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04/02/2023 HSM 1 by Dr Mesfin Addisse 1
INTRODUCTION TO MANAGEMENT
OF HEALTH SERVICES
Graduate training: Master of Public Health
Department of Community Health
Instructor(s): Dr.Mesfin Addisse, Dr.Getnet
Meteke, Dr.Damene H/Mariam,
and honorary staff
MANAGEMENT
OF HEALTH SERVICES- I

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………
 MHS is a two-part course (COMH 608
and COMH 609), designed
 to help MPH students have a firm
foundation in the principles and tools
of management as applied to health.
 Thus Emphasis is placed on
 on guiding students to acquire the
skills to identify and address
management problems.

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Objectives of the course
 Recognize a variety of leadership and
management styles and to classify one’s
own style of leadership and management.
 To understand the importance of and be
able to critically appraise an organization’s
mission and goals.
 To be able to conduct a strategic analysis
and elaborate a health plan, including its
objectives, strategic and operational plans
and a plan for strategic control of
progress.

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Objectives of the course………..
 To understand key models and be able to use
basic tools for management decision-making.
 To understand the concept of social
responsibility and social responsiveness and
to develop a sense of professional ethics in
management.
 To understand the key elements of
organizational structure in order to select or
modify organizational design to make it
effective and appropriate to function.
 To be able to conduct an environmental
analysis and prepare a plan for managing the
organizational environment.

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Objectives of the course………..
 To develop and understand organizational
processes subsystems including
 coordination, authority, delegation,
decentralization, organizational change,
innovation, and organizational
development.
 To be able to manage human resources,
including through
 development of skills in human resource
planning,
 recruitment and selection,
 human resource development,
 supervision and performance appraisal,
and
 other aspects of personnel management.

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Course outline
 Introduction to HSM
 Planning
 Planning and strategic management
 Decision making
 Organization
 Communication
 Management Information System
 Motivation and performances
 Leadership
 Student evaluations:
Students will be graded on four criteria:
1) Class attendance & participation
2) Presentation
3) Take-home paper (Assignments)
4) Final examination

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References
 Stoner J.A.F, Freeman R.E., Gilbert Jr. D.R.
Management. 6th edition, 1996.
 Kerzner H. Project Management: A Systems
Approach to Planning, Scheduling and Controlling,
2nd edition. 1984.
 Rakich, J.S. Managing Health Services
Organizations, 2nd edition, 1985.
 Rao V.S.P and Narayana P.S. Principles and
Practices of management, 1st edition (1987), Konark
Publishers.
 Hersey P., Blanchard K.H. and Johnson D.E.
Management of organizational behavior: Utilizing
human resources, 7th edition (1996), Prentice Hall.
 Kreitner R. Management. 7th edition (1998), Arizona
State University, Houghton Mifflin Company, New
York.
 Shortell S. M. and Kaluzny A.D. (1997). Essentials of
Health Care Management, Delmar Publishers

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MODULE 1
INTRODUCTION TO
HEALTH SERVICES MANAGEMENT- I

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Key Definitions
 Health:- is the maximization of the biological &
clinical indicators of organ function & the
maximization of physical, mental, & role functioning
in every day life.
 Health care:- is the total societal effort, undertaken
in the private & public sectors, focused on pursuing
health.
 Health services:- are specific activities within the
larger domain of health care undertaken to maintain
or improve health or to prevent decrements of
health.
 Health service organizations:- are entities that
provide the organizational structure within which the
delivery of health services is made directly to
consumers, whether the purpose of the services is
preventive, acute chronic, restorative or palliative.

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UNIT 1:
 ORGANIZATIONS AND THE NEED
FOR MANAGEMENT
 Objectives:
Define relationships between management and
organization
Identify and discuss the management process
Discuss on the managerial roles, types of managers
and skills required

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Definitions and concepts
 What is the experience of this class?
 Are /were you a member of any
organization?
 Organization
 Two or more people who work together in a
structured way to achieve a specific goal or set
of goals.
 formal and informal
 In both people are kept together
 believing there is a benefit working together to
achieve a common goal
 What does goal mean ?

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Defn……
 Goal : The purpose that organization
strives to achieve.
 GOALS are the fundamental elements of an
organization. Why?
 Goal is the reason to exist and an organization
can not exist without a goal
 An organization can have more than one goal
 What do all organizations need to achieve goals?
To achieve goals all organizations should
 Have a method and
 Have to acquire and allocate resources
Thus the need for management.
What is management?

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 The process of planning, organizing, staffing, leading,
and controlling the work of organization members and
of using all available organizational resources to reach
stated organizational goals.
 It is a process of reaching (predetermined) organizational
goals by working with and through people and other
organizational resources (finance, equipment, information,
and information).
 It is a process of utilizing efficiently the available resource
to achieve organizational goals.
 It is the practice of consciously and continually shaping
organizations.
 Planning:-managers think through their goals and actions in advance.
 Organizing:-managers coordinate the human and material resource
of the organization.
 Leading:- how managers direct and influence subordinates, getting
others to perform essential tasks.
 Controlling:-managers attempt to assure that the organization is
moving toward its goals.
Management

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Manag…..
 Whether formal or informal organizations managers are
BASIC. (???? Management process occurs in a formal
organizational setting)
 Who are the managers?
 Why are they basic?
 In all organizations managers are essential. Because
managers are:
 People responsible for directing the effort’s aimed at helping
organizations achieve their goals
 People responsible for helping organization members set and reach
goals.
Definition: HSO/HS managers are people formally
appointed to positions of authority in organizations or
systems who enable others to do their direct or support
work effectively, who have responsibility for resource
utilization, & who are accountable for work results.

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Exercise
 Discuss on the goals of the organization
that you have worked for.
 What are the reasons for the existence of
the organization?
 Why do we study organizations and
management?

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Reasons For Studying Organization & Management
 1. Living in the Present :
 organizations have role on the standard of living
 We relay on organizations daily for food,
clothing, medical care, etc.
2. Building the Future:
 Organizations work or move to the desirable
future;
 new treatment for diseases, new practices, new
products, new management, etc.
 Positive/Negative impact

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Reasons For Studying Organization & Management…….
3. Remembering the Past :
 Connections to the past history.
 Patterns of human relationship
 People define themselves in terms of the
organization they have been a part of.
 Keeping record and value own history and
keeping traditions alive.
 How would history be important? Give some
examples of organizations and their history.

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Management as a specialty in time and
human relationships
 Management deals with time
 Time Management is to create a desirable future.
 Management is either practiced or is a reflection of a
particular historical era.
 Management produces effects that emerge over time.
 Organizations, managers and other individuals deals with
time
 Management deals with human relationships
 Managers act in relationships : two-way streets. Influence
on both sides
 Managers act in relationships that have spillover effects
for other people. Better or worse
 Managers juggle multiple simultaneous relationships.
 Organizations, managers and other individuals think about
future human relationships and
 About new relationship and modify existing ones.

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Managing and managers
 Managers and organizational
performance

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Managing and managers
 Managers and organizational performance
 Management is a major and PRINCIPAL activity
that is responsible to make a difference how the
organization
 is doing, affecting and affected by people.
 Thus there is a need for measuring Managers and
organizational performance.
 Managerial performance measures
 How efficient and effective a manager is.
 How well a manager determines and achieves
organizational objectives.
 Organizational performance: measures
 How efficient & effective an organization is.
 How well it achieves it’s objectives.

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Managing and managers……..
 Which one is the best for managers / organizations,
efficiency or effectiveness?
 Effective management is the main resource of developed
countries
 Effective management is the most needed resource of
developing countries
 Efficiency: the ability to minimize the use of resources in
achieving organizational objectives. “Doing things right.”
 Effectiveness: the ability to determine appropriate
objective. “Doing the right thing.”

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The Management process
 Management: different definitions but common
elements:
 Management is a process : a set of interrelated
and interactive on-going activities and functions.
 Process: a systematic method of handling activities.
 Involves achieving goals
 Involves achieving goals through people and
utilization of other resources
 Occurs in formal organization setting
 Management is a process: a set of interrelated and
interactive on-going activities and functions.
What does this definition imply ?

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Functions : Management functions
 describes how managers do what they do.
 Basic management functions or activities that make
up the management process are:
i) Planning
 It is the process of establishing goals and a suitable
course of action to achieve the goals.
 Helps to deal with the present and anticipate the
future. Planning:-managers think through their goals
and actions in advance.
 It involves what to do, how to do and when to do
 Planning is a primary management function. Why?
 Through planning managers clearly put and outline
exactly what organizations must do to be successful.

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The Management functions ………….
ii) Organizing
 Organizing:-managers coordinate the human and
material resource of the organization.
 Organizing creates a mechanism to put plans into
action. How?
 Through Assigning the tasks developed
during planning to individuals/groups within the
organization.
 It is the process of arranging and allocating
work, authority and resources among organization
members to achieve goals.
 It involves establishing authority & responsibility
relationships; division of work, job design,
coordination, information and feedback systems in
the organization.

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The Management functions ………….
 Do we need different structures for different goals.
 Do we need different structures depending on the
available resources?
 Organizational design:
The process of matching an organizational structure
to goals and resources.
How do you address relationships and time in this
process?
New people to join the structure of relationship:
staffing (is both technical and social)

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The Management functions ………….
iii) Leading (directing, motivating, and
communicating)
 Primarily concerned with people in the
organization.
 It is the process of directing and influencing the
task-related activities of group members or an
entire organization.
 The process of guiding the activities of organization
members in appropriate direction.
 Influencing ,directing , actuate (activate ,motivate)
 Time and relationships.

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The Management functions ………….
iv) Controlling
 The process of ensuring/ conforming the actual
activities in relation to planned activities.
 A function for which managers:
 Establish standards of performance
 Gather information and Measure current performance
 Compare performance with standard
 Taking corrective action
 Rewarding

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The Management functions ………….
v) Decision Making
 Choosing between or among alternatives.
 a function made at all levels from planning up to
controlling.
 Senior managers make policy decissions and resource
allocation decisions that affect the entire and various
parts of the organizations.
 Middle- and first-level managers make decisions
about allocating and utilizing resources provided by
senior management within their areas of authority
and responsibility.

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The Management functions ………….
 . PLANNING (deciding
in advance what is to
be done)
ORGANIZING (developing
international patterns of relationships
among people and other resources)
DECISION MAKING
(Choosing between
or among
alternatives)
STAFFING
(Acquiring,
maintaining, and
retaining human
resources)
DIRECTING
(Initiating work in
the organization)
CONTROLING
(Regulating
activities in
accordance
with plans)

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The Management functions ………….
 Time and relationships?
 Through time do all the established
relations work.
 To be successful which function must be
performed well by managers?

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Types of managers and managerial roles
A. Classification by management level
 Traditional by level in the hierarchy
First-line (or first/ low level) ,Supervisory mangers:
Middle managers: Middle level
Top/ senior managers : high level
 Other classification
Policy level
Administrative or coordinating level
Operations level

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1. First-line (or first/ low level) ,Supervisory
mangers:
 Responsible for the work of operating and do
not supervise other managers
 Direct non management employees and
have authority and responsibility for overseeing
a specific type of work and a particular group
of workers.
 First or lowest level of managers in the
organizational hierarchy.

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2. Middle managers
 Managers in the midrange of the
organizational hierarchy
 They are responsible for other managers and
sometimes for some operating employees
 They report to more senior managers
3.Top managers / senior
 Mangers responsible for the overall
management of the organization
 They establish operating policies and guide the
organization’s interaction with its environment.
 Small in number

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 List types of managers for the three
levels by choosing one organization.
1. First-line mangers:
Supervisors, School directors, Coaches, Technical
supervisor
2.Middle director
Department heads, Heads of services
3. Top managers:
executive officer, president vice president

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 Are there different names for a manager?
Different names of manager include
executive administrator, leader, boss, principal,
chief, supervisor, senior manager, superintendent,
commissioner, overseer, officer, Coach ,President,
Executive, Prime minister etc.
Attributes common to all regardless of title or level
 formally appointed to positions of authority by the
organization
 directing work efforts of others subordinates and
non subordinates
 responsible utilization of organizational resources
 accountable to superiors for work results

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Are non-managers
 responsible for utilization of organizational resources?
 accountable to superiors for work results?
 Senior, middle, and first level managers are responsible
for very different types of activities. But all of these
activities are important and no organization can be
successful unless the management work at each level is
done well and unless the work at each level is carefully
integrated with that done at the other levels.
 If both are responsible,
 What is the difference between managers and non
managers?
 The non managers are not formally appointed to
positions of authority by the organization for directing
work efforts of others.

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B. Functional and general manager
Classification based on scope of activities
 Functions: Refers to a group of similar activities
in an organization, such as marketing, production,
finance.
 Functional Manager: Responsible for one
organizational functional area/activity e.g. finance,
human resource management
 General Manager: Responsible for all
functional activities e.g. a company’s functional
activities such as production, sales, marketing,
and finance.

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 Is it possible to have more than one general
manager in an organization?
 Do both functional and general managers perform
the four management functions?
 Yes, the difference is in the scope of activities
they oversee.
 The primary differentiation between levels of
managers is the degree of authority and scope of
responsibility and organizational activity.

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c) Management level and skills
 major resource
 primary determinant for a manager to be effective
and efficient
 performance and personality traits
 Three basic types of skills are needed for successful
management
1.Technical skill:
 the ability to use procedures, techniques and
knowledge of a specialized field
 using specialized knowledge and expertise in executing
work related techniques and procedures.
 Related to things :process or physical objects

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Management level and skills……
2.Human (interpersonal) skill :
the ability to work /get along with, understand, motivate,
and lead other people as individuals.
builds cooperation among the team.
Working with people : Attitude, communication.
3.Conceptual skill:
Ability to see the organization as a whole (the mental
abilities of managers to visualize the complex relationships
in a workplace-among people, among departments, among
various organizations…).
 A manager with this skill has the ability or better understand
how various functions of the organization complement one
another
 The relationship of the organization to its environment
 How changes in one part of the organization affect the rest
of the organization

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Management level and skills……
 All managers use all these three types of skills in performing
management work but in different mix (degree).
 The senior manager is vitally concerned with how the service in
general fits into the organization.
 In contrast the low level manager, whose primary function is to
troubleshoot an entire operating staff, may be constantly required to
make decisions on the basis of technical knowledge of procedures
while rarely having time to think about the relationship of the specific
service to other departments of the organization.
Which skill is needed by all managers?
 Because the common denominator are people at all levels,
an inability to work with people, not a lack of technical
skills, is the main reason some managers fail to reach their
full potential.
 A manager with Human skill
 Knows weaknesses and strengths,
 Knows how feelings hurt others.
Choose
 Either people have to be controlled Vs self discipline
 Do not make wrong judgments about people without studying
contents of information.

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Managerial Roles
In addition to engaging in the function of
management managers also perform other
activities associated with certain management
positions.
Two ways to answer the question, "What do
managers do?" are
 the functional approach (traditional) and
 the role approach ( depicted by Henry Mintzberg)
 Managerial functions relate to the desired
outcomes of managerial action,
 Managerial roles categorize managers' actual
behavior.

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The Managerial Roles……
Henry Mintzberg
 concluded from his observation of managers that
management is best explained in terms of roles.
 criticized the functional approach:
 for making management appear to be simple, more
orderly /Methodical /neat than it really is.
 Managers practically adopt certain patterns of behavior
(roles) when feeling managerial positions.
 The ten facts of managerial life, derived from direct
observation, characterize managers as hard-
working and busy people who engage in many and
varied, primarily oral, interactions with others.
 Three managerial role categories (of a formal
authority and status), according to Mintzberg, are
interpersonal, informational, and decisional.

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The Managerial Roles……
1)Interpersonal Roles-
 The tree interpersonal roles managers play
are as:-
a) figurehead - they engage in activities that are
ceremonial and symbolic in nature; as a symbol
of legal authority, attending ceremonies, signing
documents, etc.
b) liaison - role involves formal and informal contacts
beyond the vertical chain of command (both
inside and with external stakeholders), to
establish relationships that will help them achieve
organizational objectives. i.e. links in horizontal as
well as vertical chain of communications
c) influencer - role includes motivating & leadership
when they seek to inspire, and set examples
through their own behavior. i.e. managers are
accountable, responsible, & motivator.

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The Managerial Roles……
2) Informational Roles –
The three informational roles are:
a) Monitor - filter, evaluate and choose to act or react
to that information.
b) Disseminator - role involves choosing to
disseminate the information.
communicating selected information to
subordinates
c) Spokesperson - represent and speak on behalf of
the organization.
communicating selected information to outsiders

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The Managerial Roles……
3) Decision-Maker Roles-
The authority granted by their organization &
supported by their interpersonal & informational
roles; permits managers to play decisional roles.
There are four decision maker roles:
a) Entrepreneur /Change agent: designing and initiating
changes within the organization .organizations are
internally dynamic and continuously affected by the
environment.
Unless managers act ?
b) Disturbance Handler-They handle both internal and
external disturbances and take corrective action.
They anticipate disturbances and resolve conflicts.
c) Resource allocator - managers decide who gets what
based on priority setting.
d) Negotiator - managers choose how to interact with their
superiors, peers, and subordinates. i.e. Negotiating with
other parties representing organizational interests.

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The Managerial Roles……
Roles are interrelated: Liaison ,information,
decision making…
 A key message on role of managers is they have to
be very versatile when it comes to dealing with
human relationship.
 When the interconnected roles are each played
well, the result is synergistic.
 Being a good negotiator makes a manager a better
disturbance handler.
 Playing the information roles effectively improves
performance in the decisional roles because managers
have information with which to make decisions.

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The Managerial Roles: Roles are interrelated ……
 Different levels of these roles is used at different
levels of managers & by different individuals.
 Senior managers engage in figure head, entrepreneur, and
spokesperson roles more frequently than do other
managers.
 Middle level managers often are heavily involved in
disturbance handler and resource allocator roles, and
many of them rely on their abilities to successfully play
their informational roles as a key ingredient in their work.
 First level managers may play leader , disturbance handler,
and negotiator roles extensively in their daily work.
Exercise
 Provide prominent examples of interpersonal roles that you had as a
manager or have observed from a manager.
 Provide prominent examples of informational roles that you had as a
manager or have observed from a manager.
 Provide prominent examples of decision-making roles that you had as a
manager or have observed from a manager.