PHM 222: FOUNDATIONS OF

HEALTHCARE ORGANIZATIONAL
BEHAVIOUR

TOPIC 1: INTRODUCTION
BY: CLEMENTINE GWOSWAR.
 Definitions & Concepts
1. Health
2. Healthcare
3. Organization/Healthcare organizations
4. Public Health Organization
5. Behavior
6. Organizational Behavior
7. Organizational structure
8. Organizational culture
9. Organizational economics
 1. Health
• What is the official definition of health?

• The Constitution of the World Health Organization, which

came into force on April 7, 1948, defined health as:

"a state of complete physical, mental and social well-

being and not merely the absence of disease or
infirmity.”
 1. Health cont…
Other definitions of health:

• Today, three types of definition of health seem to be

possible and are used.

• The first is that:

– “Health is the absence of any disease or impairment”.

 1. “Health” cont…

• Another one is:

– “Health” is a state of balance between various internal

factors that govern operations of the body and mind, taking
into consideration being in harmony or balance, with the
external environment….It is a dynamic condition resulting
from a body's constant adjustment and adaptation in
response to stresses and changes in the environment for
maintaining an inner equilibrium called homeostasis (see
next slide).
 Homeostasis means


Disposition of living beings (and inanimate and appropriately designed

systems) to keep on functioning at an optimum level, despite changes in the
environment within certain limits.

 Homeostasis employs feedback mechanisms to maintain the dynamic

equilibrium of a self-regulating system, similar to the way a tight-rope
walker maintains balance on the rope. Human body's maintenance of its
optimum temperature and chemical balance is an example of homeostasis.
 1. “Health“ cont…
• The word "health" refers to a state of complete
emotional and physical well-being....

• Health also can be defined as physical, mental,

and social wellbeing, and as a resource for
living a full life. It refers not only to the
absence of disease, but the ability to recover and
bounce back from illness and other problems.

• Healthcare exists to help people maintain this

optimal state of health.
 Different components of health
 There are six different Types of Health aspects
1.Physical health.
2.Emotional health.
3.Mental/Intellectual health.
4.Social health.
5.Environmental health.
6.Spiritual health.

 Each of the 6 components of health is somehow integrated, which

incorporates social, physical, emotional, spiritual, cognitive, and cultural
health.

 Healthcare exists to help people maintain the optimal state of health.

 2. Healthcare:
Health care means the efforts made to maintain or restore
physical, mental, or emotional well-being especially by
trained and licensed professionals —usually hyphenated
when used attributively health-care providers

Healthcare is the organized provision of medical care to

individuals or a community.

Although the word “healthcare” does not appear, “childcare”, “eldercare,”

and “health care” do. The OED and Webster's Dictionary both designate
“health care” as a noun. The AMA Style Manual gives “health care” and
adds that it need not be hyphenated when used as an adjective, as in
“health care organization.”
 3. Organization:
• Organization is defined as a social unit of people that is structured and

managed to meet a need or to pursue collective goals.

• All organizations have a management structure that determines

relationships between the different activities and the members.

• It subdivides and assigns roles, responsibilities, and authority to carry out

different tasks.

• Organizations are open systems meaning that they affect, and are affected

by their environment.
• Organizations should operate on code of ethics.
 Code of Ethics

This is a written set of guidelines issued by an

organization to its workers and management to help
them conduct their actions in accordance with its
primary values and ethical standards.
 3 b). Healthcare organization

A healthcare organization also sometimes

referred to as health care system, is an
organization of health oriented people,
institutions, and resources that deliver health
care services to meet the health needs of target
populations.
 What is a healthcare preferred provider
organization (PPO)
• Preferred Provider Organization is a type of health
plan that contracts with medical providers, such as
hospitals and doctors, to create a network of
participating providers.

• For example you can use doctors, hospitals, and

other providers outside of the network for an
additional cost under that provider.
 4. What is a public health organization
 Public health organization is concerned with:
promoting healthy lifestyles,
 researching disease and injury prevention
 detecting, preventing and responding to
infectious diseases.

• Public health connects all people.

• Public health is the science of protecting and

improving the health of people and their
communities.
 5. Behavior
• Behavior is a response of an individual or
group to an action, environment, person, or
stimulus.

• Behavioral Theory
• This is the belief that a leader's rate of success
is based on the way in which they behave.

• (Discuss)
 6. Organizational behavior

• Organizational behavior is the study of both

group and individual performance and action
within an enterprise.

• Organizational behavior field of study scans

human behavior in the working atmosphere.
It determines its effect on job structure,
performance, communication, motivation,
leadership, decision making abilities
 7. Organizational structure
 Definition:
The hierarchical arrangement of lines of authority,
communications, rights and duties of an organization.

 Organizational structure determines how the roles,

power and responsibilities are assigned, controlled, and
coordinated, and how information flows between the
different levels of management.
 Organizational structure (2)
• A structure depends on the organization's objectives and
strategy.

• In a centralized structure, the top layer of management has

most of the decision making power and has tight control
over departments and divisions.

• In a decentralized structure, the decision making power is

distributed and the departments and divisions may have
different degrees of independence.
• This can be displayed in a form of organogram or
organizational chart.
EXAMPLE: ORGANOGRAM - MoH KENYA
 Kenya: MoH organizational structure
• The executive head of the Ministry of Health is
the Cabinet Secretary,

• under which is the Principal Secretary

• then Director of Medical Services.

• The Director of Medical Services coordinates and

oversees the functioning of the six departments
under their watch and regulation namely:
 Departments:
• Preventive and Promotive Health
• Curative and Rehabilitation Health Services
• Standards and Quality Assurance and
regulations
• Health sector coordination & inter
governmental control
• Administrative services Policy, planning and
Health Financing ……
Example 2: County Government Dept. for Health
structure
 The importance of organizational structure:

• Organizational structure determines how the

roles, power and responsibilities are assigned,
controlled, and coordinated, and how
information flows between the different levels
of management.

• It demonstrates order and streamlines

operations.
 8. Organizational culture
 The values and behaviors that contribute to the unique social
and psychological environment of an organization.
Organizational culture includes an organization's expectations,
experiences, philosophy, and values that hold it together

 The culture is expressed in the organizations self-image, inner

workings, interactions with the outside world, and future
expectations.

 It is based on shared attitudes, beliefs, customs, and written and

unwritten rules that have been developed over time and are
considered valid.
 Organizational Culture (2)
 It is also called corporate culture and it's shown in

 1) the ways the organization conducts its business, treats its

employees, customers, and the wider community,

(2) the extent to which freedom is allowed in decision making,
developing new ideas, and personal expression,

(3) how power and information flow through its hierarchy, and

(4) how committed employees are towards collective objectives.
It affects the organization's productivity and performance, and
provides guidelines on customer care and service, product quality
and safety, attendance and punctuality, and concern for the
environment.
 Organizational Culture (3)

• Each organization has it's own unique culture

which stems from the vision of their own
leaders but all from the different experiences
that their members bring into the mix.
 9. Organizational economics
• Theory of applied economics which consists of
studying the transactions within an individual
firm versus those conducted between the firm
and other organizations e.g outsourcing services.

• It concentrates in the study of the firm's

management decisions, risk management
policies, organizational structure, compensation,
incentives, and pay plans.
 Group:

• Every organization is a group unto itself.

• A group refers to two or more people who share a

common meaning and evaluation of themselves and
come together to achieve common goals. In other
words, a group is a collection of people who interact
with one another; accept rights and obligations as
members and who share a common identity.

• A group can form a team, and a team or teams can be

formed from a group.
SESSION 2: TEAM BUILDING
 Definition of a team

A Team is a collection of individuals, who

highly communicate, directing their energies
towards a known defined goal, which is
achieved through synergy - their joint,
complementary efforts, for the benefit of all.
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 Organization Synergy
• Organization Synergy occurs when people and
processes merge seamlessly to continuously expand
the ability of the organization to deliver products
and services to its customers, while maintaining
competitiveness.

• Principle of synergy says that common interaction of

system components leads to a result that is greater
than the simple sum of components parameters.
Synergy means cooperation, collaboration or joint
effect of elements (components) of the system
 Definition of team cont…
Two or more individuals with a high
degree of interdependence geared
toward the achievement of a goal or
the completion of a task.

Teams make decisions, solve

problems, provide support,
accomplish missions, and plan their
work through consensus.
NOBODY IS PERFECT BUT A TEAM
CAN BE
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 SYNERGY: 1+1>2
Combined efforts of team members
achieve more than what individuals
can
Together
Each
Achieves
More
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 Example:

• If you have an apple and I have an apple and

we exchange these apples then you and I will
still each have one apple. But if you have an
idea and I have an idea and we exchange
• these ideas, then each of us will have two
ideas.

George Bernard Shaw

 Types of Teams
Formal-work related teams e.g. Health

Management Team (HMT).

Work Group – people working together every day

in same office with similar processes and

equipment
Informal e.g. Athletic Team – people working

together to win a game

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 Culture in the Context of Team Building

• Culture is the general pattern of behavior, shared

beliefs and values that members have in common.

• Culture can be inferred from what people say, do

and think.

• Culture reflects the underlying assumptions about

the way work is performed and what behavior and
actions are encouraged or discouraged

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 Elements of Culture
• Communication and • Relationships
language
• Value and norms
• Sense of self and space
• Beliefs and attitudes
• Dress and appearance
• Mental process and
• Food and feeding habits learning

• Time and time • Work habits and

consciousness practices

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 Elements of culture cont…
Rewards and Perception
recognition
Predisposition
Music and dance
Stereotypes
Art and literature
Gestures and body
Religion
language
Laws Aesthetics.

Customs
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 Elements of culture cont…

• Strategy-vision, mission,
core values • Continuous learning and
improvement
• Service charter
• Monitoring and
evaluating team
• Establish habits, practices, activities
values, beliefs and
subcultures
• Address negative
cultural habits

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 Rationale for Team Building in
Healthcare organization/ health
system
 Team Exercise
• Instructions for Observers
• Instructions for Team members
• Team Exercise
• Scoring, Team members and Observer
comments
• Discussion
 Team Exercise

The main importance of team exercise iso

they have centre of command; did they think
of choosing a leader; listening ability,
orderliness, the tactics and the winning
strategies…..
 Team Activity 1
• Instructions to observers on teams’ behaviour
• Instructions to each team on what to do.

• Competition Exercise - using

– The Rabbit
– wall
– paper
– Arrow
 Team activity

(i) Outline two main challenges in the area

of team building facing your organization.

(ii) Suggest two strategies for addressing

each of the challenges highlighted in (i)
above

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 Rationale of Team Building
Team building is necessary because:-
• Managers spend 50% of their working day in one
team or another.

• Organizations are broken down into functional teams

known as divisions, departments and sections.

• Organizational tasks require the cooperation of

individuals in units and sub-units.

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 Why is Teamwork Important in
Healthcare?

Healthcare delivery system has potential to be

outstanding

Health system is currently not as safe, effective,

or efficient as it should be.
Promoting teamwork and good communication
among health professionals can dramatically
improve healthcare delivery, resulting in much
better outcomes for the patients.

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 TEAM DEVELOPMENT PROCESS
Bruce Tuckman et al (1965, 1977)
FORMING (The Polite Stage)

STORMING
STORMING CONFLICT IS EVIDENT (The Fighting Stage)

FROM “Disorder & instability “, TO

(ORDER) & STABILITY) (The Settling Stage)

ACHIEVE GOALS & RESULTS

PERFORMING (The Performing Stage)

EXIT IN STYLE, REWARD & SANCTION

ADJOURNING (The “Ending” Stage)
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 STAGE 1 - FORMING
• Provide structure , broad goals/norms/TOR and clarify task
direction

• Focus on basic information, keep social distance

• Allow for “get-acquainted time” , break the ice, create atmosphere

of confidence and optimism

• Members tend to feel suspicious and confused

• Be visionary, inspiring, facilitate

communication/interaction/active involvement

• Members tend to accept the power & authority figure

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 STAGE 2 - STORMING
Conflict evident but encourage participation, and
appreciate individual differences

Leader is a facilitator , trainer, coach and role

model

Acknowledge personalities & conflicts that emerge

and resolve issues

Lack of unity & Cohesiveness prevails hence guide

others toward consensus

Get members to assume more task than people

oriented responsibilities
• Train on conflict resolution methods
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 STAGE 3 - NORMING
 Teams emerge at the norming stage in group development

 Coach and Sponsor new norms “modus operandi”

 Norms can be written or unwritten

 Give feedback and support, clarify roles, norms and values

 Plan celebrations for short term wins

 Allow for less structure and promote discussion & contributions

from all team members

 Encouraging others to make decisions and assess relevance of

norms to team productivity

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 STAGE 4 - PERFORMING

Observe ,inquire ,facilitate and fulfill needs and

achieve results
Provides little direction and allow members to
participate more in final decisions
Low amounts of two-way communication needed

Give positive reinforcement and support

Leader sets goals: team accomplishes, solves

problems, share new information

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 STAGE 5 - ADJOURNING

Strategize to help the team begin again

Help team with options for renewal or termination

Effective active listening and provision of information in many

different formats

Offer direction to move group back through initial stages and

guide the process

Create opportunities for feedback, rewards & sanctions. AND

Reflect and engage in continuous learning and improvement

for the next task

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 Difference Between Teams and Groups

• Teams embody a collective action arising out of task

interdependency
• Members of the team agree on the goal

• Members agree that they must work together to achieve

the goal
• Each member is viewed as having one or more important
roles to play to successfully achieve the goal
• There is less hierarchy within the unit than in most work
groups
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Characteristics of Effective Teams.
 TEAM EFFECTIVENESS (Francis and Young. 1979).
Team goals are developed through team interaction &
agreement.

Participation by all team members and roles are shared

Feedback is asked for, by members and freely given as a

way of evaluating the team's performance and clarifying
both feelings and interests of the members.

Leadership is distributed and shared among team

members and individuals willingly contribute their
resources as needed.

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 TEAM EFFECTIVENESS (Francis and Young. 1979).

Problem solving, discussing team issues, and critiquing team

effectiveness are encouraged by all team members.

Conflict is not suppressed members are allowed to express

negative feelings and confrontation within the team which is
managed and dealt with by team members.

Team member resources, talents, skills, knowledge, and

experiences are fully identified, recognized, and used
whenever appropriate.

Risk taking and creativity are encouraged. When mistakes

are made, they are treated as a source of learning rather than
reasons for punishment.

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 TEAM EFFECTIVENESS (Francis and Young. 1979).

• High level of interdependence among members

• Team leader has good people skills and is

committed to team approach

• Each member is willing to contribute , relaxed

climate for communication.

• Members develop mutual trust

• Team and individuals are prepared to take risks

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 TEAM EFFECTIVENESS (Francis and Young. 1979).

Clarity about goals and establishes targets

Roles are defined, team members know how to examine

team and individual errors without personal attacks

Team has capacity to create new ideas

Each team member knows he can influence the team

agenda
Team decision making involves a process that
encourages active participation by all members.

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 Team Leader
An effective team leader makes sure that:

• Team members understand and share the

leader’s vision

• Team members respect and ideally like one

another

• Individuals derive satisfaction from being

members of the team
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 Cont…..
• The team learns to work together in a relaxed
fashion
• Team recognition and credit for a good job is
freely given
• Team members understand and share goals,
objectives, vision and mission.

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 Causes of Team Failure
• Unclear goals and objectives
• Non-measurable goals
• Ill-defined boundaries and responsibilities
• Inappropriate leadership style, and behavior
• Ineffective meetings

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 Cont…..
• Unwillingness of team members to accept
responsibility
• Individually oriented rewards and/or
recognition
• Functional resistance and politics
• Stifling of individual creativity and other
resourcefulness

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 Symptoms of a Failing Team
• No shows at scheduled meetings/events
• Late arrival and early departure
• Substitutes, time and time again
• Chronic complaining and non-constructive
criticism
• Domination and bull-dozing
• Drop outs (from the team)AND
• Missed/unmet deadlines

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 IMPORTANT NOTE:

• Ensure appropriate mix of team

members that will ensure task
accomplishment.

• Ensure you have the right people sitting

on the right seats in your bus?

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SESSION 3: MANAGING TEAM DIVERSITY
 What Is Conflict Resolution?

 Conflict is a natural phenomenon, neither

good or bad, but may have positive or
negative outcomes

 Conflict management is a process of working

through opposing views in order to reach a
common goal or mutual purpose.

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 Key Components of Conflict Resolution
:
• Control emotional responses

• Seek understanding

• Identify needs and common interests of self and

others in the team

• Seek mutual benefit or purpose

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 A MODEL OF STYLES TO HANDLE CONFLICT
THOMAS, K(1976)

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 Reactions to Team Conflict
Competitive/Domination
(Shark):
Winning conflict at expense
of others
Forcing Vs Contending
Compromise (Fox)
Focus on give & Take
Firm Vs Flexible
Collaborative/Integration
(Owl)
Try to ensure everyone wins
The best but most difficult
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Avoidance (Turtle)
• Refusing to become involved
in conflict
• Protecting vs Widthdrawing
Accomodating
(Teddy Bear)
• Yielding ones opinion to
appease others
• Yielding vs Conceding
69
 Accommodation
Uses Danger of Inappropriate Use

•To build the relationship •Your needs are not met

•When the issue is relatively •You may begin to feel taken

unimportant to you, but advantage of and resentful
important to the other person

•When you have less experience

or expertise than the other person

•When preserving harmony and

avoiding disruption are especially
important
 Avoidance
Uses Danger of Inappropriate Use

•When the issue or relationship is •Conflict may fester until

unimportant it escalates

•To prevent an immediate conflict (e.g. •The relationship remains

inappropriate time, place, or feelings are superficial
escalated)

•When someone else can resolve the

conflict more effectively

•When you have little chance of

satisfying your concerns (e.g. national
policy, someone’s basic personality, etc.)
 Collaboration
Uses Danger of Inappropriate
Use
•To find a solution that integrates •May waste time and
both sets of concerns, as they are energy on issues that
both important are not important

•To merge insights from people with
different perspectives on a problem
•When commitment and “buy-in” is
needed to implement a solution
•As the process can
take longer it may
frustrate some people

•When hard feelings have been

interfering with an interpersonal,
working relationship
 Competition/Directive
Uses Danger of Inappropriate Use

•When quick, decisive action is •May weaken

important, such as emergencies relationships if it is
perceived that you won
•When your core values need to be and the other person
defended lost

•When it is important to you to have it •You receive less input

your own way and ideas from others

•Others may not “buy-

in” and sabotage the
decision
 Conflict Resolution Skills & Roadblocks
• Get the facts
AVOID
• Engage in Active/Reflective • Name calling
Listening
• Personalizing issues
• Defuse/manage anger
/negotiate outcomes • Sarcasm/Ridicule/Insulting

• Empathize and appeal to • Threats/Blaming/Inflexibility

cognitive restructuring
• Defensive body posturing. AND
• Deal with clashing Egos
• Offensive language
- Styles Of Conflicts 74
18/05/24
 QUOTES

“ASPIRE TO INSPIRE BEFORE YOU EXPIRE”

(Eugene Bell Jr.)

“RESIST THE URGE TO BE A STAR, STRIVE TO DEVELOP

STARS AND YOU WILL BE A STAR”

"Behind you, all your memories. Before you, all

your dreams. Around you, all who love you.
Within you, all you need."
(Sidney Mohede)

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 REFERENCES
Blake, R. & Mouton, J. (1985). The Managerial Grid III: The Key to
Leadership Excellence. Houston: Gulf Publishing Co.

Daft, R.D (2008). The leadership Experience 4th Ed. South-Western

Cengage Learning, Mason USA

Francis, Dave & Don Young. (1979). Improving Work Groups: A

Practical Manual for Team Building. University Associates, Inc., San
Diego, California.

Thomas, K. (1976). Conflict and Conflict management “ In Handbook

of Industrial and Organizational Behaviour, ed M.D. Dunnette. New
York:John Wiley. Pg.900

JICA Health Systems Strengthening training manual (SEMAH) 2010

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