HSM

BY. MS. ASABA MARION

BscN-KIU,PGDME –CIU & MsMW- ACE-PUTOR
Contacts 0778670084/0753931275
Email ;[email protected]
HEALTH SERVICE MANAGEMENT

• OBJECTIVES
• Define terms; management,leadership,administration
• Describe the principles of management
• Explain the functions of management
• Mention the characteristics of a manager
• Outline the functions of a manager
 Management
• Introduction
• It is very important to teach and train nurses and midwives in
leadership and management so as to ensure they better able to
work together with the other health team managers and prepare
them for practice.
 DEFINITION OF TERMS
• Management is the process of forecasting and planning, organizing,
leading, coordinating and controlling the resources of an
organization in the efficient and effective pursuit of a specified
organizational goal.Henri Fayol (1916)
• Management: Is the process of making efficient use of resources
and to get people to work harmoniously together in order to
achieve the organizational objectives/goals.
• OR
• Is the process of getting work done through other people.
• Leadership: is the process of influencing others towards a goal.
(Bennie and Nanas, 1985)
• Leader: is an influential person who has the ability to lead a group
or department without having a formal appointment.
• Manager: is a formally and officially responsible individual for the
work of a given group. For example; ward in charge, principal of a
school is officially responsible to ensure that the unit accomplishes
its tasks well.
• Authority: is the legitimate right to a manager or a leader by an
organization in order to command subordinates and to act in the
interest of an organization to achieve its goals.
• Power: is to influence others to act. Or it’s the ability to impose the
will on others to bring about certain behavior. (This power can be
reward power, coercive power)
• Nursing management: is the process of working through nursing
personnel to promote and maintain health, prevent illness and
suffering. Therefore the role of nurse manager is to plan, organize,
direct and control available resources in order to provide effective
care to groups of clients efficiently.
 Importance of Management
• It helps in Achieving Group Goals - It arranges the factors of
production, assembles and organizes the resources, integrates the
resources in effective manner to achieve goals.
• By defining objective of organization clearly there would be no
wastage of time, money and effort. Management converts
disorganized resources of men, machines, money etc. into useful
enterprise.
• These resources are coordinated, directed and controlled in such
a manner that enterprise work towards attainment of goals.
• Optimum Utilization of Resources - Management utilizes all the
physical & human resources productively. This leads to efficacy
in management.
• Reduces Costs - It gets maximum results through minimum
input by proper planning and by using minimum input & getting
maximum output.
• Management uses physical, human and financial resources in
such a manner which results in best combination. This helps in
cost reduction.
• Establishes Sound Organization - No overlapping of efforts
(smooth and coordinated functions). It establishes effective
authority & responsibility relationship i.e. who is accountable
to whom, who can give instructions to whom, who are
superiors & who are subordinates.
• Management fills up various positions with right persons,
having right skills, training and qualification.
• Establishes Equilibrium - It enables the organization to
survive in changing environment. It keeps in touch with the
changing environment.
• It adapts organization to changing demand of market /
changing needs of societies. It is responsible for growth and
survival of organization.
 DIFFERENCES BETWEEN THE LEADER AND THE MANAGER

LEADER MANAGER
May or may not have an official Appointed officially to the position.
appointment.  
Have the power and authority to Have power and authority to enforce
enforce decisions as long as decisions.
followers are willing to be lead.  
 

Influence others either formally or Carry out predetermined policies, rules

informally and regulations
Has a variety of roles than the Carries out specific functions, duties and
manager Manipulates resources responsibilities
(people, money etc) to achieve
organizational goals.
A manager strives to obtain results by Focuses on group process, information
making rules, remaining in control, gathering, feedback and empowering
and reacting to situations they may others.
encounter.(achieves power by virtue  
of his/her position)
Managers have subordinates who  A leader chooses to achieve goals through
follow their rules. passion, heart, (human emotions) and
  charisma achieves power through
influence and charisma.
 WORKPLACE MANAGEMENT
THEORIES
• Understanding and applying the best practices from management
theories can help you be more effective in guiding your team to
success.
• Many of these theories gave rise to the leadership approaches
commonly used to guide and grow organizations today, and you can
choose from among them to identify the strategies that will work
best for you and your team.
• Understanding and applying management theories takes practice
and possibly some trial and error.
 What are management theories?
• Management theories are a collection of ideas that recommend
general rules for how to manage an organization or business.
• Management theories address how supervisors implement
strategies to accomplish organizational goals and how they motivate
employees to perform at their highest ability.
• Typically, leaders apply concepts from different management
theories that best suit their employees and company culture.
• Although many management theories were created centuries ago,
they still provide many beneficial frameworks for leading teams in
the workplace and running businesses today.
 Types of management theories
• There are seven important management theories to be aware of:
• 1. Scientific management theory
• Developed by Frederick Taylor, he was one of the first to study
work performance scientifically. Taylor’s principles recommended
that the scientific method should be used to perform tasks in the
workplace, as opposed to the leader relying on their judgment or
the personal discretion of team members. His philosophy
emphasized that forcing people to work hard would result in the
most productive workplace. Instead, he recommended simplifying
tasks to increase productivity. He suggested that leaders assign
team members to jobs that best match their abilities, train them
thoroughly and supervise them to ensure they are efficient in the
• 2.Principles of administrative management theory
• Henri Fayol, a senior executive and mining engineer, developed this
theory when he examined an organization through the perspective
of the managers and situations they might encounter.
• He believed that leaders had six main functions, to forecast, plan,
coordinate, command and control, and he developed principles that
outlined how leaders should organize and interact with their teams.
• He suggested that the principles should not be rigid but that it
should be left up to the manager to determine how they use them
to manage efficiently and effectively.
• The principles he outlined are:
• Initiative: This refers to the level of freedom employees should have to carry
out their responsibilities without being forced or ordered. 
• Equity: This principle implies everyone in the organization should be treated
equally and that it should be an environment of kindness.
• Scalar chain: This principle says there should be a chain of supervisors from
the top level of management to the lower level and that communication
generally flows from top to bottom. He emphasized that there is no hard rule
regarding the communication process through the chain of command.
• Remuneration of personnel: This principle refers to the assertion that there
should be both monetary and non-monetary remuneration based on
performance levels to create a bond between the employee and the
organization
• 3. Bureaucratic management theory
• Developed by Max Weber, bureaucratic management theory focuses
on structuring organizations in a hierarchy so there are clear rules of
governance.
• His principles for creating this system include a chain of command,
clear division of labor, separation of personal and organizational
assets of the owner, strict and consistent rules and regulations,
meticulous recordkeeping and documentation and the selection and
promotion of employees based on their performance and
qualifications. 
• This theory has played a key role in establishing standards and
procedures that are at the core of most organizations today.
• 4. Human relations theory
• This theory was developed by Elton Mayo, who conducted
experiments designed to improve productivity that laid the
foundation for the human relations movement.
• His focus was on changing working conditions like lighting, break
times and the length of the workday. Every change he tested was
met with an improvement in performance.
• Ultimately, he concluded that the improvements weren’t due to
the changes but the result of the researchers paying attention to
the employees and making them feel valued. 
• 6. Contingency management theory
• Developed by Fred Fiedler, this theory’s primary focus is that no one
management approach works for every organization.
• Fiedler suggested that a leader’s traits were directly related to how
effectively they lead their team.
• He asserts that there are leadership traits that apply to every kind of
situation and that a leader must be flexible to adapt to a changing
environment.
• 7. Theory X and Y
• American social psychologist, Douglas McGregor, introduced X and Y theories
in his book, “The Human Side of Enterprise,” where he concluded that two
different styles of management are guided by their perceptions of team
member motivations.
• Managers who assume employees are apathetic or dislike their work use
theory X, which is authoritarian. Theory Y is used by managers who believe
employees are responsible, committed and self-motivated.
• This is a participative management style that gives rise to a more
collaborative work environment, whereas theory X leads to micromanaging.
• He concluded that large organizations may rely on theory X to keep everyone
focused on meeting organizational goals. Smaller businesses, where
employees are part of the decision-making process and where creativity is
encouraged, tend to use theory Y.
Tips for using management theories in the workplace
• Here are some tips to help you apply the best practices from these
management theories in your workplace:
• Invest in employee training
• As Taylor proposes in his scientific management theory, you can
boost employee productivity by observing work processes and then
creating policies recommending best practices. Invest in training
your employees to be more effective in their roles. You will generally
find that it boosts their productivity and improves overall on-the-job
performance. Human relations theory can impact productivity as
well, since the attention you give team members and the interest
you pay in their performances can increase their productivity.
• 
• Give employees power in making decisions
• Take a cue from the human relations theory by encouraging
interpersonal relationships and creating a collaborate environment.
Give your team members more power in making decisions.
• This could mean giving them more control within their roles or
allowing greater contribution to departmental goals and strategies.
• Consider creating sub-groups within your department and allowing
those teams greater decision-making abilities to reach organizational
goals.
 Benefits of management theories
• There are several reasons why leaders should study and apply
management theories, including:
• Increased productivity: Using these theories, leaders learn how to
make the most of their team members, improving performances and
increasing productivity.
• Simplified decision-making:MGT theories give leaders strategies that
speed up the decision-making process, helping those leaders be more
effective in their roles.
• Increased collaboration: Leaders learn how to encourage team
member participation and increase collaboration in the workplace.
• Increased objectivity: Mgt theories encourage leaders to make
scientifically proven changes rather than relying on their judgment.
 Managerial functions
• Planning; Managers should ensure that the resources available
now and in the future are used in the most efficient way to
attain the pre-set goals.
• Organizing; they should establish a deliberate structure of roles
and empower the roles players to perform.
• Staffing; managers should fill and keep filled the positions in the
organization. This requires taking staff inventory, recruiting,
selecting, inducting, promoting, motivating, etc.
• Leading; they should influence people so that they can contribute
to group and organizational goals. It requires motivation, good
communication and good leadership styles.
• Controlling; measuring and correcting activities to ensure that
everything is done as planned. What are the control mechanisms in
your organization?
• Coordinating; ensuring that different individual roles mesh with
the efforts of others, harmonizing them to contribute to the
common goal.
Assignment 5
• Read and make notice on PRINCIPLES OF MANAGEMENT
I. Division of labour
II. Establishment of authority
III. Enforcement of discipline
IV. Unity of command
V. Unity of direction etc
• To be submitted on a communicated date
Functions of management
Planning

Controlling Organizing

Leading Staffing
 CHARACTERISTICS/QUALITIES OF A
GOOD MANAGER OR LEADER
• Knowledgeable: since the management problems are complex
and many faced, a manager should be knowledgeable in order
to process the information into useful data for decision making
and also differentiate between facts and non- facts.
• Decisiveness: a manager should have the ability to prompt and
desirable decisions.
• Ability to handle conflict: should be able to listen, positively
respond to criticism and handle conflict and differences in a
constructive manner.
• Emotional stability: he should be able to adjust to life, calm,
cool and calculated reaction to undesirable situations and
obstacles.
• Honesty & Integrity: are crucial to get your people to believe
you and buy in to the journey you are taking them on
• Have vision: know where you are, where you want to go and
enroll your team in charting a path for the future
• Inspirational: inspire your team to be all they can by making
sure they understand their role in the bigger picture
• Ability to Challenge: do not be afraid to challenge the status
quo, do things differently and have the courage to think
outside the box
• Communication Skills: keep your team informed of the
journey, where you are, where you are heading and share
any roadblocks you may encounter along the way
 FUNCTIONS OF A MANAGER
• Recruitment, maintaining and firing of staff. This is vital to ensure
that you have competent and enough staff to do the available tasks.
• Formally evaluate performance of staff on a regular basis for
example through appraisal, supportsupervisionand provide feedback
accordingly.
• Recommend staff for promotion or further study which will motivate
the staff and also enable the organization to have staff with
expertise.
• Prepare and adhere to the proposed budget so as to ensure
appropriate resource utilization and minimize loss/wastage.
• Assign and program the work of staff members so as to prevent
role conflict.
• Should be able to handle problems/conflicts occurring at work
place.
• Plan for the activities of the organization
• Empower the employees through assigning responsibilities or
delegation.
• Motivate workers so as to better perform their roles which will
lead to attainment of organizational objectives
Self study
• read and make notice on the FUNCTIONS OF MANAGEMENT IN
DETAILS
 Concepts of management
• Three of the most important concepts in healthcare management
are effectiveness, efficiency and equity.
• 1  Effectiveness
• The concept of effectiveness is a measure of how well an
organization, or a person in an organization, is meeting their goals.
• For example, if the goal is to provide high quality healthcare and the
organization or person succeeds in doing so, then they are working
effectively.
• If the healthcare provision is poor and people are not satisfied, then
the organization or person is not effective.
• Health manager effectiveness involves doing the right things to move
the health sector closer to its objectives and at the same time
continually learning from that experience.
• Monitoring and control helps you to measure performance against
set objectives and standards and thus assess effectiveness and how
well an objective has been achieved.
• E.g A Health Extension Practitioner is set an objective to distribute
500 malaria bed nets during one year and succeeds in distributing
100 .What do you think went wrong?
• 2  Efficiency
• Healthcare management involves getting things done using human,
financial and material resources so that the goal of improving the
health of the community can be achieved.
• Efficiency is a measure of how well the health sector is using its
resources to achieve that goal.
• If money and materials are being used well and there is little
wastage, then you are working efficiently.
• If costs are too high or materials are being wasted, then your activity
is inefficient.
• Efficiency involves doing things right, using resources wisely
and with a minimum of waste.
• E.g Health Post A has received an anti-malarial drug with
only one month’s shelf life remaining. It expires after one
month having served only a few people. Is this an efficient
use of resources?
• 3. Equity
• Access to healthcare is the basic right of all people. However, this
does not always happen in real life for many reasons.
• Health inequalities are a result of the unfair distribution of resources
and may be associated with low income levels, housing, education,
gender, geographically inaccessible areas and sometimes with
ethnicity.
• As a Health Extension Practitioner you have an important role to play
in allocating resources equally to all the diversified groups in your
community, with a special focus on those who are deprived and
denied access to healthcare.
CONFLICT RESOLUTION
 CONFLICT RESOLUTION

• Definition of Conflict
• Conflict is an expressed struggle between at least two
interdependent parties
• Other definitions,
• A battle, contest or opposing forces existing between primitive
desires and moral, religious or ethical ideas ( Webster’s Dictionary)
• A state of incompatibility of ideas between two or more parties or
individuals
Conflict resolution cont
• Types of conflicts
• Inter-personal and intra-personal
• Inter-group and intra-group
• Competitive and Disruptive
Causes of conflicts
• General causes of conflicts
• Poor Communication: – little, wrong, No information
• Poorly defined goals
• Divergent personal values
• Lack of cooperation/trust
• Competition of scarce resources
• Unclear roles/lack of job description
Conflict resolution cont
• STAGES OF CONFLICT
• Latent conflict.
• Conflict Emergency.
• Conflict Escalation.
• Hurting/Stalemate.
• De-escalation
• Settlement/ Resolution
• Post conflict peace building and reconciliation.
• Latent conflict.
• People have different ideas, values, personalities and needs,
which can create situations where others agree with their
thoughts or actions.
• This in itself is not a problem, unless an event occurs to
expose these differences
• Conflict Emergency
• At the emergence stage, conflict starts to set in as the parties
involved recognize that they have different ideas and
opinions on a given topic.
• The differences cause discord and tension.
• The conflict may not become apparent until a "triggering
event" leads to the emergency (or beginning) of the obvious
conflict.
• Conflict Escalation.
• If the parties involved in a conflict cannot come to a
resolution, the conflict may escalate.
• When a conflict escalates, it may draw more people into the
situation, heightening any already existing tension.
• The escalation stage is intense and during this stage people
pick sides and view their opponents as the enemy.
• Stalemate(hurting)
• Stalemate is the most intense stage and arises out of a conflict
escalating. During the stalemate stage, the conflict has spiraled out
of control to a point where neither side is in a position to agree to
anything.
• The pain of continuing the conflict exceeds that of maintaining the
confrontation, and thus called hurting stalemate.
• By this point, participants are not willing to back down from their
stances, and each side insists that its beliefs are ultimately right.
• Even in a situation where a member of one side feels that there may
be merit in the other side’s stance, there’s an unwillingness to admit
it because of a need to protect interests.
• De- Escalation.
• Even the most intense conflicts calm down at some point, as
one or more of the persons involved in the conflict realize
they are not likely to reach a conclusion if they continue with
their unwillingness to look at the conflict from all sides.
• During this stage, parties begin to negotiate and consider
coming up with a solution.
 Conflict handling techniques
• Dispute settlement/Resolution.
• After hearing from all parties involved in the conflict, participants are
sometimes able to come up with a resolution for the problem they are
facing.
• As an administrator, you may have to work with the involved parties to
settle the conflict very well by shifting the focus to what is really
important.
• Post conflict/peace building.
• If the parties reach a solution, it’s necessary to repair the relationships
that may have been damaged during the escalated conflict because It’s
more likely that the participants used harsh words or even fought while
in the midst of the conflict.
 CONFLICT MANAGEMENT
• Conflict management is the practice of identifying and handling a
conflict in a sensible, fair and efficient manner.
• Approaches used,
• The conflict styles.
• The “interest-based relational approach”.
• The tool-conflict resolution process.
• The conflict resolution styles.
• Competition (win-lose situation)
• Accommodation (win-win situation)
• Avoidance (lose-lose situation)
• Compromise (lose-lose situation)
• Collaboration (win-win situation)
• Competition:
• Take a firm stand, and know what you want. Operate from a position
of power, drawn from things like position, rank, expertise, or
persuasive ability. This style can be useful,
• When there is an emergency and a decision needs to be made
fast.
 • When the decision is unpopular.
• When defending against someone who is trying to exploit
the situation selfishly.
• However it can leave people feeling bruised, unsatisfied and
resentful when used in less urgent situations.
• Collaboration.
• Try to meet the needs of the parties involved. Be highly
assertive, cooperate effectively and acknowledge that
everyone is important. This style is useful
• When you need to bring together a variety of viewpoints to
get the best solution.
• When there have been previous conflicts in the group.
• When the situation is too important for a simple trade-off.
• Compromising:
• Try to find a solution that will at least partially satisfy
everyone. Everyone is expected to give up something.
Compromise is useful,
• When the cost of conflict is higher than the cost of losing
ground.
• When equal strength opponents are at a standstill.
• When there is a deadline looming.
• Accommodating:
• This style indicates a willingness to meet the needs of
others at the expense of the person's own needs. The
accommodator often knows when to give in to others, but
can be persuaded to surrender a position even when it is not
warranted. This person is not assertive but is highly
cooperative.
• Accommodation is appropriate,
• When the issues matter more to the other party.
 • When peace is more valuable than winning.
• When you want to be in a position to collect on this
"favour" you gave.
• However people may not return favours, and overall
this approach is unlikely to give the best outcomes.
• Avoiding:
• Seek to evade the conflict entirely, delegate controversial decisions,
accept default decisions, and don’t hurt anyone's feelings.
• This style can be appropriate,
• When victory is impossible.
• When the controversy is trivial.
• When someone else is in a better position to solve the problem.
• However in many situations this is a weak and ineffective approach
to take.
• INTEREST-BASED RELATIONAL APPROACH
• This type of conflict resolution respects individual differences while
helping people avoid becoming too entrenched in a fixed position. It
involves;
• Making sure that good relationships are the first priority.
• Keeping people and problems separate
• Paying attention to the interests that are being presented.
• Listening to what both parties have to say.
• Set out the facts
• Explore options and solutions together.
 A CONFLICT RESOLUTION PROCESS
• This involves the following steps,
• Set the scene.
• Make sure that people understand that the conflict may be a mutual
problem, which may be best resolved through discussion and
negotiation rather than through raw aggression.
• If you are involved in the conflict, emphasize the fact that you are
presenting your perception of the problem. Use active listening skills
to ensure you hear and understand other's positions and
perceptions.
• And make sure that when you talk, you're using an adult, assertive
approach rather than a submissive or aggressive style.
• Gather information:
• Here you are trying to get to the underlying interests, needs, and
concerns. Ask for the other person's viewpoint and confirm that you
respect his or her opinion and need his or her cooperation to solve
the problem.
• Try to understand his or her motivations and goals, and see how
your actions may be affecting these.
• Agree about the problem
• This sounds like an obvious step, but often different underlying
needs, interests and goals can cause people to perceive problems
very differently. You'll need to agree the problems that you are trying
to solve before you'll find a mutually acceptable solution.
• Sometimes different people will see different but interlocking
problems – if you can't reach a common perception of the problem,
then at the very least, you need to understand what the other person
sees as the problem.
• Get possible solutions:
• If everyone is going to feel satisfied with the resolution, it will help if
everyone has had fair input in generating solutions. Brainstorm
possible solutions, and be open to all ideas, including ones you never
considered before.
• Negotiate the solution.
• By this stage, the conflict may be resolved: Both sides may better
understand the position of the other, and a mutually satisfactory
solution may be clear to all.
• However you may also have uncovered real differences between your
positions. This is where a technique like win-win negotiation can be
useful to find a solution that, at least to some extent, satisfies
everyone.
Remember these,
• Assure privacy

• Empathize than sympathize

• Listen actively

• Maintain equity

• Focus on issue, not on personality

• Avoid blame
• Identify key theme

• Re-state key theme frequently

• Encourage feedback

• Identify alternate solutions

• Give your positive feedback

• Agree on an action plan

CONFLICT PREVENTION

•Brainstorm
 Prevention of conflicts at workplace
• Communicate effectively
• Frequent meeting of your team
• Allow your team to express openly
• Sharing objectives
• Having a clear and detailed job description
• Distributing task fairly (do your appointment duties, job
description, task assignment)
• Never criticize team members publicly
• Always be fair and just with your team
• Being a role model
•QUESTION
•??
References
• Amri M.Ngatia, mwakilasa A.O(1993) a guide for training
teachers of health workers 1st edition AMREF Nairobi
• MOH(12012) management of medicines and health supplies
1st edition
• Rees W.David & porter Christian(2008) skills of
management .6th edition ,Palgrave Macmillan
•