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ORGANISASI &
     MANAJEMEN

    Ayun Sriatmi, Dra, M.Kes


    PROGRAM MAGISTER EPIDEMIOLOGI
       UNIVERSITAS DIPONEGORO

                   
TOPIK MATRIKULASI
    1. Pengertian Dasar Organisasi & Manajemen
       (Kesehatan)
    2. Fungsi Manajemen (Kesehatan)
    3. Pengambilan Keputusan Manajerial
    4. Sistem Kesehatan
    5. Manajemen Sumber Daya Manusia
    6. Manajemen Pembiayaan Kesehatan
    7. Manajemen Logistik Kesehatan




                          
Mengapa
    ORGANISASI & MANAJEMEN
        perlu dipelajari ?




               
Organizations & Manager
                                     Organization Theory & Health Care Management
          Need to….                                 Managerial Role                                          Need to….


        Motivate & Lead                   Operate the                             Renew                        Chart
        people and group               technical system                      the organization                the future


1.    Satisfying                1.    Determining the                1.    Determining appro­           1.   Managing strate­
      individual need                 appropriate work                     priate organization               gically
      & values                        design                               design.
      ­ Perception              2.    Establishing                   2.    Aquiring resources           2.   Anticipating the
      ­ Motivation                    communication &                      & managing the                    Future
      ­ Negotiation                   coordination                         environment
2.    Providing direction             mechanism                      3.    Managing change &
      ­ Leadership              3.    Controlling per­                     innovation
      ­ Managership                   formance                       4.    Attaining Goals
3.    Recognizing the                 ­ Authority                          ­ Effective
      nature of groups                ­ Power                              ­ Efficient 
      ­ Social structure of           ­ Influence                                                      In response to problems
        work group                                                                                     survival & growth
                                                                                                       (long­term survival, 
                                                                                                       long­run performance
                                                                          In response to problems      & growth)
                                     In response to problems              of the environment
     In response problems
     In response to problems         of technical performance             (complexity & uncertainty,
     of personil (commitment,        (productivity, eficiency,            technology & social
     absenteism, turn­over,          quality & customer satis­            change, competitive force,
     apathy & conflict among         faction)                             multiple performance
     professionals)
     professionals                                                        demand) 
                                                                  
ORGANISASI
        &
    MANAJEMEN
    ( dasar-dasar &
      pengertian )



            
ORGANISATIONS
    “ The framework of the management process”
    “ Organizations are intricate human strategies
      designed to achieve certain objectives”
    “ Organizations are systems of inter-dependend
      human being”




                           
ORGANISASI
PENGERTIAN :
  Sekumpulan orang-orang yang diarahkan
  utk mencapai tujuan spesifik

KARAKTERISTIK ORGANISASI :
 a. Orang-orang
 b. Tujuan
 c. Struktur



                     
ASAS-ASAS ORGANISASI
    a.   Struktur
    b.   Departemenisasi
    c.   Pencapaian tujuan
    d.   Kerjasama
    e.   Hierarki wewenang & tanggung jawab
    f.   Sentralisasi vs Desentralisasi
    g.   Pembagian kerja / Divisi
    h.   Kejelasan tugas
    i.   Span of control / Rentang Kendali
    j.   Effektivitas
    k.   Efisiensi




                                
KEY ORGANIZATIONAL VARIABLES

        1.   Purpose & Goals
        2.   People
        3.   Tasks
        4.   Technology
        5.   Culture
        6.   External Environment


                     
JENIS-JENIS ORGANISASI

    1.   Organisasi Lini / Garis
    2.   Organisasi Lini & Staff
    3.   Organisasi Fungsional
    4.   Organisasi Panitia / Tim Kerja




                       
TRADITIONAL ORGANIZATION                       NEW ORGANIZATION

  a.   Stable                             a. Dynamic
  b.   In-flexible                        b. Flexible
  c.   Job-focused                        c. Skills-focused
  d.   Work is defined by job             d. Work is defined in terms of
       position                              tasks tk anywhereo be done
  e.   Individual oriented                e. Team oriented
  f.   Permanent jobs                     f. Temporary jobs
  g.   Command oriented                   g. Involvement oriented
  h.   Manager always make                h. Employees participate in
       decision                              decision making
  i.   Rule oriented                      i. Customer oriented
  j.   Relatively homogeneus              j. Diverse workforce
       workforce                          k. Workdays have no time
  k.   Workdays defined as 9 to 5            boundaries
  l.   Hierarchical relationship          l. Lateral & Networked
  m.   Work organizational facility          relationship
       during specific hours              m. Work anywhere, anytime
                                       
Why are organizations
         changing ?




               
BUDAYA ORGANISASI
Adalah sistem kesamaan perilaku dan keyakinan-
  keyakinan tertentu dalam suatu organisasi yang
  dapat mempengaruhi bagaimana para anggota
  organisasi bertindak / bekerja

Meliputi :
 a. sistem / pola tata nilai ( rules & taboos )
 b. simbol-simbol
 c. ritual
 d. mitos
 e. praktek



                            
IMPLIKASI BUDAYA ORGANISASI

1. Budaya adalah PERSEPSI
   ( berdasarkan apa yang dilihat, didengar,
   dirasakan & pengalaman dalam
   organisasi )
2. Anggota organisasi cenderung
   menggambarkan budaya organisasi
   dalam terminologi yg sama




                       
DIMENSIONS OF ORGANIZATIONAL CULTURE
                                                           Degree to which employees are 
                                                           expected to exhibit precision, 
      Degree to which employees are                        analysis and attention to detail
                                           Attention to
      encouraged to be innovative &
      to take risks                           Detail
                                           Low……….High                           Degree to which 
                  Innovation &                                                   managers focus
                   Risk Taking                                                   on results or 
                                                               Outcome           outcomes rather 
                 Low………..….High                               Orientation        than on how 
                                                             Low……….High         these outcomes 
                                                                                 are achieved
Degree to which                        Organizational
organizational                            Culture
decisions and                                                       People
actions          Stability
                                                                  Orientation
emphasize 
maintaining the Low….…High                                          Low……….High
status quo                                                                  Degree to which 
                                                                            management
                                                            Team
                         Aggressiveness                                     decisions take into
                                                       Orientation          account the effects
                          Low……………..High              Low………….High          on people in the
        Degree to which employees are                                       organizations
                                                   Degree to which work is 
        aggressive & competitive rather            organized around teams 
        than cooperative                           rather than individuals


                                                
Weak Cultures         Moderate Cultures       Strong Cultures




     Strong cultures are cultures in which the key values
     are deeply held and widely shared – have a greater
        influence on employees than do weak cultures




                                
How Employees Learn
              Culture ?
    1. Organizational “stories”
    2. Corporate “rituals”
    3. Material “symbols” (get a
       “feel” for the material .i.e.
       place, lay-out, facilities, dress,
       etc
    4. Language


                       
ENVIRONMENT OF ORGANIZATION

    a.   INTERNAL - ENVIRONMENT

    b.   EXTERNAL – ENVIRONMENT
         • Specific Environment
         • General Environment




                   
SPECIFIC - ENVIRONMENT

      1.   Customers
      2.   Suppliers
      3.   Competitors
      4.   Public Pressure Groups




                     
GENERAL - ENVIRONMENT
     1.   Economic Conditions
     2.   Political / Legal Conditions
     3.   Socio-Cultural Conditions
     4.   Demographic Conditions
     5.   Technological
     6.   Global



                      
How The Environment Affects Organization ?


    • Through the degree of environmental
      uncertainty, which is determined by two
      dimensions :
      a. The degree of changes
      b. The degree of complexity in an
      organization’s environment




                          
MANAGEMENT
“ Management is a social process … the process
  consists of … planning, control, coordination
  & motivation” ( Brech )
“ To manage is to forecast and plan, to
  organize, to command, to coordinate and to
  control “ ( Fayol )
“ Managing is an operational process initially
  best dissected by analysing the managerial
  functions… The five essentials managerial
  functions are : planning, organising, staffing,
  directing and leading, and controlling.”
  ( Koontz & O’Donnell )

                         
MANAGEMENT
“ Management as the process of
  coordinating work activities so that
  they are completed efficiently and
  effectively with and through other
  people”
  (Robbins)




                     
MANAGEMENT

• Proses pengaturan berbagai sumberdaya
  organisasi untuk mencapai tujuan yg sdh
  ditentukan melalui pelaksanaan fungsi-
  fungsi tertentu.

• Sumberdaya organisasi :
  Man, Money, Material, Machines, Methods,
  & Market (6M)


                      
EFFICIENCY :
     “doing things right”

      EFFECTIVENESS :
    “doing the right things”




                
FUNGSI MANAJEMEN

Taylor     :    Planning, Organizing,     Actuating,
  Controlling (POAC)
Fayol      :    Planning, Organising,Commanding,
  Coordinating, Controlling (POCCC)
Koontz & :      Planning, Organising, Staffing,
O’Donnell Directing, Leading, Controlling
                      ( POSDLC)
Robbins :       Planning, Organising, Leading,
  Controlling (POLC)
Depkes     :    P1 – P2 – P3




                            
PERKEMBANGAN MANAJEMEN
1.   TEORI KLASIK
     * Scientific Management
     * Orientasi pd struktur & aktivitas formal.
     * Efektivitas organisasi sangat ditentukan oleh
       kejelasan pembagian kerja, hirarki
     kewenangan yg tegas & rentang kendali
     * Pendekatan preskriptif, melihat bgm manager
       melaks fungsi kepemimpinan dlm organisasi
     * Tokoh : Henry Fayol, Taylor, Weber (teori
       birokrasi )



                           
PERKEMBANGAN MANAJEMEN
2.   TEORI HUMAN RELATION
     * Aspek “human factor at work” dan “social
     relationship”
     * Perhatian pd issu-issu yg menyangkut
     motivasi, komunikasi interpersonal & gaya
     kepemimpinan.
     * Fokus pd “individual satisfaction”
     * Pemikiran fundamental pendekatan human
     relation dlm manajemen adalah bahwa
     “human needs” adalah faktor terpenting utk
     tercapainya efektivitas organisasi
     * Tokoh : Elton Mayo (“Hawthorne Studies ),
     McGregor, Likert, Herzberg, etc

                           
PERKEMBANGAN MANAJEMEN
3.   TEORI SISTEM & PENDEKATAN KONTINGENSI
     * Memandang organisasi sbg suatu sistem yg
       kompleks, mencakup orang-orang, tugas &
       teknologi.
     * Organisasi adalah bagian dari lingkungan yg
       lebih besar yg saling berinteraksi &
     dipengaruhi oleh faktor2 sosial lainnya
     (teknis & ekonomi)
     * Organisasi sbg “sistem terbuka” dan “sistem
       tertutup” dengan lingkungannya



                           
PERKEMBANGAN MANAJEMEN
4.   PENDEKATAN MANAJEMEN MODERN
     * Efektivitas organisasi dilihat pd kemampuan /
       fokus melihat issu-issu strategis
     * Orientasi pd efektivitas & efisiensi organisasi
     * Bagaimana mengembangkan visi & missi-
       missi strategis & implementasi dari nilai &
       budaya organisasional, a.l : memanage
     perubahan, mempromosikan TQM,
     pencapaian “organizational excelence”,
     pemberdayaan personal & hubungan dgn
     “stake-holder”


                            
MANAGEMENT ROLES
    a. INTERPERSONAL ROLES
            * Figurhead
              * Leader
              * Liaison
    b. INFORMATIONAL ROLES
              * Monitor
           * Disseminator
            * Spokesman
     c. DECISIONAL ROLES
            * Entrepreneur
        * Disturbance handler
         * Resource allocator
 
              * Negotiator
                   
MANAGEMENT - SKILLS

1.   TECHNICAL – SKILLS
     Knowlegde of an proficiency in a certain
     specialized field
2.   HUMAN – SKILLS
     The ability to work well with other people both
     individually and in a group
3.   CONCEPTUAL – SKILLS
     The ability to think and to conceptualized about
     abstract and complex situations

     ( Henry Mintzberg )

                            
MANAGEMENT LEVEL


         Top Manager



        Middle Manager


        Lower Manager




               
Top
    Management      CONCEPTUAL
                      SKILLS




    Middle                             HUMAN
    Management                         SKILLS




    Lower – Level                               TECHNICAL
    Management                                    SKILLS



                        Level of importance



                                    
MANAGERIAL - JOBS
Are affected by the extend of, and the relationship
    between :

a.   The “core” of the jobs ( the responsibilities of
     the job-holder which cannot be delegated ) or
     the “demands” of jobs
b.   The “constraints” of the jobs
c.   The “choices” available to the job-holder by way
     of different work from another person




                           
Relationship between Management
        and Organization



         HOW ?

                
KEY VARIABLES OF MANAGEMENT

                 a. People
            b. Work & Structures
          c. System & Procedures
      d. The Goals of the Organization
        e. The Technology Available
     f. The Culture of the Organization


                      
MANAGING IN DIFFERENT AND
         CHANGING SITUATIONS
    • Management is not ( and cannot be) based on
      simplistic principles
    • Different and changing situations require
      managers to use different approaches &
      techniques
    • Entrepreneurial skills
    • Contingency – Perspective :
      An approach that says that organizations are
      different, face different situations (contingencies)
      and require different ways of managing


                               
POPULAR CONTINGENCY
               VARIABLES


    1.   Organization Size
    2.   Routineness of Task Technology
    3.   Environmental Uncertainty
    4.   Individual Differences



                      

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Organisasi & Manajemen

  • 1. ORGANISASI & MANAJEMEN Ayun Sriatmi, Dra, M.Kes PROGRAM MAGISTER EPIDEMIOLOGI UNIVERSITAS DIPONEGORO    
  • 2. TOPIK MATRIKULASI 1. Pengertian Dasar Organisasi & Manajemen (Kesehatan) 2. Fungsi Manajemen (Kesehatan) 3. Pengambilan Keputusan Manajerial 4. Sistem Kesehatan 5. Manajemen Sumber Daya Manusia 6. Manajemen Pembiayaan Kesehatan 7. Manajemen Logistik Kesehatan    
  • 3. Mengapa ORGANISASI & MANAJEMEN perlu dipelajari ?    
  • 4. Organizations & Manager Organization Theory & Health Care Management Need to…. Managerial Role Need to…. Motivate & Lead  Operate the Renew Chart people and group technical system the organization the future 1. Satisfying  1. Determining the 1. Determining appro­ 1. Managing strate­ individual need  appropriate work  priate organization gically & values design design. ­ Perception 2. Establishing 2. Aquiring resources 2. Anticipating the ­ Motivation communication & & managing the Future ­ Negotiation coordination environment 2. Providing direction mechanism 3. Managing change & ­ Leadership 3. Controlling per­ innovation ­ Managership formance 4. Attaining Goals 3. Recognizing the  ­ Authority ­ Effective nature of groups ­ Power ­ Efficient  ­ Social structure of  ­ Influence In response to problems   work group survival & growth (long­term survival,  long­run performance In response to problems & growth) In response to problems of the environment In response problems In response to problems of technical performance  (complexity & uncertainty, of personil (commitment, (productivity, eficiency, technology & social absenteism, turn­over, quality & customer satis­ change, competitive force, apathy & conflict among faction) multiple performance professionals) professionals demand)     
  • 5. ORGANISASI & MANAJEMEN ( dasar-dasar & pengertian )    
  • 6. ORGANISATIONS “ The framework of the management process” “ Organizations are intricate human strategies designed to achieve certain objectives” “ Organizations are systems of inter-dependend human being”    
  • 7. ORGANISASI PENGERTIAN : Sekumpulan orang-orang yang diarahkan utk mencapai tujuan spesifik KARAKTERISTIK ORGANISASI : a. Orang-orang b. Tujuan c. Struktur    
  • 8. ASAS-ASAS ORGANISASI a. Struktur b. Departemenisasi c. Pencapaian tujuan d. Kerjasama e. Hierarki wewenang & tanggung jawab f. Sentralisasi vs Desentralisasi g. Pembagian kerja / Divisi h. Kejelasan tugas i. Span of control / Rentang Kendali j. Effektivitas k. Efisiensi    
  • 9. KEY ORGANIZATIONAL VARIABLES 1. Purpose & Goals 2. People 3. Tasks 4. Technology 5. Culture 6. External Environment    
  • 10. JENIS-JENIS ORGANISASI 1. Organisasi Lini / Garis 2. Organisasi Lini & Staff 3. Organisasi Fungsional 4. Organisasi Panitia / Tim Kerja    
  • 11. TRADITIONAL ORGANIZATION NEW ORGANIZATION a. Stable a. Dynamic b. In-flexible b. Flexible c. Job-focused c. Skills-focused d. Work is defined by job d. Work is defined in terms of position tasks tk anywhereo be done e. Individual oriented e. Team oriented f. Permanent jobs f. Temporary jobs g. Command oriented g. Involvement oriented h. Manager always make h. Employees participate in decision decision making i. Rule oriented i. Customer oriented j. Relatively homogeneus j. Diverse workforce workforce k. Workdays have no time k. Workdays defined as 9 to 5 boundaries l. Hierarchical relationship l. Lateral & Networked m. Work organizational facility relationship during specific hours m. Work anywhere, anytime    
  • 12. Why are organizations changing ?    
  • 13. BUDAYA ORGANISASI Adalah sistem kesamaan perilaku dan keyakinan- keyakinan tertentu dalam suatu organisasi yang dapat mempengaruhi bagaimana para anggota organisasi bertindak / bekerja Meliputi : a. sistem / pola tata nilai ( rules & taboos ) b. simbol-simbol c. ritual d. mitos e. praktek    
  • 14. IMPLIKASI BUDAYA ORGANISASI 1. Budaya adalah PERSEPSI ( berdasarkan apa yang dilihat, didengar, dirasakan & pengalaman dalam organisasi ) 2. Anggota organisasi cenderung menggambarkan budaya organisasi dalam terminologi yg sama    
  • 15. DIMENSIONS OF ORGANIZATIONAL CULTURE Degree to which employees are  expected to exhibit precision,  Degree to which employees are  analysis and attention to detail Attention to encouraged to be innovative & to take risks Detail Low……….High Degree to which  Innovation & managers focus Risk Taking on results or  Outcome outcomes rather  Low………..….High Orientation than on how  Low……….High these outcomes  are achieved Degree to which  Organizational organizational Culture decisions and People actions  Stability Orientation emphasize  maintaining the Low….…High Low……….High status quo Degree to which  management Team Aggressiveness decisions take into Orientation account the effects Low……………..High Low………….High on people in the Degree to which employees are  organizations Degree to which work is  aggressive & competitive rather  organized around teams  than cooperative rather than individuals    
  • 16. Weak Cultures Moderate Cultures Strong Cultures Strong cultures are cultures in which the key values are deeply held and widely shared – have a greater influence on employees than do weak cultures    
  • 17. How Employees Learn Culture ? 1. Organizational “stories” 2. Corporate “rituals” 3. Material “symbols” (get a “feel” for the material .i.e. place, lay-out, facilities, dress, etc 4. Language    
  • 18. ENVIRONMENT OF ORGANIZATION a. INTERNAL - ENVIRONMENT b. EXTERNAL – ENVIRONMENT • Specific Environment • General Environment    
  • 19. SPECIFIC - ENVIRONMENT 1. Customers 2. Suppliers 3. Competitors 4. Public Pressure Groups    
  • 20. GENERAL - ENVIRONMENT 1. Economic Conditions 2. Political / Legal Conditions 3. Socio-Cultural Conditions 4. Demographic Conditions 5. Technological 6. Global    
  • 21. How The Environment Affects Organization ? • Through the degree of environmental uncertainty, which is determined by two dimensions : a. The degree of changes b. The degree of complexity in an organization’s environment    
  • 22. MANAGEMENT “ Management is a social process … the process consists of … planning, control, coordination & motivation” ( Brech ) “ To manage is to forecast and plan, to organize, to command, to coordinate and to control “ ( Fayol ) “ Managing is an operational process initially best dissected by analysing the managerial functions… The five essentials managerial functions are : planning, organising, staffing, directing and leading, and controlling.” ( Koontz & O’Donnell )    
  • 23. MANAGEMENT “ Management as the process of coordinating work activities so that they are completed efficiently and effectively with and through other people” (Robbins)    
  • 24. MANAGEMENT • Proses pengaturan berbagai sumberdaya organisasi untuk mencapai tujuan yg sdh ditentukan melalui pelaksanaan fungsi- fungsi tertentu. • Sumberdaya organisasi : Man, Money, Material, Machines, Methods, & Market (6M)    
  • 25. EFFICIENCY : “doing things right” EFFECTIVENESS : “doing the right things”    
  • 26. FUNGSI MANAJEMEN Taylor : Planning, Organizing, Actuating, Controlling (POAC) Fayol : Planning, Organising,Commanding, Coordinating, Controlling (POCCC) Koontz & : Planning, Organising, Staffing, O’Donnell Directing, Leading, Controlling ( POSDLC) Robbins : Planning, Organising, Leading, Controlling (POLC) Depkes : P1 – P2 – P3    
  • 27. PERKEMBANGAN MANAJEMEN 1. TEORI KLASIK * Scientific Management * Orientasi pd struktur & aktivitas formal. * Efektivitas organisasi sangat ditentukan oleh kejelasan pembagian kerja, hirarki kewenangan yg tegas & rentang kendali * Pendekatan preskriptif, melihat bgm manager melaks fungsi kepemimpinan dlm organisasi * Tokoh : Henry Fayol, Taylor, Weber (teori birokrasi )    
  • 28. PERKEMBANGAN MANAJEMEN 2. TEORI HUMAN RELATION * Aspek “human factor at work” dan “social relationship” * Perhatian pd issu-issu yg menyangkut motivasi, komunikasi interpersonal & gaya kepemimpinan. * Fokus pd “individual satisfaction” * Pemikiran fundamental pendekatan human relation dlm manajemen adalah bahwa “human needs” adalah faktor terpenting utk tercapainya efektivitas organisasi * Tokoh : Elton Mayo (“Hawthorne Studies ), McGregor, Likert, Herzberg, etc    
  • 29. PERKEMBANGAN MANAJEMEN 3. TEORI SISTEM & PENDEKATAN KONTINGENSI * Memandang organisasi sbg suatu sistem yg kompleks, mencakup orang-orang, tugas & teknologi. * Organisasi adalah bagian dari lingkungan yg lebih besar yg saling berinteraksi & dipengaruhi oleh faktor2 sosial lainnya (teknis & ekonomi) * Organisasi sbg “sistem terbuka” dan “sistem tertutup” dengan lingkungannya    
  • 30. PERKEMBANGAN MANAJEMEN 4. PENDEKATAN MANAJEMEN MODERN * Efektivitas organisasi dilihat pd kemampuan / fokus melihat issu-issu strategis * Orientasi pd efektivitas & efisiensi organisasi * Bagaimana mengembangkan visi & missi- missi strategis & implementasi dari nilai & budaya organisasional, a.l : memanage perubahan, mempromosikan TQM, pencapaian “organizational excelence”, pemberdayaan personal & hubungan dgn “stake-holder”    
  • 31. MANAGEMENT ROLES a. INTERPERSONAL ROLES * Figurhead * Leader * Liaison b. INFORMATIONAL ROLES * Monitor * Disseminator * Spokesman c. DECISIONAL ROLES * Entrepreneur * Disturbance handler * Resource allocator   * Negotiator  
  • 32. MANAGEMENT - SKILLS 1. TECHNICAL – SKILLS Knowlegde of an proficiency in a certain specialized field 2. HUMAN – SKILLS The ability to work well with other people both individually and in a group 3. CONCEPTUAL – SKILLS The ability to think and to conceptualized about abstract and complex situations ( Henry Mintzberg )    
  • 33. MANAGEMENT LEVEL Top Manager Middle Manager Lower Manager    
  • 34. Top Management CONCEPTUAL SKILLS Middle HUMAN Management SKILLS Lower – Level TECHNICAL Management SKILLS Level of importance    
  • 35. MANAGERIAL - JOBS Are affected by the extend of, and the relationship between : a. The “core” of the jobs ( the responsibilities of the job-holder which cannot be delegated ) or the “demands” of jobs b. The “constraints” of the jobs c. The “choices” available to the job-holder by way of different work from another person    
  • 36. Relationship between Management and Organization HOW ?    
  • 37. KEY VARIABLES OF MANAGEMENT a. People b. Work & Structures c. System & Procedures d. The Goals of the Organization e. The Technology Available f. The Culture of the Organization    
  • 38. MANAGING IN DIFFERENT AND CHANGING SITUATIONS • Management is not ( and cannot be) based on simplistic principles • Different and changing situations require managers to use different approaches & techniques • Entrepreneurial skills • Contingency – Perspective : An approach that says that organizations are different, face different situations (contingencies) and require different ways of managing    
  • 39. POPULAR CONTINGENCY VARIABLES 1. Organization Size 2. Routineness of Task Technology 3. Environmental Uncertainty 4. Individual Differences