Health Service Management

For Medical students

By: Tilahun Fufa (BSc, MPH)

Course Description
 This course is designed to enable students to address the numerous

challenges associated with delivery of health services.

 It also provides knowledge about health policy and health service

delivery system.

 The course covers important issues like leadership, management

and governance; management of health resources

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 Course objectives

This course is aimed at:

 Improving Leadership, Management and Governance skills
and practices required to sustainably improve the health
status of the population.

 Providing the basic concepts and principles of

management so as to efficiently use resources, ways to
identify problem and make a plan according to priority

 Organizing the health team activities and mobilize

resources within the health care delivery system to solve
the existing problems.
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Course contents
1. Introduction
 Meaning and scope of management
 Definition of some technical terms
 The roles and skills of health manager

2. Introduction to Leading, Managing and governance

 Introduction to LMG
 Managing practice
 Leading practice
 Governance practice
 LMG for the result model

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Course contents…

3. Health care planning

Basics of planning
Strategic planning
The challenge model

4. Organization
Management theory
 Earlier management theory
 Contemporary Management Theory

Principles of organization
Organizational structure
5. Decision making
6. Monitoring and evaluation
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Course contents…

7. LEADING HEALTH TEAM

 Coaching to support others
 Creating high performance teams
 Gaining commitment not just compliance
 Inspiring others
 Leading through breakdowns

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Course contents…

8. HEALTH CARE DELIVERY SYSTEM AND

HEALTH POLICY
 Evolution of modern medicine in Ethiopia
 Primary health care
 Health policy of Ethiopia
 National Health Sector development/ transformation plan
 Health Care delivery system

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 Course contents…

9. Governance in health
10. Resource management

 Human resource management.

 Financial management

 Logistic and pharmaceutical management

 Managing time, equipment, and space.

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 References:

 Challi Jira, et al, Health Service Management for Health Science

Students, January 2003, Jimma University

 Stoner J.A.F, Freeman R.E., Gilbert Jr. D.R. Management (1996)
 6th edition.**

 Leadership, management and governance in service training

modules for federal and regional health managers, FMOH, A.A.
February 2014.

 Jonathon S. Rakich, et al, Managing Health Service organizations,

third edition, 1992.

 Stephen M. Shortell and Arnold D. Kaluzy, Essentials of Health

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Care Management, 1997.
References:

 Challi Jira, Health Planning for Students of Health Sciences,

lecture note, Jimma University, 2002.

 Andrew Green, 1996; An Introduction to Health Planning in

Developing countries.

 On Being In charge- A Guide for middle – level management

in PHC, WHO, Geneva, 1992.

 Theresa J.k. Drinka and Phillip G. Clark, Health Care Team

Work, 2000
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Evaluation (tentative)
 Mid exam 1 ( CH 1-3)= 20%
 Mid exam 2 ( CH 4-6)= 20%
 Final exam (CH 7-10)=45%
 Assignment = 15%
Assignment with presentation
 Reproductive health policy of Ethiopia (group-i)
 Health extension program of Ethiopia(group-ii)
 Health and pharmaceutical sector reforms (group-iii)
 Systems thinking approaches for health systems strengthening
(group-iv)
 Leading and Managing Change (Group-V)

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Health service management

 Outline of the presentation

 Definition of management

 Concepts in management

 Principles of management

 Types of management

 Role of managers
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What is Management?

 The Practice of management has existed ever since man has

been organized into communities.

 Management is so old and universal.

 Although so old as practice & universal it has no agreed on

definition.

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 Definition…..

 Some regard it as …….. getting things done.

 Others consider
 it is the process of reaching organizational goals by working
with and through people and other resources.
 Others also consider as the process of directing,
coordinating, and influencing the operations of an
organization to obtain desired results and enhance total
performance.
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 Definition…..

 The definition of management is based on two principles:

1. Commitment to achievement, and

2. Importance of people and other resources.

 People are the most important resource for getting things done.

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 Definition…..

 Management is an organized process that guides the utilization

of various resources to meet a desired organizational goal.

(MSH working definition)

Health Management, therefore, is

 The application of management principles for health
care

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Importance of Management

 Management is universal and necessary function because

every organization requires:-
 Making of decisions  
 Coordinating of activities
 Handling of people and
 Evaluating the performance directed toward its
objectives.
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 Administration and Management

These terms are used interchangeably in government and

business organizations.
Administration :
 Means overall determination of polices and major objectives.
Functionally
 It is the laying down of the general purpose of the organization.
 The framing of its major polices.
 The formulation of general plan of procedure.
 The inauguration of broad programs and approval of projects that
fall within the general programme.

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 Management

 Is essentially an executive function, the active direction of

human effort.

Same person may perform both functions.

 As we go down the hierarchical ladder,
 the administrative function became less and less

and
 the management function more and more.

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 Administration  President
 Vice president
 School
 Department
Management
 Units

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 Management as an art, Science and a
Profession

 Development of management as a science is of recent origin.

 Management as:-
 Science, it is the body of knowledge and discipline.
 An art, its application to the solution of practical problem/ organizational
problems.
 Profession, managers use the knowledge of management theory while
performing their managerial functions.

 Therefore, Management is a science as well as an art and a profession.

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 Concepts and Principles in
Management

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 1. Concepts in Management

1.1. Effectiveness
 Is the degree to which a stated objective is being achieved.
 It is something that management tries to improve.
 It is about reaching goals
 Management strives for high goal attainment (high
effectiveness).
 It is the comparison of objectives with their achievement

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Concepts……….
1.2. Efficiency
 It is concerned with the balanced use of resources (money,
material, human resource, time, space and information)
 There is no wastage of resources
 Management strives for low resource waste (high efficiency)
 Technical efficiency- produce out put with minimum resources
 Cost effectiveness efficiency- produce out put with minimum cost
 Allocative efficiency - produce out put which people value most

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Concepts……….

1.3. Economy of scarce resources

 Some, and often many, resources are scarce and costly

thus we have to economize
1.4. Work Relations
 Work activities should be designed and structured so as to
support each other towards the achievement of objectives

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 Concepts……….
1.5. Information
 Management needs information if it is to make the right
decision for action.
 At the same time, information can easily handicap
management, if it is not the right kind, at the right time and
in the right hands.

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 2. Principles in Management

2.1. Management by Objectives

 The objective should state:
 What is to be accomplished, How much of it
 Where & When it is to be done & completed

 To use this principles /philosophy

 First management sets the clear objectives
 Then evaluate whether achieved/not achieved.
 Therefore, a clear objectives makes it possible to evaluate how
effectiveness of the objectives.
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 Principles…….
2.2 Learning from experience
 Analysis of the results between the objectives and achievement
made.
 Identify better performance from other.
 Then learn from the experience gained.

2.3 Division of labor

 It is bringing about balance of work among the different
people/group.

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 Principles…….
2.4. Substitution of resources
 Often when the resources that are normally used to provide service
became scarce or too expensive, different resources may be used to
provide the intended results.
2.5. Convergence of work
 Working relations should contribute to the success of each activity
and so to general effectiveness.
 These working relations of activities are:-
 the logical relations with each other
 time relations or sequence
 spatial relations between activities
 functional and structural-working relations between people
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 Principles…….

2.5 Convergence of Work

 Working relations should contribute to the success of each
activity and so to general effectiveness.
 These working relations of activities are:-
 the logical relations with each other
 time relations or sequence
 spatial relations between activities
 functional and structural-working relations between people

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2.6. Functions Determine Structure
 When the work is defined i.e. the function and duties of the
individual members of the team are clearly defined and known
to all.
 The working relations (the structure) follow.
 The exact nature of authority will be clearly delineated on the
structure.

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Delegation

 It is assigning job activities and corresponding authority to

specific individuals within the organization
 Delegation takes place when some body's authority is lent.
 It enable that person to take responsibility when the
occasion arises.

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Management by exception.

 It indicates two things:-

1. Don't be overloaded with the routine, unnecessary
information, be selective.
2. Make BIG decision first.

In short management by exception means

 Selectivity in information and
 Priority in decision
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 Shortest decision-path

 This principle deals with issue:-

 Who should make which decision?

 When and where?

 Decision must be made as closely as possible in time and place to

the object of decision and to those affected by it.

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 Types of managers
and
managerial Roles

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 A. Type of Health Service Managers

The 3 types of managers

1. Senior/Top Managers
2. Middle Managers
3. First Line Managers
 The primary differences between levels of managers are the
degree of authority and the scope of responsibility

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Top Managers
 Responsible for the overall management of the
organization
 Guide the organization’s interaction with its
environment.
 Conceptual Skill is more needed for them:
 The ability to visualize the organization as the whole
and its relationship with the community and other

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 2. Middle Managers

 Managers in the mid range of the organizational hierarchy

 They are responsible for other managers and sometimes for
some operating employees
 They report to more senior managers
 Human Skill is more needed for them:
 This is the ability to work with others and win cooperation from the
health team other sectors and the community

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 3. First Line (or lowest level) Managers:

 They are responsible for the work of operating

 They do not supervise other managers
 Technical Skills is (mostly) important for this kind of
managers:
 The understanding of technical element of activities
 They have to proficient in specific kind of technical
activity
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 B. Managerial Roles

 Was presented and developed by

 Henry Mintzberg
in 1970s.

 According to his view, the managers are overburdened

with obligations.

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…….. Roles

 The managerial roles are categorized into three major areas

with further classification:

1. Interpersonal role
2. Informational role
3. Decision-making role

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 1. Interpersonal role:

 Is the personal contact that a manager does which is vital in

his/her daily activities.
 The interpersonal roles are designated by

 Figurehead:

 this role symbolizes the legal authority of the manager

 such as: attending ceremonies, signing documents, etc.

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 Interpersonal……

 Leader: as a leader a manager is accountable, responsible, and

motivator of the staff he is working with.
 Liaison: a manager creates links/connects in horizontal as well
as vertically.
 It facilitates communication in and out side the
organization.

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 2. Informational role:

 This role is related to communication and information channeling

 Monitor: serving as a focal person for all types of

communications
 Disseminator: communicating selected information to
subordinates
 Spokesperson: communicating selected information to
outsiders

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 1. Decision-making role

 A manger has a
 Legal authority to decide on the assigned matters.
 Based on his job description.

 Entrepreneur: designing and initiating changes within the

organization

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 Disturbance handler:
 Taking corrective action and
 handling conflicts
 Resource allocator:
 Decides on resources and their distribution
 Negotiator:
 Negotiating with other parties representing organizational interests

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