay increases,
mixture of level along the organizational
promotions, recognition of accomplishment
hierarchy and personal factors are involved in
and status symbols such as office size and
this case.
location.
G. Information Power
C. III. Coercive power
is based on the data available in the hands of
Coercive power is based on the leader’s ability
the leader. Similarly, the information power
to punish people or prevent them from
of a health team leader is made up of both
obtaining desired rewards. This type of power
organizational and personal factors.

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Health Services Management Compiled by: Kiddus Yitbarek, 2022

Effective leaders are those who a. Basic leadership style and

b. Management grid model
 Can translate power into influence,
a. Basic leadership styles
 Understand the source of their power and
act accordingly, There are 5 different styles described under
 Understand the costs, risks and benefits the basic styles:
of using each kind of power and
Autocratic leadership style: Decision
 Are able to recognize which to use in
making is traditional where the leader
different situations and with different
makes and announces decisions. The role
people.
of subordinates is to carry out orders
Leadership Theories without an opportunity to materially alter
decisions made by the leader. Therefore,
1. Trait theories of leadership
these leaders employ a unilateral or
These theorists assume that traits, whether
exploitative technique where supervision
of intelligence, personality or ability, are
and control is tight.
associated with effective leadership. The
Consultative leadership style: Leaders
theory attempts to determine a list of
using this style of leadership consult
distinctive characteristics accounting for
followers about the decisions they make
effective leadership. Moreover, the theory
but stops short of permitting full
states that leaders are effective because of
participation of subordinates. Hence, the
the characteristics they were born with.
leader presents decisions but invites
2. Behavioral leadership theory questions and suggestions so that
understanding and acceptance are
Behavioral theories of leadership are based
enhanced.
upon the belief that great leaders are made,
Participatory leadership style: Leader
not born. Rooted in behaviorism, this
presents tentative decision for discussion
leadership theory focuses on the actions of
and is ready to subsequently make some
leaders, not on mental qualities or internal
changes on the decision based on the feed
states. Hence, it is assumed that if specific
backs from the discussion. This leader
behaviors were associated with leadership
makes greater use of participation and
success, then programs could be designed to
less use of authority than autocratic and
train people to practice those behaviors.
consultative styles.
According to this theory, people can learn to
Democratic leadership style: Democratic
become leaders through teaching and
leaders work towards team building for
observation.
consensus and full participation.
In this group of leadership theories we will Consequently, the manager with this style
discuss two commonly mentioned theories. of leadership presents problems, initiates

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Health Services Management Compiled by: Kiddus Yitbarek, 2022

open discussion, defines limits and asks He/she doesn’t interfere and participates
the team to make communal decision. in decision making with no more influence
Laissez – faire leadership style: The than other members of the group making
leader permits followers to function leader and follower roles indistinguishable.
within limits set by leader’s superior.

b. Managerial grid model (1, 1) Impoverished style: In this style,

managers have low concern for both people
The Managerial Grid Model (1964) is a
and production. Managers use this style to
behavioral leadership model developed by
avoid getting into trouble. The main concern
Robert Blake and Jane Mouton. This model
for the manager is not to be held responsible
gives an infinite opportunity for adjusting
for any mistakes, which results in less
leadership styles based on two very important
innovative decisions.
factors,
(9, 1) Production oriented (produce or
 concern for employee (y) and
perish) style With a high concern for
 concern for production (x)
production, and a low concern for people,
managers using this style find employee needs
unimportant; they provide their employees
with money and expect performance back.
Managers using this style also pressure their
employees through rules and punishments to
achieve the company goals.

(5, 5) Middle of the road style Managers

using this style try to balance between
company goals and workers' needs. By giving
some concern to both people and production,
managers who use this style hope to achieve
suitable performance but doing so gives away

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Health Services Management
a bit of each concern so that neither
production nor people needs are met.
(1, 9) Country Club style: This style has a
high concern for people and a low concern for
production. Managers using this style pay
much attention to the security and comfort
of the employees, in hopes that this would
increase performance. The resulting
atmosphere is usually friendly, but
necessarily that productive.
(9, 9) Team style (Task manager): In this
style, high concern is paid both to people and
production. Managers choosing to use this
style encourage teamwork and commitment
among employees. This method relies heavily
on making employees feel as a constructive
part of the organization. This style is
considered to be ideal although the theorists
recognize that it may be difficult
implement in some work situations.
3. Situational leadership theories
The different styles of leadership can be
applied based on prevailing conditions at spot
time. The situational leadership theories
attempt to determine the appropriate style
for various situations. Three of
theories are discussed below.
a) Contingency theory
This theory focused on specifying situations
in which certain leader styles would be
particularly effective. The hypothesis behind
this theory is that effective leadership is
contingent on whether the elements in a
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Compiled by: Kiddus Yitbarek, 2022
particular leadership situation fit the style of
the leader.
Three important situational dimensions
 Leader-member relations: the degree
of confidence the subordinates have in
the leader. It also includes the loyalty
shown by the leader and the leader’s
attractiveness.
not
 Task structure: the degree to which
the followers’ jobs are routine as
contrasted with non-routine.
 Position power: the power inherent in
the leadership position.
b) Leadership Continuum model
This theory attempts to explain effective
leadership as interplay among:
 the leader’s relationship behavior
 the leader’s task behavior
to
 the follower’s readiness level
Therefore, the theory focuses on followers
as the key situational variables.
c) Path goal model
This theory postulates that the most
successful leaders are those who increase
these subordinate motivation by charting out and
clarifying the paths to high performance. It
states that leaders are effective because of
their impact on subordinates’ motivation,
ability to perform effectively and
satisfaction.
In this model there are four categories of
leader behaviors:
1) Directive leadership
Health Services Management
 tells followers what to do and how to
do it
 requires that they follow rules and
procedures
 schedules and coordinates the work
2) Supportive leadership
 Friendly and approachable
 Exhibits consideration for the status,
well-being and needs of followers
3) Participative
 Consults followers
 ask for opinions and suggestions and
considers them
4) Achievement oriented
 establishes changing goals for
followers
 expects excellent performance
 exhibits confidence that they will
meet expectations
Part II: Motivation
Job Performance: is a focused behavior
or purposeful work. Jobs exist to achieve
specific and defined results (outputs) and
people are employed so that organizations can
achieve those results.
Motivation, ability, and environment are the
major influences over employee performance.
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 Motivation: the desire to achieve a goal or
a certain performance level, leading to
goal-directed behavior.
 Ability: having the skills and knowledge
required to perform the job
 Environment: having the resources,
information, and support one needs to
perform well
Motivation is:
The reasons for people’s actions, desires, and
needs.
One’s direction to behavior, or what causes a
person to want to repeat a behavior.
These are forces within (endogenous) or
outside (exogenous) the individual or group
that initiate, direct, and sustain action
towards a predetermined goal or sets of
goals.
• Motivation is an inner drive that directs a
person’s behavior toward goals.
• A goal is the satisfaction of a need
• A need is the difference between a
desired state and the actual state.
Leadership style influence level of motivation.
Intrinsic Vs Extrinsic motivations
Intrinsic motivation: is the self-desire to
seek out new things and new challenges, to
analyze one’s capacity, to observe and to gain
knowledge. It is driven by an interest or
enjoyment in the task itself, and exists within
the individual rather than relying on external
pressures or a desire for reward.
Health Services Management Compiled by: Kiddus Yitbarek, 2022

Extrinsic motivation: is the performance of Maslow put forward a theory that there are
an activity in order to attain a desired five levels of human needs which employees
outcome. It is an opposite of intrinsic need to have fulfilled at work. In this
motivation. motivational theory, there are two
fundamental premises. These are:
Comes from influences outside of the
individual.  Only needs not yet satisfied influence
behavior and an adequately fulfilled
Where do people get the motivation to carry
need is no more a motivator.
out and continue to push with persistence?
 People’s needs are arranged in a
Theories of Motivation
hierarchy and once a need is fulfilled
These theories are of two groups: another emerges and demands
fulfillment.
i. Need-based (Content) theories and
ii. Process-based (behavior) theories. Therefore, for every employee of an
i. Need-based (Content) theories organization all of the needs are structured
into a hierarchy and only once a lower level of
These groups of theories seek to determine
need has been fully met, would a worker be
how managers motivate people by studying
motivated by the opportunity of having the
their needs.
next need up in the hierarchy satisfied.
a. Maslow’s Hierarchy of needs

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Health Services Management Compiled by: Kiddus Yitbarek, 2022

b. Alderfer’s ERG theory employee if not present but would not in

themselves actually motivate employees to
Alderfer reduced the number of need levels
work harder (hygiene factors). Motivators are
to three. He agreed with Maslow that each
more concerned with the actual job itself. For
individual’s needs are arranged in a hierarchy.
instance how interesting the work is and how
Employees are motivated by these 3 needs:
much opportunity it gives for extra
 Existence needs refers to our concern responsibility, recognition and promotion.
with basic material existence motivators.
Hygiene factors are factors which ‘surround
Implies physiological and safety needs of
the job’ rather than the job itself. For
Maslow (i.e material and physical).
example a worker will only turn up to work if
 Relatedness needs refers to the
an organization has provided a reasonable
motivation we have for maintaining
level of pay and safe working conditions but
interpersonal relationships. Satisfied by
these factors will not make him work harder
meaningful social and interpersonal
at his job once he is there.
relationship (affection and social needs).
 The opposite of satisfaction is not
 Growth needs refers to an intrinsic
dissatisfaction, it is no satisfaction.
desire for personal development.
 The opposite of dissatisfaction is not
Satisfied by an individual through creative
satisfaction, it is no dissatisfaction.
and productive contributions (esteem and
 Managers must be concerned with one set
self actualization).
of factors to minimize dissatisfaction and
another to help people achieve
satisfaction
ii. Process-based theories

These theories focus on how individuals’

expectations and preferences for outcomes
that are associated with or resulting from
their performance actually influence
performance. Three of these are discussed
below.
c. Herzberg’s two factor theory
a) Expectancy theory
Herzberg argued that there were certain
The expectancy theory says that individuals
factors that an organization could introduce
have different sets of goals and can be
that would directly motivate employees to
motivated if they have certain expectations.
work harder (Motivators). However, there
were also factors that would de-motivate an

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Health Services Management Compiled by: Kiddus Yitbarek, 2022

This theory is based upon the following three  Punishments decrease a behavior.
beliefs.  Neither Rewards nor Punishments
extinguish a behavior.
 Expectancy: Employees have different
1. Positive reinforcement:
expectations and levels of confidence
Used to increase the desired behavior. If the
about what they are capable of doing.
praise immediately follows the positive
Management must discover what
behavior, the employee will see a link between
resources, training, or supervision the
the behavior and positive consequences and
employees need. Whether the person
will be motivated to repeat similar behaviors.
believes that high levels of effort will
lead to outcomes of interest such as
2. Negative reinforcement:
performance or success.
Is also used to increase the desired behavior.
 Instrumentality: The degree to which the
Involves removal of unpleasant outcomes once
person believes that performance is
desired behavior is demonstrated.
related to secondary outcomes such as
rewards. Management must ensure that 3. Extinction
promises of rewards are fulfilled and that Is used to decrease the frequency of
employees are aware of that. negative behaviors. The removal of rewards
 Valence: The depth of the want of an following negative behavior. Negative
employee for extrinsic [money, promotion, behaviors are demonstrated because they are
free time, benefits] or intrinsic being inadvertently rewarded
[satisfaction] rewards. It is the value of 4. Punishment
the rewards awaiting the person as a It is another method of reducing the
result of performance. Management must frequency of undesirable behaviors.
discover what employees appreciate. Punishment involves presenting negative
consequences following unwanted behaviors.
Giving an employee a warning for consistently
being late to work is an example of
punishment.

In using reinforcement/punishment:
 Don’t reward all employees equally.
b) Reinforcement theory  Inform employees what to do
This theory is based on the assumption that  Tell employees when and what they are
much of motivated behavior is a learned one. doing wrong.
 Rewards increase a behavior.

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Health Services Management Compiled by: Kiddus Yitbarek, 2022

 Punishment/reward in ways visible to

co-workers.
 Be fair.
c) Equity theory

When people feel fairly or advantageously

treated they are more likely to be motivated;
when they feel unfairly treated they are
highly prone to feelings of disaffection and
de-motivation.

The way that people measure this sense of

fairness is at the heart of Equity Theory. It
states that individuals assess whether reward
are equitable distributed within an
organization. Moreover, people calculate the
ratio of their efforts to the rewards they
receive and compare them to the ratio they
believe exist for others in similar situations.

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