Chapter Two

Principles of Health Management

The principles of management are the essential underlying factors that form the

foundations of successful management. They serve as statements of fundamental

truth and guidelines for decisions and actions of Managers. They are derived at

through observation and analysis of events which managers have to face in practice.

These principles, which are derived at through observation and analysis of events,

faced by Managers in practice include:

1. Unity of Command

2. Theory of Equity

3. Esprit de Corps

4. Division of Work

5. Authority and Responsibility

6. Discipline

7. Subordination of Individual Interest

8. Unity of Direction

9. Remuneration

10. The Degree of Centralization

11. Scalar Chain

12. Order

13. Stability of Tenure of Personnel

14. Initiative

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Unity of Command - It states that every Junior Staff should receive orders

and be accountable to one and only one superior. If an employee receives orders

from more than one superior, it is likely to create confusion and conflict. Unity of

Command also makes it easier to fix responsibility for mistakes. The more complete

an individual’s reporting relationship to a single superior, the less conflict there should

be in instructions. The snag about it any way is that more loyalty is paid to the

superior.

Theory of Equity - Calls for employees to be treated kindly and in a just way

in the workplace. Managers should be fair and impartial when dealing with

employees.

Esprit de Corps - This refers to the need of Managers to ensure and develop

morale in the workplace; individually and communally. Team spirit helps develop an

atmosphere of mutual trust and understanding

Division of Work - The specialization of the workforce according to the skills a

person has, creating specific professional development within the labour force and

therefore increasing productivity; leads to specialization which increases the

efficiency of labor.

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Authority and Responsibility - Authority in administration implies the

right of a superior to give order to his subordinates. This principle suggests that there

must be parity between authority and responsibility. They are co-existent and go

together, and are two sides of the same coin.

Discipline - Discipline refers to obedience, proper conduct in relation to others,

respect of authority, etc. It is essential for the smooth functioning of all organizations.

Subordination of individual interest - Management must put aside

personal considerations and put Organizational objectives first. Therefore the interest

of goals of the organization must prevail over the personal interests of individuals.

Unity of Direction - All those working in the same line of activity must

understand and pursue the same objectives. All related activities should be put under

one group, there should be one plan of action for them, and they should be under the

control of one manager. It seeks to ensure unity of action, focusing of efforts and

coordination of strength.

Remuneration - Workers must be paid sufficiently as this is a chief motivation

of employees and therefore greatly influences productivity. The quantum and

methods of remuneration payable should be fair, reasonable and rewarding of effort.

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Degree of centralization - The amount of power wielded with the central

management depends on company size. Centralization implies the concentration of

decision making authority at the top management. Sharing of authority with lower

levels is called decentralization. The organization should strive to achieve a proper

balance.

Scalar chain - refers to the chain of superiors ranging from top management to

the lowest rank. The principle suggests that there should be a clear line of authority

from top to bottom linking all managers at all levels. The principle suggests that there

should be a clear line of authority from top to bottom linking all managers at all levels.

It is considered a chain of command. It involves a concept called a "gang plank"

using which a subordinate may contact a superior or his superior in case of an

emergency, defying the hierarchy of control.

Order – Social order ensures the fluid operation of an organization through

authoritative procedure. Material order ensures safety and efficiency in the

workplace.

Stability of Tenure of Personnel - The period of service should not be

too short and employees should not be moved from positions frequently. An

employee cannot render useful service if he is removed before he becomes

accustomed to the work assigned to him.

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Initiative - Using the initiative of employees can add strength and new ideas to an

organization. Initiative on the part of employees is a source of strength for the

organization because it provides new and better ideas. Employees are likely to take

greater interest in the functioning of the organization.

Elements of Management

The following are typical management processes or elements, which are to be

implemented if one is to succeed as an effective manager.

1. Planning.

2. Organizing.

3. Leading.

4. Communicating.

5. Controlling.

Importance of Planning

According to Adeleke (2004), Planning if a process of setting goals for an

organization. Planning bridges the gap between where we are and where we want to

go. The main questions pertaining to planning are: what are we driving at here and

what outcome do we want from this? It must be borne in mind that planning is the first

element of Management sequence upon which every other thing is based.

Management is all about organizing groups of people to work together productively

towards known and clear goals or objectives of an organization.

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There are several stages of Management ranging from very senior Personnel such

as those at the rank of Executive Secretaries who are regarded as Policy Makers or

Planners, to other Senior or middle level Workforce as Policy Implementers, all

supervising small groups of employees. In designing an environment for the effective

performance of individuals working together in groups, a Manager’s most essential

task is to see that everyone understands the group’s purpose and objectives and its

methods of attaining them. If group effort is to be effective, people must know what

they are expected to accomplish. Planning involves selecting missions and objectives

and the actions to achieve them; it requires decision making that is choosing from

among alternative future courses of action. Plans thus provide a rational approach to

achieving pre-selected objectives. Planning bridges the gap from where we are to

where we want to go. Although we can seldom predict the exact future and although

factors beyond our control may interfere with the best laid plans, unless we plan, we

will be leaving events to chance. Planning is a way of trying to ensure that the

resources available now and in the future are used in the best possible way. Planning

helps us to reduce uncertainty. Planning gives us the basis from which to decide

what we want to achieve and what to do if we do not have enough resources to meet

the needs.

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Significance of Planning

Planning is done for varieties of reasons, which may be obvious or concealed, praise

worthy or deplorable. Those involved in a planning process should try to identify

these diverse reasons since they will have a major impact on planning processes and

methods used and on eventual outcome. Planning is usually advocated as the

rational approach to decision making and ultimately to shaping future events. Thus

planning can:

 Prepare the ground for decision making (Pre-Planning).

 Provide options for decision making.

 Improve the quality of decisions.

 Provide for orderly implementation of activities and allocation of activities.

Provide a frame work for monitoring and evaluating progress towards defined targets

and goals. The importance of planning includes the value of a systematic way of

identifying problems, setting priorities and developing action plans. Although planning

does not automatically ensure that a programme will be successful, it does give us a

good start towards achieving our goals.

Planning goes through five distinct cycles as illustrated below:

1. Needs Assessment.

2. Planning.

3. Implementation.

4. Monitoring.

5. Evaluation.

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Types of Planning

Three types of planning are distinctly identified and they are as follows:

a) Strategic Planning or Long-Range Planning: This type of planning is a long

range planning that covers all the operational activities of an Organization. Its aim is

towards improving the overall effectiveness of the organization. Strategic planning

has a long duration of one year and more

b) Tactical Planning or Medium-Range Planning: This type of plan is designed to

cover a period of at most one year. In tactical or medium-range planning, the

manager determines the various options available to achieve organizational goals

within one year.

c) Operational Planning or Short-Range Planning: Here the plan is designed to

cover a short period and often focuses on specific organizational need such as staff

recruitment.

Approaches to Planning

There are three basic approaches to planning which are as follows:

1. Top-Bottom Approach: In this approach, the Top Management sets the goals

and plans for all the lower cadres of management to implement. It is based on

the principle that only the top-management has all the means and knowledge to

plan for the organization. This model of planning is on Theory X view of

Management, which says that man by nature dislikes work and responsibility and

prefers to be directed.

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 It has however been argued that the Top-Bottom Approach is against the spirit of

good management practices, where every member of the team is expected to

play a major role in planning, implementation, monitoring and evaluation of

programmes.

2. Bottom-Top Approach: During this type of planning, various departments or

interest groups prepare their own goals and plans that are presented to

Management for approval. This approach is based on Theory Y view of

management, which states that man by nature likes and enjoys work and

responsibility and will be more committed if allowed to participate in the planning

and execution of a programme of activity.

3. Goals-Down Plans-Up Approach: In this situation, Management critically

examines organizational opportunities and resource needs and develops an

annual work plan. In the process, every unit or department is involved in

developing the plan and once approved it becomes the official organizational

plan for the period. According to Parkinson et al (1998), participation gives

employees a sense of belonging and an opportunity to use their talents in their

tasks.

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The importance of planning includes the value of a systematic way of identifying

problems, setting priorities and developing action plans. Although planning does not

automatically ensure that a programme will be successful, it does give us a good

start towards achieving our goals. As the adage goes, “HE WHO FAILS TO PLAN,

PLANS TO FAIL”.

Experience shows that in order to develop and implement a successful programme,

we need to involve all the local people who are intended to benefit from the

programme as well as those who might be affected by it.

Organizing

The usual questions asked with regards organizing as an element of management

are: how can I get people and equipment to where they are needed and who will do

what and when?

Organizing as a management task involves coordinating and directing organizational

resources in a way that set objectives are carried out. Organization helps to secure

the vision of the organization to work smoothly and to ensure unity of effort.

Organizing therefore involves identifying the activities which need to be done to

achieve organizational goals.

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Leading

The word lead means a lot. It may mean to show a way to an individual or a group, to

guide, to cause to act or to influence. Leading in short is influencing people so that

they can contribute to organizational or group goal and has to do mainly with the

interpersonal aspect of managing (Adeleke 2004). Leading starts with the questions

like has he started work or did that stuff come from the right place? Leading is about

influencing people so that they can contribute to organizational and group goals. All

Managers would agree that their most common problems arise from people who by

nature have different characters and therefore very unpredictable. People are

believed to have different desires, attitudes and behavior as individuals and as in

groups.

Management and Communication

Communication as a vital part of management is about who needs, In any

organization, communication should flow from the top to bottom and from the bottom

to top. In other words, communication should be a two way channel process.

Communication is to know what and how we can best get this message across? It

links all management processes together and managers could not do their jobs

without communicating. Communication is an attempt to achieve a complete and

accurate understanding between two or more people. It is an act characterized by a

desire in one or more individuals to exchange information, ideas and feelings.

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In a more precise way, communication can be thought of as a process by which

people attempt to share meaning through transmission of symbolic messages.

Communication involves an exchange of ideas and information. Effective

communication within an organization is essential for the success of that organization

as it helps the staff to understand the policies, values and objectives of the

organization. One of the major causes of crisis in any organization is a gap in

communication, which breeds misconception, distrust, rumours and low staff moral

that can in turn lead to labour unrest. Very often, low staff moral leads to low work

output.

Definition of Communication

Communication is different from Information and Education. Information and

Education are processes where pieces of knowledge are passed from a person who

knows to individuals who do not know. Information and education are one-way

processes. Communication is the act of exchanging information or ideas. It is a two-

way or a circular process:

(1) Sender transmits one piece of information;

(2) Receiver gets the information;

(3) Receiver sends a feed-back, and

(4) Sender gets the feedback. And the process may continue over, and over again.

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Types of Communication

 Channels of communication: through images (example: printed materials); by

means of sound, eg. Radio and a combination of images and sound eg.

Television.

 Means of communication: person-to-person, which involves a direct contact or

mass-media eg. newspapers, billboards, radio, telephone, television, internet

etc.

Communication Barriers

There are several impediments to communication. A communication can fail

because:

 The Sender uses a language that the Receiver does not understand eg.

English for people who do not speak English in certain communities.

 The Sender uses words that the Receiver cannot understand eg. technical

medical terms to a non-medical person.

 The Sender uses signals that the Receiver cannot understand eg. written

message for people who cannot read.

 The Sender communicates to people who are not interested in the message;

 The Receiver has worries that occupy his/her mind.

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Managing and Communicating

Communication can be interchangeably used with managing. It is not possible for a

manager to manage well without communicating. Managers spend their days

communicating with other people, with subordinates, peers, superiors and so on by

telephone, face-to-face meetings, written memos, and reports etc. Communication is

an integral part of the other elements of the management processes.

Purpose of Communication

There are a number of reasons why good communication is vital for management.

They are:

1. Decision-Making- Management is concerned about decision-making and the

quality of those decisions depends to a large extent on the quality of the

information communicated to decision makers.

2. Organizing- Communication is important in starting organizational processes.

These are processes that are concerned with resource mobilization, developing

them and giving services to the people.

3. Influencing- Communication is all about persuading, informing and educating.

4. Activating- Communication initiates action. It serves as the regulating mechanism

for beginning and continuing.

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Communication Cycle

Communication has five stages and all of these stages have to be completed for the

process to be said to be a success.

1. Perceive.

2. Encode.

3. Transmit.

4. Receive and Decode.

5. Respond.

Perceive

Communication is centered around perception. It involves an individual assigning

meaning to the signals he receives from the environment. The initiator of a message

must receive some signals from the environment that he perceives as requiring

attention. The entire purpose in communicating is to transmit information about an

initial perceptions to a second person. In view of this, the initiator must clearly define

what he wishes to convey. I f he succeeds in structuring thoughts, then the receiver

of the message should in turn perceive the need for action.

Encode

As long as the initiator clearly defines the thoughts he wishes to convey, then he puts

these thoughts into a code using communication symbols that will be understood by

the receiver. Messages must be encoded in clear and simple terms.

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Transmit

Transmission is the sending of communication symbols from the initiator to the

receiver. The quality, cost accuracy and speed of the means of transmission must be

taken into consideration.

Receive and decode

Once the initiator has sent out a message, the receiver must assign meaning to it.

Thus the receiver must in other words, decode the message. If in the process, the

receiver fails to understand what the message tries to convey, then the process is not

considered successful.

Response

The final stage in a communication process is response. The response to a message

by the receiver shows exactly how well the original perception and message have

been conveyed.

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Principles of communication

An effective communication is not just the function of an effective communication

system. There is the need to examine the principles, criteria for and quality of the

communication. The following can be considered as principles of good

communication:

1. Both the Sender and the Intended Receiver must be clearly identified.

2. The language used by the Sender must be within the understanding of the

receiver and be capable of being interpreted by the latter in a way intended by

the Sender.

3. A Message must be clear before communicating it.

4. The true purpose of the message must be identified and examined.

5. The setting in which communication is made must be examined carefully.

6. Be aware of overtones used in any communication.

7. Communication must be followed up in order to check that the intended

meaning has been received and understood.

8. Good communication depends on a willingness to listen and understand.

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 Barriers to effective communication

Barriers to effective communication can be identified as follows:

1. Lack of preparation reduces the effectiveness of communication.

2. Lack of clarity in a message leads to how vague that message is, therefore will

lead to its ineffectiveness.

3. Lack of openness can be a cause of poor communication.

4. Un-clarified assumptions underlying messages may cause problems and

prevent effective communications.

In essence, the main drawback with oral communication is that in general, there is

often no accepted record of what was said by the sender and receiver during the

course of the conversation. A reliance on memory can be dangerous and

unintentional or deliberate changes can ensue at a later date, leading to disputes.

Controlling

The commonest questions about controlling are: how do we compare with the

available budget and how can we find replacement for faulty equipment. Controlling

is about measuring and correcting individual and organizational performance to

ensure that events conform with plans. In short, controlling facilitates the

accomplishment of plans

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