HEALTH SERVICE MANAGEMENT

HSM 4860
Unit 5:Principles of Organisation in the Health Services
Objectives
Organise time, patient care, personnel, the therapeutic environment,
equipment and supplies.
 Motivate the importance of organisation in the health services.
 Differentiate between the four elements of organisational structure.
 Discuss organisation in a health service unit with regards to:
-Time.
-Patient care.
-The environment.
-Facilities, Equipment and Supplies.
-Scheduling of personnel.
The importance of organisation in the
health services
Its important to organize because of the following factors:
 Work analysis: organization leads to the analysis of the work that must
be done and the resources available.
 Allocation of responsibilities: employees will know for which task they
are responsible.
 Accountability: employees will be liable for the positive as well as
negative outcomes of the tasks for which they are responsible.
 Clear channels of communication: information is distributed through the
correct channels at all levels of the organization.
The importance of organisation in the health services

 Productive utilization of resources: by grouping patients with the same

illness, effective use is made of human resources and expensive
technical equipment.
 Division of work: related activities and tasks of individual employees are
grouped together in specialized departments.
 Co-ordination of activities: there are various activities taking place in the
environment of the patient.
 Prevention of duplication: organization prevents overlapping and
duplication of activities in a service.
 Clear lines of authority: employees know to whom they must report.
Organisational structure
 Organisational structure: the formal system of working relationships that
separates and integrates tasks is known as the organisational structure.
 It provides a framework for allocating
responsibility,authority,accountability and delegation to various posts.
 An organisational structure is necessary for the following reasons:
-People and resources must be allocated to tasks.
-Responsibilities have to be clarified through job descriptions and lines of
authority.
-Employees must know what is expected of them through the establishment
of rules ,regulations, performance standards and procedures.
-Decision making and problem solving become easy.
Organisational structure divided into four elements:
Specialisation, standardisation,coordination and authority
 Specialisation: occurs when specialised tasks are identified in an organisation
and assigned to groups or individuals who are appropriately trained.
 Growing organisational are forced to specialise because of the following
factors:
-Individual expertise is enhanced by the repetition of tasks.
-Transfer time can be reduced as it becomes unnecessary for a person to carry
out more than one task.
-Specialised equipment is better maintained and utilized when operated by only
one person.
-Training costs are reduced because only one worker is trained for each
component of a particular task.
Specialisation continue.

 A consequences of specialization is the formation of different sections.

 The work is subdivided horizontally and formally assigned to different
sections, a process called departmentalization.
 Some organization may have only one form of departmentalization while
others have different forms .Which are:
-Functional departmentalization.
-Geographical or area departmentalization.
-Product or service departmentalization (Divisional structures).
Functional departmentalization
 Functions are grouped according to the field of specialization for example
medical, surgical and intensive care units.
 Most hospital use functional departmentalization.
 Advantages & Disadvantages of functional departmentalization
Geographical or area departmentalization:
 Method commonly used by organizations when operating in different
geographical areas.
 Health services has similar clinics countrywide. The idea is to focused
attention on the needs of the individual customers.
 Advantages & Disadvantages of area departmentalization
Product or service departmentalization
(Divisional structures)
 As organization grows, the weakness of functional
departmentalization often become apparent.
 Gives rise to product or service departmentalization, which is
a structure of self-contained units, each able to design and
produce its own goods or services.
 Advantages & Disadvantages of product or service
departmentalization
Standardisation
 The process whereby an organization develops procedures to ensure
and that employees perform their work in a uniform and consistent
manner.
 Procedures are planned and followed , labor and time are saved,
equipment and supplies used economicaly and individuals protected
from bodily harm and potential hazards .
 Procedures manuals, job descriptions and rules and regulations are
examples of methods to enhance this process.
 This also means standardisation of supplies and equipment.
Coordination
 Process of integration of all the activities of the different employees and
departments.
 It requires knowledge of the functions and problems of the different
departments.
 One of the main functions of the unit manager to integrate all the efforts of
the various care providers.
 Effective communication within an organization forms the key to the
coordination of activities in an organization.
 It is important to understand the role of organizational communication in the
management of the organization.
 The flow of communication has four directions namely
downwards,upwards,horizontally and laterally.
Communication and Coordination

 Communication and Coordination are closely linked to the organisational principles summarised as
follows:
-The unity of command principle
-The scalar principle (chain of command).
-The span of control principle: factors affecting the span of control principle are:
The competence of both supervisor and worker.
The physical division of subordinates.
The extent to which the manager must carry out non-managerial work.
The types of tasks being supervised.
Incidence of problems in the supervisor’s department.
Extent of standardised objective rules and procedures in the organisation.
The degree of physical dispersion of tasks.
The degree of interaction required between supervisor and workers.
Authority.
Responsibility, accountability, authority and delegation
 Authority is the power given to someone to make decisions and take actions, ”the right to
act”.
 Authority always implies responsibility and accountability.
 Authority is the right of an employee to organize resources and make decisions to
complete delegated tasks successfully.
 Responsibility refers to the manager’s duty to attain the goals and objectives of the
organization.
 Responsibility is the obligation or commitment of a manager or subordinate to carry out
an assignment according to the received instructions.
 Delegation is an important element of authority. The process by which managers assign
authority and responsibility to subordinates.
Authority.
Centralisation and decentralisation of authority
 Centralisation involves a high degree of authority at the top.
 Decentralisation involves a high degree of delegated authority to the
lower levels of management.
 No organisation is completely centralised or decentralised;
 Organisations differ only in the degree to which they are centralisation
and decentralisation.

Factors that affect the decision to centralise or decentralised.

Advantages & Disadvantages centralisation and decentralisation
Line and staff authority

 Two types of authority found within the organization.

 Line and staff authority.
 Line authority seen as authority, assignment of work and supervision of
employees delegated down the line of command.
 Staff authority is an indirect and supplementary authority, applying
specialized knowledge to a particular field.
 Staff authority function is usually to support advise and recommend.
The matrix organizational structure

 The matrix organizational structure is based on the multiple

authority and support systems.
 There are two lines of authority.
 The functional departmental authority line runs vertically, while the
projects authority lines runs horizontally.
 Every matrix has three unique sets of relationships namely:
-the top manager,
-project manager,
-subordinate.
Organisation in a health service unit

 Managers have to organize the day to day running of the units.

 Managers to coordinate the patient care activities in a cost-effective manner, without
compromising the quality of patient care and patient satisfaction.
 Organizing people, materials and time involves deciding which activities must be
performed to achieve the organization’s objectives.
 Factors that need consideration when organizing a healthcare unit:
-Priorities,-Allocation of scarce resources,-Timing and sequence,-Date lines,
-Organizational goals,-Skills mix of healthcare professionals,-Characteristics of the work.
 The organizational responsibilities of the manager in charge of the unit include the
organization of time,personnel,environment,equipment and supplies.
Organisation of time
 Successful time management is a result of organizing skills.
 Routine are necessary to organize time effectively.
 Routines are habituated ways of responding to occurrences in everyday life.
 Routine is about completing activities within a certain time frame and sequence.
 Healthcare professionals, equipment and supplies are utilized economically by
following routines.
 Routine ensures the standardization of equipment, supplies and work procedures.
 Routine underpin the development of the safe standards of patient care and
orderliness in the unit and assist the organisationand allocation of duties
throughout the working day.
 Routine also reduces the chances of error, promote increased efficiency and
remove ambiguity and confusion, should however not be inflexible.
Organisation of time continue.

 Healthcare professionals to should be able to make decision at the right time

and under the appropriate circumstances when to suspend routine activities.
 Most healthcare units are having internal activities.
 Routines are planned and should revolve around the patients needs, rather
than the needs of the nursing or medical staff.
 The patients individual needs should be given priority rather than the
routine itself and getting everything done.
 Checklist are important tools that managers can use to ensure that routine
tasks are completed on time.
 Setting priorities is another method used by managers to organize time, as
the process of prioritization helps to determine which activities are most
important. .
Organisation for patient care

 Nursing assignments involve the allocation of professional duties to nursing staff within the
unit.
 Allocation is done according to their experience and scope of the practice.
 Principles to be considered in making assignments:
-Tasks and responsibilities should be in writing and personally prepared by the manger in charge.
-Assignments to be specific and avoid ambiguities.
-Sound nursing care assignments should ensure that all work areas are covered.
-Health care professional should allocated so that adequate cover of the unit is available at all
times.
-Contingencies for emergencies must be provided .
-In preparing nursing assignments, the manager must bear in mind the central policy of the nursing
service department.
-Supervision provided must be adequate.
 Organisation for patient care

 Different nursing care delivery systems or methods to assign

nursing staff to patient care.
 The goals of successful patient care delivery include “high
quality and low cost.
 The methods that are used are:
-Functional

-Case assignment
-Team nursing
-Primary nursing and
-Modular nursing.
 Organisation of the environment

 The manager is responsible to ensure that the environment of the unit is conducive to the patients
welfare and suitable for healthcare professionals to work in.
 The most important environmental factors to be considered are as follow:
-Safety of patients, staff members and visitors:
-Plumbing
-Cleanliness
-Quietness
-Privacy
-Temperature
-Humidity
-Ventilation
-Lighting
Safety of patients, staff members and visitors

 Special precaution to prevent medico-legal hazards.

 Prevention of slippery floors, unprotected windows, broken steps, faulty electrical
equipment, unlocked medicine cupboards and bath room left open in children’s wards.
 Staff to be orientated and to receive regular in-service education on the prevention of
cross-infection and
 Handling of blood-products.
 Faulty equipment's should be reported immediately, on-functional lights. Leaking tapes
etc.,
 Regular inspection for the fire equipment by the responsible company.
 Manager responsible to monitor the servicing of the extinguishers.
 Policies should be in place to address issues such as :early warning systems incase of
fire, all personnel to know exactly where the fire extinguishers are, how to use the
evacuation procedures for patients and staff.
Organisation Facilities
 Facilities refers to the building structure.
 Managers can contribute to a safe and effective environment by controlling the features
in the unit.
 Areas that need repair and maintenance for example broken windows, must be reported
on the correct forms and sent to the responsible person.
 Safety committees in the institution are responsible for inspecting facilities for any
irregularities and checking that repairs are done as soon as possible.
 Extensions or renovations to facilities: motivations for extensions or renovations to
existing facilities should be directed through the correct channels.
 Maintenance of facilities:authories have policies concerning the maintenance of
facilities.
 Organisation Equipment

 Equipment comprises a large portion of the health service budget.

 Quality can be rendered with adequate equipment of high quality to meet
the needs of the patients and to improve the health workers productivity.
 Equipment are divided in the following categories:
-Fixed equipment: built into the facility structure.
-Loose equipment: not part of the structure and is moveable.
-Non expendable: part of the capital budget
-Expendable: consumable items.
Organisation Equipment
 Using Equipment: following principles apply:
-Equipment to be use for the purpose that it was intended for.
-Standardised equipment to be used as it contributes to negotiating a good price when purchasing a follow-up
service and maintenance for a negotiated period .
-Standardisation also facilitates in-service training.
-Nursing personnel to be taught about the use of the equipment's.
-Health care professional are not taught how to use equipment's properly, they tend to improvise, which can lead
to inefficient and dangerous practices.
-Equipment to be kept clean, that is essential for rendering safe care.
-Equipment to be cleaned according to instructions supplied, as noon compliance can contribute to cross infection.
-It may be necessary for equipment to undergo special cleaning methods, Tobe sent to specific department
specialising in cleaning of equipment after use.
-The must be clear instructions as how this should be done, as non-adherence may damage the equipment.
- Equipment must be maintained so that it is ready for use and in the right place.
- Health workers have the responsibility to attend to equipment vigilantly, even though a service contract for its
maintenance exist.
Organisation Equipment
 Acquiring Equipment

 Self –study.
Organisation Equipment

 Stock control:
-The control of equipment is usually performed by keeping an inventory.
-Close co-operation between the acquisition department and the manager is necessary to
ensure that the inventory is up to date.
-After stock taking is done by the relevant support services all equipment's can be accounted
for.
-Its not the duty of nursing staff to do the stocktaking, they should be involved in the case of
specialized medical equipment.
-A computerized system for taking inventory and control over the use of equipment is
normally used.
-All equipment's to have a code, that should be entered into the computer once delivered to
the unit.
-A printout to be send to the unit at regular intervals to compile an inventory on what is in the
unit.
 Stock control continue.
-Local authorities to provide a computer printout to the health services clinic on a monthly basis.
-Records items that have been purchased ,cost involved and the amount of money left over for
those specific items.
-Health services managers must control this carefully, as overspending is not allowed.
-Money not used by the end of financial year goes back into the budget.
-All new items should first be checked by a standardization committee before being put to use in
the units.
-The item should be evaluated and reported.
-Factors to consider are cost, safety ,availability, maintenance and cleaning.
-Supervision of equipment includes checking all equipment received in the unit for completeness
and working order.
-When a unit borrow-equipment from another unit, it should be entered into a borrowing book.
-The date, time, name of unit and equipment borrowed should be entered and space provided for
the signature and date returned.
-The equipment on the emergency trolley should be checked daily and after it has been used.
Organisation Supplies
 Linen supplies
 General principles regarding the storage and
control of supplies.
 Self –study.
Principles of supply chain management
-To ensure that billing is accurate and complete.
-To ensure that rebates are captured.
-IT systems should support maximum flexibility putting the emphasis on the
bar coding to streamline processes.
-Manage the utilization of an item at the floor level ,at the point where the
user-the nurse, is basically documenting the use of that item.
-Nurses to check the utilization patterns of items to reduce stock on the
shelves and overall reduction in the inventory sitting on the floor.
-Nurse to have strong value analysis process and the best , most efficient and
effective products,
-Understand why the supply chain strategic plan is essential and know how to
communicate about it with senior executives.
Organisation Scheduling of Personnel
 Scheduling of staff or planning the duty roster is one of the unit
manager’s less satisfying duties.
 Principles for the manager to consider when planning a unit schedule
with the on-or off-duties of the nursing staff:
-Sufficient staff are available for patient care to be rendered for the whole
24 hour period.
-Provision is made for the times of high intensity of work, for example
operation days & admission days.
-An equitable distribution of the staff is available throughout the working
week.
-There is an equitable distribution between senior and junior staff members,
taking into account periods where more or fewer senior staff are needed.
Principles for the manager to consider when planning a
unit schedule with the on-or off-duties of the nursing staff:
-Sufficient staff are provided for periods when teaching or meetings are to take place.
-Staff members requests are accommodated as far as possible, considering patient
care needs.
-Resting times for staff members are distributed ,that they do not become chronically
overworked.
-A trained nurse is in charge of each shift, as far as possible.
-Continuity should be provided, whether senior staff are returning after days off.
-The coverage of weekends and public holidays is worked out to achieve cost
effective utilization of staff.
-Days off to be spaced together and half days should follow on from each other ,
References

 See course outline.