Introduction To LMG

Patient service
Into to L&M
1 GN(PhD) 1/10/2024
Who is the most important person in the hospital?
Why?
The Patient
2 Into to L&M GN(PhD) 1/10/2024
Types of patient services
Clinical
– Diagnosis
– Treatment
– Inpatient care
– Therapeutic communication e.t.c
Non-clinical
– Diet
– Safety
– Comforting environment
– Welcoming with courtesy
– Effective communication E.t.c

Organization
A formally structured collection of

– People with different knowledge and skill
– Structure: hierarchy, relationship, work culture, and
politics
– Systems: Interactions, working environment
– Processes: service delivery meanness
– Functions: human resources, financial activities
– Legal personality of internal rules and procedures
Into to L&M GN(PhD) 1/10/2024 4

Management
Attaining organizational goals
through effective and efficient use
of organizational resources:
o People
o Time
o Space
o Materials
o Money

Management
cont’d
Efficiency
Getting work
done through
others Effectiveness
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1/10/2024
Management
(cont’d)
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Effectiveness Efficiency Efficient, but not Effective, but
Effective not Efficient
Degree of achieving The use of minimal Goals not achieved Wasted Resources
the stated organization resources to produce a
goal desired volume of
output.

Forecasting
Projecting the economic, social,

political, and technological
trends for the future of the
facility and the resources that
will be available to it

Concepts of Management
– Effectiveness
– Efficiency
– Economy of Scarce Resources
– Work Relation
– Information

Principles of
Management
1. Management by Objectives
2. Learning From Experience
3. Division of Labour
4. Substitution of Resources
5. Convergence of Work
6. Functions Determine Structure
7. Delegation
8. Management by Exception
9. Shortest Decision-Path

What Is It Like to
Be a Manager?
– Long hours
– Most time spent in oral communication
– Fast-paced and requires a high energy
level to be successful
– Managers should not
o Put self-interest first
o Ask others to do things they
wouldn’t do
o Vent your frustrations
o Resist change

Successful Managers’ Attributes
– Personal Impact through Leadership

– Team-Building Skills
– Self-objectivity
– Analytic Thinking
– Creative Thinking
– Behavioral Flexibility
– Oral Communication
– Written Communication
– Resistance to Stress
– Tolerance of Uncertainty
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What make managers successful?
– Hard work
– Smart work
– Patience
– Out-of-box thinking
– Reading
– Ethical Consciousness
– Collaborative relationship
Referring To Management Theories
1. Pre-Classical management theory

2. Classical management theory
3. Contemporary management theory

Pre-Classical
Anything before 1900

1. Attila the Hun
2. Industrial Revolution
3. Adam Smith

Attila the Hun
▪ The Romans have done great things, but their time is past. What they
have done, we can do. We should rule the world
▪ Above all other traits, one who desires to lead must possess an
intrinsic desire to achieve substantial personal recognition and be
willing to earn it in all fairness
• Reward and recognition to motivate allies and cool down the enemies
o Make your enemies irrelevant
o Self-awareness and embodied potential
o Internal Desire
o Willingness
o Ethics

Henry R. Towne Charles Babbage
(1844 – 1924) (1792 - 1871)
Pre-classical:-Industrial Substitution of machines for
Revolution human power
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Pre-classical:-Adam
Smith (1776)
Division of Labor
– Breakdown of jobs into narrow and repetitive tasks increases
productivity
– Specialization of job

Classical Theory Approach and Features
Predict and control behavior in organizations
Models were military and the Catholic Church

Scientific management:-
Frederick W. Taylor
Functional specialization of managers’ duties
Maximize worker capacity and profits
Piece-rate Incentive systems for normal work

done during a day
Workers are motivated almost solely by wages
used the stopwatch, observation, measurement,

and scientific comparison

Scientific management :Frank &
Lillian Gilbreth
Time and Motion Studies to find the most

economical motion for each task to
enhance performance and reduce fatigue
1. Break down each action into
components
2. Find better ways to perform it
3. Reorganize each action to be
more efficient
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Scientific • Developed a task and bonus structure
management: Henry • The relationship of task to time
L. Gantt (1861-1919)
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The Administrative Approach
Henry Fayol (1841-1925):
Functions of management:
• Planning
• Organizing
• Staffing
• Leading
• Controlling
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Bureaucratic School: Max Weber
(1864-1920)
Bureaucracy and Organizational Structure
• Written rules
• Procedure
• Disciplinary actions
• Control
• Hierarchy of authority
• Fair evaluation
• Reward
• System of task relationships

Mary Parker Follett
• Negotiation
• Conflict resolution
• Power sharing

The Hawthorne Experiment:
Elton Mayo (1880-1949
• Employees would work hard if they believed
management was concerned and paid particular
attention to their welfare
• Values, desires, and needs may be more important
than physical conditions.
• The discovery of the social human

Behavioural
Science theories:
Abraham Maslow
Theory of motivation based

on the idea that individuals
work to satisfy unfulfilled
needs.

Behavioural Science theories :
Theories X and Y (Douglas
McGregor 1960)
Theory X: classical theory
• Pessimistic, negative view of workers
• Assumes
o Workers are irresponsible, unresponsive to
change, lack ambition, hate work, are lazy, will
do as little as possible, and are motivated only by
money.
o Managers must closely supervise, and people

must be carefully controlled and coerced into
working through reward and punishment

Theory Y: Modern
Management Theory
Optimistic, positive view of workers
• Capable of accepting responsibility, self-direction,
and self-control and of being imaginative and
creative(Not lazy)
• Motivated by wanting to do a good job and will do
well if the opportunity is presented
• Enjoy expending physical and mental effort in work
as much as play and rest
• Managers should allow the worker great latitude
and create an organization to stimulate the worker

Behavioral science theories:
Frederick Herzberg (1923 – 2000)
1. Motivation factors
• Job content
• Achievement
• Recognition
• Intrinsic rewards
2. Hygiene factors:
• Policies
• Pay
• Guidelines for administration
• Rules affecting job security
• Physical surroundings
• Nature of supervision

Behavioural Science theories:
Acquired – Needs Theory (David C McClelland) 1960
Need for achievement

Need for power
Need for affiliation

Equity theory: (J. Stacy Adams 1963)
A theory of motivation that suggests

individuals modify their behavior
based on perceptions of fair
treatment and equitable rewards

Goal – Setting theory (Edwin
Locke)
Results with higher achievement follow when

employees participate in goal-setting
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Behavioral science
theories:
Rensis Likert’s
theory
1. Exploitive-authoritative
2. Benevolent – authoritative
3. Consultative system
4. Participative group

Behavioral science theories:
Robert Blacke and Jane Mouton
Managerial/Leadership Grid

Contemporary
Approaches
1/10/2024
Contemporary
Approaches:
System’s Theories
Systems theory
• Views organizations as a unified,
purposeful system composed of
interrelated parts.
• Considers relationships inside and
outside the organization.
• The environment consists of forces,

conditions, and influences outside the
organization.

Contemporary Approaches:
Contingency Management
Assumes there is no one best way to manage.

• The environment impacts the
organization, and managers must be
flexible.
• The way the organization is designed, and
control systems selected depend on the
environment
• Technological environments change
rapidly, so must managers
Managing in Different and Changing Situations
Require managers to use different approaches
and techniques
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Managerial Roles
Interpersonal Informational Decisional

1. Entrepreneur
1. Monitor
1. Figurehead
2. Disturbance
1. Disseminator Handler
2. Leader
3. Resource
2. Spokesperson Allocator
3. Liaison
4. Negotiator
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40
Management level
Top level managers
Middle managers
First-Line managers
Managerial skills
Technical Skills Human Skill
Conceptual Skill Design Skill

Core skills and their use in the different levels
Managerial levels
Lower Middle Top
Conceptual skills
Human skills
Technical skills

Management Functions
Classical Updated
Management Functions Management Functions
Planning
Making Things Happen
Organizing
Meeting the Competition
Staffing
Organizing People,
Leading Projects, and Processes
Controlling
44
DIRECTING
leading, guiding, and motivating

employees to work effectively to
accomplish organizational goals and
objectives.
▪ Supervision
▪ Motivation
▪ Leadership
▪ Communication

Function Task
Supportive To counsel

To consult
Educative To set up learning relationship

To teach
Managerial To monitor administrative aspects

To monitor professional and ethical issues
To evaluate
WHAT IS CLINICAL SUPERVISION? 46

Expertise Experience Training Acceptability
Characteristics of clinical supervisors

LEADERSHIP
49 Leadership
Impacting, inspiring, and influencing

people willingly toward the achievement
of group goals through speaking,
listening, and acting in a way that
mobilizes self and others to realize visions,
possibilities, and dreams

50 Leadership….
– You can buy people’s time

– You can buy their physical presence at a given place
– You can even buy a measured number of their skilled muscular
motions per hour
– But you cannot buy the devotion of their hearts, minds, or souls.
You must earn these through your leadership skill.

51 Is leadership only the
concern of top managers?
“Leadership should be everyone’s

business..” Kouzes and Posner
(1993)

52
Competencies of Leaders
Leading yourself
• To lead others, firstly, we must lead ourselves.
• An important aspect of leadership is knowing yourself'.

Adair (1986:20)

53
The concern of Leaders in general
• Shaping the future

• Creating new realities

54 Transformation
– A fundamental shift in the deep orientation of a person, organization or

society such that the world is seen in new ways , new actions, and new
results

Reflection
"I believe that when you stop renewing and are no longer open to change
and the possibilities that continually unfold, you stop being alive and
are just getting through the years. Transformation doesn't happen
unless you're willing: It's your choice.“
— Oprah

Transformational Model of Leadership
A New Level of Thinking « Our current problems cannot be solved with the
same level of thinking which created them. »
Albert Einstein
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Emotional Intelligence

58

59
Emotional Intelligence Competencies

60 Styles of leadership
Benevolent Team
Leader Leader
(Y) (Z)
concern for
people
Laissez-faire Autocratic
Leader Leader
(L) (X)
1
concern for production → 9

61 Telling style (S1- High task, low relationship) with
followers who are unable and unwilling or
insecure about performing the task (R1).
Selling style (S2 -high task, high relationship) with

followers who are unable but are willing or
confident in performing the task (R2)
Situational
Leadership Participating style (S3 – low task, high relationship)
Theory with followers who are able but unwilling or
lacking in confidence in performing task (R3)
Delegating style (S4 – low task, low relationship

with follower who are both able and willing and
have confidence in performing the task (R4)
62
Leaders and
Managers Subject
Essence
Leader
Change
Manager
Stability
Focus Leading Change Managing Change
Have Followers Subordinates

Seeks Vision Objectives
Detail Sets direction Plans detail
Power Personal Charisma Formal Authority
Appeal to Heart Head

Energy Passion Control

63
Leaders and
Managers Subject
Dynamic
Leader
Proactive
Manager
Reactive
Persuasion Sell Tell
Style Transformational Transactional
Exchange Excitement for work Money for Work
Risk Takes risks Minimize Risks
Rules Breaks rules Makes rules
Conflict Uses conflict Avoid conflict
Direction New roads Existing roads
Blame Takes Blames others
blame/responsible

64
Leadership
VS
Leadership Management
Produces change and movement Produces order and consistency
Establishing direction Planning and budgeting
Management Creating a vision

Clarifying the big picture
Establishing agendas
Setting timetables
Setting strategies Allocating resources
Aligning People Organizing and Staffing
Communicating goals Provide structure
Seeking commitment Making job placements
Building teams and coalitions Establishing rules and procedures
Motivating and Inspiring Controlling and Problem Solving
Inspiring and energize Developing incentives
Empowering subordinates Generating creative solutions
Satisfying unmet needs Taking corrective action

Communication A Key to create Understanding

65
Communication.

66
Formal communication
Vertical communication
Horizontal Communication
Diagonal communication
An informal channel
– Commonly seen in an organization is often called the grapevine (i.e.,

rumors and gossip).

Modes of
Communication
1. Written communication
2. Oral communication
3. Nonverbal communication

Barriers of Communication
Poor Listening Psychological Environmental Semantic

Block Distractions Barriers

Planning : Starting at the Top
Clarify how the organization will

Strategic Plans serve customers and position
itself against competitors (2-5 years)
An inspirational statement of an
Vision organization’s purpose
(2 sentences)
Overall goal that unifies efforts toward

its vision, stretches and challenges,
Mission
and possesses a finish line and
71 time frame. Flows from vision.

Planning: Bending in the Middle
Specify how an organization will use

resources, budgets, and people to
Tactical Plans
accomplish goals within its mission.
(6 months to 2 years)
Management
by Develop and carry out tactical plans
Objectives

Finishing at the Bottom
Day-to-day plans for producing or

Operational
delivering products and services over
Plans
a 30-day to six-month period

Elements or function of human resource
management
 Acquisition of human resources:

Human resource planning
Selection
Recruitment
Orientation.
 Retention :
Performance appraisals
Placement
Training and development
Motivation and discipline.

Use of Burrhus Frederic Skinner’s behaviorism
theory to modify behavior
Behaviour is learned through operant conditioning and
associated with particular consequences
1. Positive reinforcement
✓ Strengthening behaviour
✓ holding positive reinforcement weakens behavior
2. Negative reinforcement
▪ Inhibiting undesired behavior like punishment
3. Extinction
▪ Extinguish the undesired behavior by removing a
positive reinforcer
4. Shaping
▪ selectively reinforcing behavior that is successively close
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Team
Building
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76 GN(PhD)
Team Vs Group
Team Group
Goal oriented Task oriented
Collective centre Individual centre
Participatory leadership Dictatorial leadership
Welcome differences Suppress differences
Take risk Avoid risk
Competition with outside Competition within

77
Failure in
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78 GN(PhD)
Ways to Build High
Performing Teams
– None of us are as smart as all of us
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GN(PhD) 1/10/2024
Open area , JoHari Window Blind area
Open self Blind self
Free area Known to Self Not known to Self Blind spot
Free self
The arena 1 2
OPEN BLIND
Known to Others
3 4
Not Known to HIDDEN UNKOWN
Others
Hidden area
Hidden self Unknown area
Avoided area Unknown self
Avoided self
80 Into to L&M
façade GN(PhD) 80 1/10/2024
Understand Leadership roles in group
dynamics(Team building).
Coordinator Facilitator Trainer Observer Gap filler Monitor

Understand
Stages of Stages Needs
team Task Needs Interpersonal

Needs
forming Forming
Storming
Orientation
Clarification
Acceptance
Belonging
Norming Organization Cohesion
Performing Achievement Interdependence
Adjourning Completion Disengagement
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82 GN(PhD)
Conflict
Resolution
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– Everyone faces conflict in their
lives daily.
– It is an accepted and expected

part of life

Conflict
Internal discord • Differences in

economic and
results from professional values
differences in ideas, • Competing interest
values, or feelings b/n • Scare resources
two or more people. • poorly defined role
• expectations

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Conflict Management style
Self assessment

Decision
Making
88 Into to L&M 1/10/2024

GN(PhD)
What Is Rational Decision Making?
89
Decision Making
• Choosing a solution from available alternatives.
Rational Decision Making
• A systematic process of defining problems,

evaluating alternatives, and choosing optimal
solutions.

Ways of Decision Making
– Relying on tradition: making the same

decisions that had been undertaken when
similar problems arouse in the past
– Consultation: Based on suggestions from an
expert or higher-level management
– Priori reasoning: based on assumptions
– Logical decision making: systematic approach

Steps to rational decision making
91
1 Define the problem and scan environment
2 Identify decision criteria
3 Weight the criteria
4 Generate alternative courses of action
5 Evaluate each alternative
6 Compute the optimal decision

Group Decision Making
Group Polarization
• Tendency to shift toward more extreme

positions after group discussion
Risky Neutral Cautious
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Decision makers attribute
o Knowledge, experience, Perception ,
personality, judgment, Values , and
Factors philosophy
Influencing
The situation
Decision
o Urgency of problems , time pressures
Making
o Magnitude , importance
o Structure , uncertainty , risk, Cost benefit
Environmental constraints
Internal
External
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MONITORING AND
EVALUATION
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Monitoring and evaluation
Where you want to be (what you want to

achieve/to be)
The steps taken to reach the goal

Goal Objective

Monitoring
Goal Objective Input Process Output

96
Evaluation
97
Goal Objective Input Process Output Outcome Impact

MONITORING EVALUATION
Process Evaluation Effectiveness Evaluation
INPUT PROCESS OUTPUT OUTCOME IMPACT
Their differences
Monitoring Evaluation
• An essential part of good day to day • An essential activity in a long-term
management process
• Takes place during the implementation • Done often at midterm or at the end
phase of the program
• Generally focuses on the question “Are we • Generally focuses on the question, “Are
doing things right?” we doing the right thing?”

Change Management
99
Success & Failure Factors
Lewin’s Golden Rules for Change

Lewin’s Change Management Model The Three-stage Model
Practical Steps for Using the Model
Change Communication Awareness
Resistance to Change
Why Change Fails
100 Top barriers in major change initiatives:
 Competing resources 48%
 Functional boundaries 44%
 Lack of change skills 42%
 Middle management 38%
 Communication 34%
 Employee resistance 33%
 Initiative fatigue 32%
 Unrealistic timetables 31%
Source: Price Water house Coopers
Making Change Succeed
101 Good communication 100%
Strong senior management support 95%
Setting intermediate goals and deadlines 95%
Having an adaptive plan 91%
Having access to adequate resources 86%
Demonstrating urgency of change 86%
Setting performance measures 81%
Delivering early, tangible results (quick wins) 76%
Benchmarking competitors 62%
Source: PricewaterhouseCoopers
Lewin’s Change Management Model
102
Lewin’s Golden Rules for Change
• Change should only be implemented for good reason.

• Change is most effective when done gradually
• Change should be planned and not sporadic or sudden.
• Participatory

103
Kurt Lewin’s Three

Stages to Manage
Change

Stage 1 – Unfreeze:
104
1. Determine what needs to change

2. Ensure there is strong support from senior management
3. Create the need for change
◼ Use your vision and strategy as supporting evidence
◼ Communicate the vision in terms of the change required
4. Manage and understand the doubts and concerns
◼ Remain open to employee concerns and address them in terms of the need to change

Stage 2 – Change
105
1. Communicate often
◼ Describe the benefits
◼ Explain specifically how the changes will affect everyone
2. Dispel rumors
◼ Answer questions openly and honestly
◼ Deal with problems quickly
◼ Relate the need for change back to operational necessities
3. Empower action
◼ Provide lots of opportunities for employee involvement
◼ Have line managers provide day-to-day direction
106 Stage 3 – Refreeze:
1. Anchor the changes into the culture
◼ Identify what supports the change
◼ Identify barriers to sustaining change
2. Develop ways to sustain the change

◼ Ensure leadership support
◼ Create a reward system if applicable
◼ Establish feedback systems
◼ Adapt the organizational structure as necessary
3. Provide support and training

◼ Keep everyone informed and supported
4. Celebrate success!

107
Framework for Change Communication
1. Why is the change necessary?
2. What are we changing to?
 (Vision)
3. How and when do we intend to get there?

 (plan)
4. What is the personal impact?

 (What's in it for me? How does it affect everyone?)
5. Is help available to support the transitions?

 (resources)

Resistance to change
108
Aptitude Attitude Threshold for Change

Inability to make the change Does not want to make the change Does not have the “energy” to make
the change

109
Managing Resistance: Aptitude
Fill knowledge and skills Reward demonstrations of

gaps through training new abilities
Mentor and model Monitor workloads to

desired behaviors and ensure they remain
skills realistic

Managing Resistance: Attitude
110
Ensure people understand why change is needed
Put the change into the context of the “Big Picture”
Convey a compelling vision for the future
If possible, personalize benefits of the change
Establish rewards, and recognition that support change objectives.

What is next?
111
Initiating Maintaining Keeping Momentum Sustaining and Excelling

Ensure strong top leadership Monthly nursing council meeting Quarterly review meeting with a
support and commitment Weekly ward-level meeting presentation by HN and
Avail Equipment and formats Supervisors
Informing- pharmacy, Laboratory, Monitor NSI
General service Directors, Establish DEU and mini-skill lab
laundry, HK, FB Find limitations and train
Assigning floor/supervisors
Launching

Into to L&M GN(PhD) 1/10/2024 112

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Patient service

3 Into to L&M GN(PhD) 1/10/2024

A formally structured collection of

Into to L&M GN(PhD) 1/10/2024 4

5 Into to L&M GN(PhD) 1/10/2024

8 Into to L&M GN(PhD) 1/10/2024

Projecting the economic, social,

9 Into to L&M GN(PhD) 1/10/2024

10 Into to L&M GN(PhD) 1/10/2024

11 Into to L&M GN(PhD) 1/10/2024

12 Into to L&M GN(PhD) 1/10/2024

– Personal Impact through Leadership

1. Pre-Classical management theory

Into to L&M GN(PhD) 1/10/2024 15

Anything before 1900

16 Into to L&M GN(PhD) 1/10/2024

17 Into to L&M GN(PhD) 1/10/2024

Pre-classical:-Industrial Substitution of machines for

Revolution human power

19 Into to L&M GN(PhD) 1/10/2024

Predict and control behavior in organizations

Models were military and the Catholic Church

20 Into to L&M GN(PhD) 1/10/2024

Functional specialization of managers’ duties

Maximize worker capacity and profits

Piece-rate Incentive systems for normal work

used the stopwatch, observation, measurement,

21 Into to L&M GN(PhD) 1/10/2024

Time and Motion Studies to find the most

1/10/2024 Into to L&M GN(PhD) 22

1/10/2024 Into to L&M GN(PhD) 25

1/10/2024 Into to L&M GN(PhD) 26

1/10/2024 Into to L&M GN(PhD) 27

Theory of motivation based

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o Managers must closely supervise, and people

1/10/2024 Into to L&M GN(PhD) 29

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Need for achievement

1/10/2024 Into to L&M GN(PhD) 32

A theory of motivation that suggests

1/10/2024 Into to L&M GN(PhD) 33

Results with higher achievement follow when

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• The environment consists of forces,

1/10/2024 Into to L&M GN(PhD) 38

Assumes there is no one best way to manage.

Interpersonal Informational Decisional

Top level managers

Technical Skills Human Skill

Conceptual Skill Design Skill

42 Into to L&M GN(PhD) 1/10/2024

Lower Middle Top

43 Into to L&M GN(PhD) 1/10/2024

leading, guiding, and motivating