HSM Lecture Notes
HSM Lecture Notes
OF HEALTH SERVICES
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.
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?
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?
Management
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.
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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.
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.
Exercise
Discuss on the goals of the organization for which you have worked.
What are the reasons for the existence of the organization?
Why do we study organizations and management?
DECISION
CONTROLIN MAKING
G (Regulating (Choosing STAFFING
activities in between or among
(Acquiring,
accordance alternatives)
maintaining, and
with plans)
retaining human
resources)
DIRECTING
(Initiating work in
the organization)
UNIT 2:
History of Management Thought- The Evolution of Management Theory
Learning Objectives:
Understand the historical context how the different management theories developed.
Distinguish the different approaches of management theory.
Management and organizations are products of their historical and social times and places. Thus
The need to understand the evolution of management theory in terms of how people have wrestled
with matters of relationships at particular times in history.
Let us compare different ages
Formal organizations existed for many centuries. such as:
The Greek and Roman armies,
The Roman Catholic Church,
Period of industrial revolution,
Early 1900’s
o Did we have similar management experience in Ethiopia and Africa?
The Axum monument
The Lalibela rock hewn churches are the result of systematically managed effort.
The Adwa battle
The Egypt’s great pyramids:
mobilized human and material resources mobilize 100,000
Have to plan, implement, coordinate, control and report.
What is our problem then?
Our problem is in terms of documentation.
They write; we did not. Still we do not.
Shall we?
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Few times if we write (rather talk), based on what?
Two examples (Stoner) of attempts how to make organizations efficient and effective since long
before terms such as management came into common usage:
Writings of Machiavelli and Sun Tzu considered as strategists
'Machiavellian' is often used to describe cunning and manipulative opportunists.
Machiavelli was a great believer in the virtues of a republic.
Machiavelli wrote in 1531.
An organization is more stable if members have the right to express their differences and solve their
conflicts within it
While one person can begin an organization, "it is lasting when it is left in the care of many and
when many desire to maintain it."
A weak manager can follow a strong one, but not another weak one, and maintain authority.
A manager seeking to change an established organization "should retain at least a shadow of the
ancient customs."
The Art of War, written by the Chinese philosopher Sun Tzu more than 2,000 years ago.
It was modified and used by Mao Zedong,
When the enemy advances, we retreat!
When the enemy halts we harass!
When the enemy seeks to avoid battle, we attack!
When the enemy retreats, we pursue!
Today these rules are being used when planning a strategy to engage business competitors.
WHY STUDY MANAGEMENT THEORY?
A theory: is a coherent group of assumptions put forth to explain the relationship between two or
more observable facts.
Theories are perspectives with which people make sense of their world experiences.
What will happen if we do not have theories?
Frustration
in dealing with other people, one has always to define even the most basic assumptions.
Thus theories:
Provide a stable focus for understanding what we experience.
Provide criteria for determining what is relevant.
Help us to communicate efficiently and thus move to more complex relationships with
other people.
Theories make it possible and challenge us to keep learning about our world.
Theories have boundaries and everything cannot be covered by any one theory.
Thus, there is a need for alternative theories and consideration of the consequences of adopting
alternative beliefs as theories do not work or our theories no longer seem too "fit" our experience.
The environment is changing.
Evolution of management theory because
it developed in bits and pieces over the years
so many people contributed to the theory and practice
As an academic study relatively new because before 1900 it was only given in 3 universities unlike
chemistry or astronomy.
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Management has interdisciplinary nature: with different fields history geography, psychology,
health, education and including religions etc.
Each discipline and professionals used, interpreted, and reformulated management according to
their own perspective.
As a result with each new perspective have come new questions and assumptions,
new research techniques ,
different technical jargons and
new conceptual frameworks.
AS a result:
There is no universally accepted theory of management. i.e. there is yet no verified general theory
or set of laws for management that we can apply to all situations.
Knowing the evolution help us to know how it was, how it is now and where it is heading.
Despite the emerging new assumptions, later ideas have not replaced earlier ones. Instead, each new
school has tended to complement or coexist with previous ones.
At the same time, each school has continued to evolve, and some have even merged with others.
Example: The integrative approaches:
the systems approach,
the contingency approach,
The dynamic engagement approach.
Different Approaches to management theory
SCIENTIFIC MANAGEMENT THEORY
THE CLASSICAL PERSPECTIVE
OPERATIONAL APPROACH
The Management Theories:
THE SCIENTIFIC MANAGEMENT SCHOOL
Production-oriented field of management dedicated to improving efficiency and minimizing waste.
Focuses on ways to improve the performance of individual workers (the only way to increase
productivity was to increase the efficiency of workers.).
Frederick W. Taylor (1856-1915): father of the scientific management school.
To increase efficiency by scientifically designing jobs
Major premises
there is always one best way and has to be discovered and put in action
workers job can be reduced to a science
Science of shoveling: based his management system on production-line time studies.
Analyzed and timed steel workers' movements on a series of jobs. Using time study as his base.
Broke each job down into its components and designed the quickest and best methods of
performing each component.
Established how much workers should be able to do with the equipment and materials at hand.
Encouraged employers to pay more productive workers at a higher rate than others, using a
"scientifically correct" rate that would benefit both company and worker.
Thus, workers were urged to surpass their previous performance standards to earn more pay. This is
the differential rate system.
The Management Theories:
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Frederick W. Taylor saw workers soldiering or deliberately working beneath their potential and
designed a 4-step method to overcome this problem.
1. Breaking the job into its smallest pieces.
2. To select the most qualified employees to perform the job and train them to do it.
3. Supervisors are used to monitor the employees to be sure they are following the methods
prescribed.
4. Continue in this fashion, but only use employees who are getting the work done.
In summary: the four principles are
Development of a true science management.
Scientific selection of workers.
Scientific education and development of workers.
Intimate, friendly cooperation between manager and labor.
According to Taylor :
the success of these principles required "a complete mental revolution" on the part of management
and labor.
Avoid quarrel over profits and rather try to increase production because both (labor & management)
had a common interest in increasing productivity.
The Management Theories: the scientific management school: HENRY L. GANTT (1861-1919) -
worked with Taylor
Gantt reconsidered Taylor's incentive system.
Abandoned the differential rate system as having too little motivational impact.
Every worker who finished a day's assigned workload would win a 50-cent bonus.
Supervisor would earn a bonus for each worker who reached the daily standard, plus an
extra bonus if all the workers reached it.
This would spur supervisors to train their workers to do a better job.
Every worker's progress was rated publicly and recorded on individual bar charts;--in black on days
the worker made the standard, in red when he or she fell below it.
Gantt originated the "Gantt chart”-which is a way to schedule work or a charting system for
production scheduling
“THE GILBRETHS”- Frank B. and Lillian M. Gilbreth (1868-1924 and 1878-1972)
a husband and wife team
Helped to find more efficient ways for workers to produce output.
Work on fatigue and motion studies
Focused on ways of promoting the individual worker's welfare.
They believed
The ultimate aim of scientific management was to help workers reach their full potential as human
beings.
Motion and fatigue were intertwined: every motion that was eliminated reduced fatigue.
Important contribution in the field of bricklaying.
Raise worker morale for obvious physical benefit and because it demonstrated management’s
concern for the worker.
changed an 18-step process into a 5-step process and
Increased productivity by about 200 percent.
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The Management Theories:
THE CLASSICAL ORGANIZATION THEORY SCHOOL
Scientific management was concerned with increasing the productivity of the shop and the
individual worker; While
Classical organization theory grew out of the need to find guidelines for managing such complex
organizations as factories.
Administrative management focuses on managing the total organization.
Focuses on managing the total organization.
concerned with the entire range of managerial performance
comprehensive analysis of management involves studying the management function as a whole
CLASSICAL ORGANIZATION THEORY SCHOOL: HENRI FAYOL (1841-1925)
founder of the classical management school
organizational functions Vs the total organization
Taylor was basically concerned with organizational functions
Fayol was interested in the total organization.
Faith in scientific methods,
Investigate managerial behavior and tried to systematize it.
Believed that sound management practice falls into certain patterns that can be identified and
analyzed.
From this basic insight, he drew up a blueprint for a cohesive doctrine of managers
Henry Fayol's universal approach assumes:
That all organizations, regardless of purpose or size, require the same management process.
And this rational process can be reduced to separate functions and principles of management.
Fayol believed that management is a skill like any other- one that could be taught once its
underlying principles was understood. Managers are nurtured than born (natured).
The first to identify the four management functions: planning, organizing, leading, and controlling.
He developed guidelines for managers to follow. These guidelines form fourteen principles for
effective management.
Fayol’s 14 Principles of management
1. Division of Labor. The more people specialize, the more efficiently they can perform their work.
Effort and attention are focused on special portion of the task.
Work specialization is the best way to use human resource.
This principle is observed by the modern assembly line.
2. Authority. Managers must give orders so that they can get things done.
Authority and responsibility should be closely related.
3. Discipline. Members in an organization need to respect the rules and agreements that govern the
organization.
Discipline results from good leadership at all levels of the organization, judiciously enforced
penalties for the sake of promoting common efforts.
4. Unity of Command. Each employee must receive instructions from only one person.
Reporting to more than one manager, conflicts in instructions and confusion of authority
5. Unity of Direction. The entire organization should be moving toward a common objective, in a common
direction.
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6. Remuneration. Consideration of variables such as cost of living, success of the organization etc. to
determine rate of payment to both employees and employers.
7. Subordination of Individual Interest to the Common Good. In any undertaking, the interests of
employees should not take precedence over the interests of the organization as a whole.
8. Centralization. Decreasing the role of subordinates in decision making is centralization; increasing their
role is decentralization.
Fayol believed that managers should retain final responsibility,
But should at the same time give their subordinates enough authority to do their jobs properly.
The problem is to find the proper degree of centralization in each case.
9. The Hierarchy. Lower line managers should always inform upper level managers.
10. Order. To increase efficiency and coordination, materials & people should be in the right place at the
right time.
People, in particular, should be in the jobs or positions they are most suited to.
11. Equity. All employees should be treated equally.
12. Stability of Staff. Retaining productive employees should always be a high priority of management.
A high employee turnover rate undermines the efficient functioning of an organization.
13. Initiative. Subordinates should be given the freedom to conceive and carry out their plans, even though
some mistakes may result.
Encourage employees to do through self direction.
14. Espirit de Corps. Promoting harmony and team spirit among members to give the organization a sense
of unity. Even small factors should help to develop the spirit.
For example, the use of verbal communications instead of formal, written communication whenever
possible.
• Are managers born or made?
Before Fayol, it was generally believed that "managers are born, not made."
Fayol insisted, management was a skill like any other--one that could be taught once its underlying
principles were understood.
CLASSICAL ORGANIZATION THEORY SCHOOL: MAX WEBER (1864-1920)
a German sociologist
emphasis how organizational resources are best utilized to attain goals
He stressed the need for a bureaucratic organization marked by clear division of labor, a strictly
defined hierarchy of authority, governed by clearly defined regulations and lines of authority.
Sought to improve the performance of organizations by making their operations predictable and
productive.
Main efforts of organizing efforts should include
1. detailed procedures and rules
2. a clearly outlined organizational hierarchy and
3. Mainly interpersonal relationship between organizational members.
He named the management system that contains these components to be a bureaucracy.
Bureaucracy: he believed that in its pure form bureaucracy represented an ideal or completely
rational form of organization.
Do people do the way Weber wanted it?
Many did not do what Weber wanted.
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Main concepts
A consistent system of abstract rules
any goal-oriented organization consisting of thousands of individuals would require the carefully
controlled regulation of its activities,
a continuous organization of official functions bound by rules
a system of rules ensures a rational approach to organization a degree of uniformity and
coordination
The rationale for rules is
Manager can use them to eliminate uncertainty in the performance of tasks due to differences
between various individuals.
A set of rules and regulations helps in providing the continuity and stability an organization needs.
Positions arranged in a hierarchy:
The need for a strictly defined hierarchy governed by clearly defined regulations and lines of
authority.
The lower one is under the control of the higher office.
Authority of a supervisor based upon expert knowledge
Authority decreases/ diminishes with succeeding level below thus resulting chain of command.
Specialization and division of labor
Activities and objectives were rationally thought out and divisions of labor were explicitly spelled
out.
Tasks necessary to accomplish goals are divided into highly specialized jobs.
Rationale
Job holders
became experts in their jobs
Are responsible for their performance
THUS: Manager knows the exact limits of each sphere of competence in order to avoid interfering
in spheres of others
technical competence
Technical competence should be emphasized for employment and that performance evaluations
should be made entirely on the basis of merit. Thus promotions on the basis of seniority and achievement.
Impersonal relationships:
emotional attachments have to be avoided in decision making
Many think of bureaucracies as vast, impersonal organizations that put impersonal efficiency ahead
of human needs.
But: Weber's model of bureaucratic management clearly advanced the formation of huge
corporations such as Ford.
Although bureaucracy has been successful for many companies,
General Electric and Xerox have become "bureaucracy busters," why?
throwing away the organization chart and
Replacing it with ever-changing constellations of teams, projects, and alliances with the goal of
unleashing employee creativity.
The Management Theories: THE BEHAVIORAL SCHOOL:
.
Internal stakeholders: groups or individuals that are not strictly part of an organization’s environment but
part of the organization itself.
Examples:
Employees,
Shareholders,
Boards of directors
2. Indirect-action elements: do not affect the organization directly but they influence the organizational
activities indirectly.
Social variables: demographics, lifestyles
Technological variables: new developments in products, processes and materials.
Economic variables: national income, per capita income, employment, etc.
Political variables: policies, laws and regulations
External scanning helps identify the outside environment and trends.
First line managers: plan in relation to specific operations or activities e.g. scheduling work activity
and allocating resource.
Differences between strategic and operational plans
Time horizon: long time (5 years) versus short time (1 years or shorter even as short as weeks).
Scope: wide range of goals versus narrow range operations.
Degree of detail: simplistic and general versus detail and specific activities.
Plan development: operational by lower level.
Gathering facts: operational is difficult?
Important concepts
Mission statement
All organizations must have an explicitly stated or implicit mission generally consisting: a statement
that identifies in broad terms the purposes for which the organization exists
The mission statement for the organization is:
a general overall goal it strives toward.
Broad organizational goal based on planning premises that justifies its existence.
A statement of purpose and function.
The mission specifies
The unique aim of the organization and what differentiate it from other.
Who are we? What are we? Why do we exist? Who is our constituency?
Reflects the philosophy of the organization and its role in the delivery.
Mission statement
future oriented
Portray organization as it will be, as if it already exists.
Must focus on one common purpose.
Must be specific to the organization, not generic.
must be a short statement,
A clearly written organizational mission statement tends to serve as a useful focus for the planning
process.
Determined by the highest body.
It is a relatively permanent part of an organization’s identity and
Can do much to unify and motivate members of an organization.
It should be written and communicated to all share-holders.
An example mission statement:
OPERATIONALIZING STRATEGY
• Strategies set goals
• Operational plan provides detailed plan that incorporates strategy in to daily activities
Operational plans: two types
• Single-use plan
• Standing plan
Single-use plan:
• Detailed courses of action that will not be repeated
In the same form in the future.
• Non repetitive in most instances.
• Focus on relatively unique situation
Program: A single use plan
• Covers relatively large set of activities
• It outlines:
Major steps required to reach objectives
Responsibility by unit or members for each step
Order and timing for each step
Projects: Smaller, separate portions of programs
• Limited in scope
• Contain distinct directives concerning time and assignment
Budgets: Financial resources allocated for certain activities in a given time
Standing plan:
An established set of decisions used to deal with recurring organizational activities
• Pre-established
• Single decision or sets of decisions for effectively guiding those activities
Importance save time as similar situations are handled in predetermined consistent manner
Policy: A standing plan that establish general guideline for decision-making
• Facilitates channeling of management thinking toward taking action consistent with reaching
organizational goals
• Sets up boundaries for decisions telling managers which decisions can be made and which can not.
Good policies are
Well thought, in harmony with objectives/purpose
Flexibility: in normal and abnormal situations
Communicated, understood and accepted
Clear
Rules:
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• Standing plans that detail specific actions to be taken in a given situation
• Help to respond to specific situations
• Specific, mandatory action??
• Room for interpretation??
Procedures: a standing plan that contains detailed guidelines for handling organizational actions that occur
regularly.
• Unlike policy : specific
Standard-operating methods
Detailed set of instructions for performing a task
Powerful tools for implementing strategy
Increases employees commitment
• Management by Objectives
It is a concept that suggests that planning and resource allocation should be based primarily on the
identified supportable goals of the organization, rather than the unpredictable/unreliable influences that
may take control of an organization’s decision making.
MBO,
• An approach to planning and controlling based on measurable and jointly set objectives.
Consists of four steps:
(1) Setting objectives jointly.
• All individuals in an organization are assigned a specialized set of objectives that they try to reach
in during specified operation period
• Objectives are set mutually and agreed upon by both
(2) Developing action plans,
(3) Periodically re-evaluating objectives and plans and monitoring performance,
Performance review how close are workers in attaining goals
(4) Conducting annual performance appraisals.
Reward based on how close employees attain stated objectives.
Advantage
1. Continually emphasize what should be done
2. Increase commitment
Disadvantage
• Increase paper work for communicating objectives, performance evaluation.
Important factor necessary
• appropriate goals to have appropriate objectives
Approach to planning
• Individual-committee
• Systematic-ad hoc
Developmental-incremental
• Refers the degree of autonomy surrounding the planning process inside and outside the
organization.
Developmental approach
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• Settings or environments with fewer constraints, and restrictions.
• It is characterized by bold, new, innovative and nontraditional approach.
• Organizational rigidity is minimal
Incremental planning
• Is less bold less innovative and traditional.
• It is due to internal and external restriction or limited managerial autonomy.
• It may occur in conducive setting but managerial perspective is characterized by:
• a limiting mind set emphasis on short term goals,
• narrow assumption and
• Desire to avoid risk.
It involves marginal not major change in direction, thrust, and strategy.
Proactive approach
• Proactive planning is overt systematic, formalized and anticipatory.
• It involves not only anticipating the future but also interfering and influencing environment.
• Making things happen and shaping events in the best interest of the organization.
Reactive approach
• Reactive planning is planning done on the rebound in response to events.
• It is non systematic and not anticipatory.
• These managers are followers.
• Act and respond because of the actions of others e.g. competitors ,rather than others react
Individuals are responsible for a limited set of activities instead of the entire task.
Work process requirements and employee skill level determine the degree of specialization
Placing capable people in each job ties directly with productivity improvement.
In order to maximize productivity, supervisors match employee skill level with task requirements
Creates simplified tasks
Fosters specialization
Opportunity for utilizing talents and interests
Job specialization may create:
Boredom and
Alienation (unfriendliness isolation distancing division)
Workflow analysis
Supervisors should perform workflow analysis
To examine how work creates or adds value to the ongoing processes in an organization.
Workflow analysis
Looks at how work moves from the customer or the demand source through the organization to the
point at which the work leaves the organization as a product or service to meet customer demand.
Thus, workflow analysis can
Be used to tighten the connection between employees' work and customers' needs.
help to make major performance breakthroughs throughout business process reengineering (BPR),
Business Process Reengineering (BPR),
A fundamental rethinking and radical redesign of business processes to achieve dramatic
improvements in costs, quality, service, and speed.
Uses workflow analysis to identify jobs that can be eliminated or recombined to improve
organizational performance.
Departmentalization
Once work activities are divided in to jobs or
jobs have been classified through work specialization,
They are grouped so those common tasks can be coordinated and can be similarly and logically
connected.
It is the basis on which work or individuals are grouped into manageable units.
An organization chart shows the formal relationships
Each single box in an organizational chart represents departments
Number and type of departments vary in each organization and
There are five traditional methods for grouping work activities.
The five basic departmentalization formats, each with its own combination of advantages and
disadvantages.
functional
product-service,
geographic location,
customer classification, and
work flow process departmentalization
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Departmentalization by function
Functional departmentalization is the most common approach
Organizes by the functions to be performed.
Advantage
This type of grouping helps to obtain efficiencies from consolidating similar specialties and people
with common skills, knowledge and orientations together in common units. Departmentalization by
product-service,
Assembles all functions needed to make and market a particular product are placed under one
executive.
E.g. major department stores are structured around product groups such as women's clothing, men's
clothing, and children's clothing.
Departmentalization by geographical regions
Groups jobs on the basis of territory or geography. For example domestic sales departmentalized by
regions such as Northeast, Southeast, Midwest, Southwest, and Northwest.
Departmentalization by process
Group’s jobs on the basis of product or customer flow.
Each process requires particular skills and offers a basis for homogeneous categorizing of work
activities.
A patient preparing for an operation would first engage in preliminary diagnostic tests, then go
through the admitting process, undergo a procedure in surgery, receive post operative care, be discharged
or out-patient follow.
These services are each administered by different departments.
Departmentalization by customer
Groups jobs on the basis of a common set of needs or problems of specific customers.
An organization may group its work according to whether it is serving private sector, public sector,
government, or not-for-profit organizations.
Current departmentalization trend
Current departmentalization trend
Is to structure work according to customer, using cross-functional teams.
Cross-functional team
Is chosen from different functions to work together across various departments to interdependently
create new products or services.
For example, a cross-functional team consisting of managers from accounting, finance, and
marketing is created to prepare a technology plan
Future trend:
Downsizing:
A version of organizational restructuring which results in decreasing the size of the organization
a move towards flatter organizational hierarchies
To increase the speed of decision making and productivity
Coordination
The integration of activities of separate parts of an organization for accomplishing the
organizational goals.
Integration: the degree to which various departments work in a unified manner
What is the effect of lack of coordination?
The degree of coordination depends on
Nature of task
Degree of interdependence of people in the various units
When do organizations need a high degree of coordination?
Coordination
High degree of coordination is needed:
When communication between units is important
For non-routine and unpredictable works
When organizations are challenged with unstable environment
When there is high interdependence between units
When the organization has set high performance objectives
For highly specialized task such as coordination among different organizations
Differentiation and division of work related to coordination
Differentiation: differences in attitude and working styles, arising naturally among members of
different departments that can complicate the coordination
Coordination
Division work : role how individuals perceive the organization, their role and how they relate
Differentiation
may complicate coordination and
Can lead to conflict among units and individuals.
Examples of differentiation
Development of individuals worker’s perspective on the goals of the organization ’we
are the best”.
Differences of departments in formality.
E.g. Specific Vs general standard.
Approaches to achieving effective coordination
Using basic management techniques
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Specify relationships (managerial hierarchy or chain of command)
Set rules and procedures
Management By Walking Around (MBWA)
Boundary-spanning To increase coordination potential
A job in which an individual acts as a liaison between departments or organizations
those are in frequent contact
Vertical information system
Lateral relationships:
Example: direct contact, committee, task force, etc.
Improve communication among departments
Reducing the need for coordination
When the need for coordination is very high and the methods mentioned above fail,
actions such as:
Providing slack (additional) resources
Creating independent units to decrease reliance on other departments
Organization Design
Designing an organization involves choosing an organizational structure that will enable the
company to most effectively achieve its goals.
Organization design is the creation of an organization's structure
functional,
divisional, and/or
Matrix.
Organizational structure can be discussed in terms of a continuum with five markers.
At one end of the continuum is mechanistic representing a functional structure, and moving toward
divisional, matrix, team- and finally organic in design.
Functional organizations
Functions or divisions arrange traditional organizations (functional structure).
The structure is based on functions.
Based on functions and specialized functions
Mainly used by smaller organizations
Most logical and basic form of departmentalization
A form of departmentalization in which individuals engaged in one functional activity, such as
marketing or finance grouped into one unit. Or
Where formal departments staffed by personnel with easily recognized responsibilities such as
production, human resources etc.
Product/market/service organization
The organization of a company into divisions that bring together those involved with a certain type
of product or market.
Division: is large organization department that resembles separate business.
There are different patterns:
Division by product
Division by geography
Division by customer
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In a divisional organization,
divisions operate as relatively autonomous businesses under the larger corporate umbrella.
divisions may be unrelated such as in a conglomerate organization
may even compete.
divisional structures are made up of self-contained strategic business units that each produces a
single product.
For example, General Motors' divisions include
Chevrolet, Oldsmobile, Pontiac, and Cadillac.
Divisional structure is closer to functional structure with particular divisions being self-contained
business units often producing a single product or group of products.
A central headquarters, focusing or results, coordinates and controls the activities, and provides
support services between divisions.
Functional departments accomplish division goals.
Weakness is the tendency to duplicate activities among divisions.
Matrix organization
Also called “multiple command system
In a matrix organization, teams are formed and team members report to two or more managers.
An organizational structure in which employee reports to both a functional or division manager and
to a project or group manager, commonly for one-of-a-kind projects
Two types of structure existing simultaneously. Two chains of command
Functional or divisional: vertical
Project or business: horizontal
By superimposing a project structure upon the functional structure, a matrix organization is
formed that allows the organization to take advantage of new opportunities.
This structure assigns specialists from different functional departments to work on one or more
projects being led by project managers.
The matrix concept facilitates working on concurrent projects by creating a dual chain of
command, the project (program, systems, or product) manager and the functional manager.
Project managers
have authority over activities geared toward achieving organizational goals while
Functional managers
Have authority over promotion decisions and performance reviews.
Matrix structures utilize functional and divisional chains of command simultaneously in the same
part of the organization.
The matrix structure falls in the middle, combining
the advantages of functional specialization
With the focus and accountability of the divisional structure.
It is useful and being used
to develop a new product,
to ensure the continuing success of a product to which several departments directly
contribute, and
DELEGATION
Future trends
Future trends are for more organizational structures:
designed to maximize responsiveness to customer needs,
a flattening of hierarchies within organizations,
downsizing and re-engineering of companies,
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decentralization of decision-making and authority,
And increased accountability.
Learning organizations
Learning organizations as those capable of turning new ideas into improved performance.
Five skills required to do this are
(1) Solving problems,
(2) Experimenting,
(3) Learning from organizational experience and history,
(4) Learning from others, and
(5) Transferring and implementing knowledge for improved performance.
Boundaryless organizations are not defined or limited by horizontal, vertical, or external boundaries
imposed by a predetermined structure.
They share many of the characteristics of flat organizations, with a strong emphasis on teams.
Cross-functional teams dissolve horizontal barriers and enable the organization to respond quickly to
environmental changes and to spearhead innovation.
Boundary less organizations can form relationships (joint ventures, intellectual property,
distribution channels, or financial resources) with customers, suppliers, and/or competitors.
Telecommuting, strategic alliances and customer-organization linkages break down external barriers,
streamlining work activities. Jack Welch, former CEO of General Electric, to facilitate interactions with
customers and suppliers, first used this un-structure.
A boundaryless environment is required by learning organizations to facilitate team collaboration
and the sharing of information. When an organization develops the continuous capacity to adapt and
survive in an increasingly competitive environment because all members take an active role in identifying
and resolving work-related issues, it has developed a learning culture.
A learning organization is one that is able to adapt and respond to change. This design empowers
employees because they acquire and share knowledge and apply this learning to decision-making. They are
pooling collective intelligence and stimulating creative thought to improve performance. Supervisors
facilitate learning by sharing and aligning the organization's vision for the future and sustaining a sense of
community and strong culture.
Coercive power
Is the threat of sanctions.
Is dependent on fear and includes, but is not limited to the ability to dismiss, assign undesirable
work, or restriction of movement.
Reward power
Self-Actualizing Managers
Have warmth, closeness, and sympathy.
Recognizes and shares negative information and feelings.
Exhibit trust, openness, and candor.
Do not achieve goals by power, deception, or manipulation.
Do not project own feelings, motivations, or blame onto others.
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Do not limit horizons; uses and develops body, mind, and senses.
Are not rationalistic; can think in unconventional ways.
Are not conforming; regulates behavior from within.
Relevance of Maslow’s Theory for Managers
A fulfilled need does not motivate an individual.
Effective managers can anticipate emerging needs based on individual need profiles and provide
opportunities for fulfillment.
The esteem level of needs satisfied by jobs and recognition provides managers with the greatest
opportunity to motivate better performance.
Herzberg’s Two-Factor Theory
A theory of motivation based on job satisfaction.
A satisfied employee is motivated from within to work harder.
A dissatisfied worker is not self-motivated to work.
Conclusion: Enriched jobs are the key to self-motivation.
Dissatisfiers - factors associated with the job context or work environment.
Satisfiers: factors associated with the nature of the task itself (job content).
Norms
The standards (degrees of acceptability and unacceptability) for conduct that help individuals judge
what is right or good or bad in a given social setting.
Norms are culturally derived and vary from one culture to another.
Norms are usually unwritten, yet have a strong influence on individual behavior.
Norms go above and beyond formal rules and written policies.
Organizational Politics
What Does Organizational Politics Involve?
The pursuit of self-interest at work in the face of real or imagined opposition.
Effects of Organizational Politics
Hinders organizational and individual effectiveness.
Is an irritant to employees.
Can have significant ethical implications.
Political Tactics
Posturing: taking credit for others work.
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Empire building: gaining control over human and material resources.
Making the supervisor look good: engaging in “apple polishing.”
Exchanging reciprocal political favors by making someone look good or covering up their mistakes.
Political Tactics
Creating power and loyalty cliques: facing superiors as a cohesive (Unified solid organized) group
rather than alone.
Engaging in destructive group competition: sabotaging the work of others through character
assassination.
Tuning
The most common, least intense and least risky type of change.
Also known as preventive maintenance and kaizen (continuous improvement).
Key is to actively anticipate and avoid problems rather than waiting for something to go wrong.
Adaptation
Incremental changes that are in reaction to external problems, events, or pressures.
Reorientation
Re-Creation
Intense and risky decisive change that reinvents the organization.
Also called “frame breaking”
Individual Reactions to Change
Objectives of OD
Deepen sense of organizational purpose.
Strengthen interpersonal trust.
Encourage problem solving rather than avoidance.
Develop a satisfying work experience.
Supplement formal authority with knowledge and skill-based authority.
Increase personal responsibility for planning and implementing.
Encourage willingness to change.
The OD Process
Unfreezing, change, refreezing
Unfreezing: neutralizing resistance by preparing people for change.
Refreezing: systematically following a change program for lasting results.
Unofficial and Informal Grassroots Change
Tempered Radicals
People who quietly try to change the dominant organizational culture in line with their convictions.
Guidelines for tempered radicals
Think small for big results.
Be authentic.
Translate.
Don’t go it alone.
Negotiating
Negotiation
A decision-making process among interdependent parties with different preferences.
Common Types of Negotiation
Two-party negotiation (e.g., buyer and seller)
Third party negotiation (e.g., agents and arbitrators)
Elements of Negotiation
Adopting a win-win attitude
Understanding that mutual beneficial agreement addresses the both parties’ interests.
Knowing your BTNA (best alternative to a negotiated agreement)
Your “bottom line” for accepting or rejecting offers.
Identifying the Bargaining Zone
Negotiation is useless if both parties involved have no common ground on which to maneuver
during bargaining.
Added Value Negotiating (AVN)
A practical five-step win-win process involving development of multiple deals.
Clarify subjective and objective interests; seeking common ground.
Identify options and their marketplace values.
The World of Communication (average daily number of messages sent and received by office
workers)
Encoding
Translating internal thought patterns into a language or code the intended receiver of the message
will likely understand and/or pay attention to.
Choice of words, gestures, or other symbols for encoding depends on the nature of the message.
Technical or no technical
Emotional or factual
Visual or auditory
Cultural diversity can create encoding challenges.
Selecting a Medium
Coping
with the Grapevine
-The grapevine cannot be extinguished.
-Attempts to stifle the grapevine as likely to stimulate it instead.
-Monitoring and officially correcting grapevine
information is perhaps the best strategy for coping with the grapevine.
Nonverbal Communication
Body Language
Nonverbal communication based on facial expressions, posture, and appearance.
Types of Body Language
Facial
Gestural
Postural
Receiving Nonverbal Communication
Awareness of nonverbal cues can give insight into deep-seated emotions.
Giving Nonverbal Feedback
Nonverbal feedback from authority figures significantly affects employee behavior.
Positive feedback builds good interpersonal relations
Sensitivity and cross-cultural training can reduce nonverbal errors when working with
individuals from other cultures.
Upward Communication
The process of encouraging employees to share their feelings and ideas with management.
Options for improving upward communication
Formal grievance procedures
Employee attitude and opinion surveys
Suggestion systems
Open-door policy
Informal meetings
Internet chat rooms
Exit interviews
Communication Problems and Promises in the Internet Age
Barriers to Communication
Process barriers
Sender barrier
Encoding barrier
Medium barrier
Decoding barrier
Receiver barrier
Feedback barrier
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Physical barriers
Devices and distance
Barriers to Communication
Semantic Barriers
Misinterpretation of the meaning of words and phrases by individuals.
Specialized occupational languages can create communication problems with outsiders.
Psychosocial Barriers
Differing backgrounds, perceptions, values, biases, needs, and expectations of individuals can block
communications.
Sexist and Racist Communication
Progressive and ethical managers are weeding sexist and racist language out of their vocabularies
and correspondence to eliminate the demeaning of women and racial minorities.
Communicating in the Online Workplace
Getting a handle on e-mail
Put short messages in the subject line.
Be sparing with graphics and attachments.
Hello! Can we talk cell phone?
Advantages are mobility and convenience.
Disadvantages are distracted drivers and disturbing calls in public places, and the risk of disclosing
private information.
Video conferences
o A live television exchange between people in different locations.
o Desire to reduce costly and possibly dangerous travel time is driving this technology.
Telecommuting
o Sending work to and from one’s office via a computer modem while working at home.
Becoming a Better Communicator
Effective Listening
Tolerate silence; keep listening.
Ask stimulating, open-ended questions.
Encourage the speaker with attentive eye contact, alert posture, and verbal encouragers.
Paraphrase what you have just heard.
Show emotion to show your sympathy with speaker.
Know your biases and prejudices.
Avoid premature judgments.
Summarize by reiterating what the speaker said.
Effective Writing
1. Keep words simple.
2. Don’t sacrifice communication to rules of composition.
3. Write concisely.
4. Be specific.
Running Meetings
Prepare ahead of time.
Have a reason for the meeting.
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Distribute an agenda.
Give participants at least a day’s notice.
Limit attendance and designate a leader.
Have a specific start and end time.
Encourage participation but keep to the agenda.
Use visual aids.
Follow up.
Table7.1
Surveys
A forecasting technique involving face-to-face interviews and mail or e-mail questionnaires.
Problems with surveys
Construction of the survey instrument.
Cost of administration.
Errors in data collection and interpretation.
Trend Analysis
The hypothetical extension of a past series of events into the future.
UNIT 8: Organization Control
Quality Improvement
Control:
Taking preventive or corrective action to keep things on track.
Checking, testing, regulation, verification, or adjustment.
Objectives are yardsticks for measuring actual performance.
Purpose of the control function
Get the job done despite environmental, organizational, and behavioral obstacles and
uncertainties.
Types of Controls
Feed forward Control:
The active anticipation and prevention of problems, rather than passive reaction.
monitor inputs
Concurrent Control:
Monitoring and adjusting ongoing activities and processes.
Internal customers: anyone in the organization who cannot do a good job unless you do a good job.
Make Continuous Improvement a Way of Life
Kaizen: a Japanese word meaning continuous improvement (quality is an endless journey).
A gain in one area does not mean loss in another.
Venues for continuous improvement
Improved and more consistent product and service quality.
Faster cycle times.
Greater flexibility.
Lower costs and less waste.
Build Teamwork and Empowerment
Teamwork
Suggestion systems.
QC circles and self-managed teams.
Team work and cross-functional teams.
Consensus Building
All value their independence.
No one accomplishes much alone.
Group Decision Making
A great deal of time is spent in meetings formulating problems, arriving at solutions, and
determining the means for implementation.
Thus, the need it is important to know
when decisions should be made with groups, and
When individuals should make them.
If there is one expert and can solve the problem, an individual should make the decision. Individual
decisions can be made quickly, and responsibility can be clearly assigned.
However, if there isn’t an expert, a group decision should be made
Groups can identify more alternatives than an individual.
diversity of experience and perspectives to a decision process
1. Globalization
2. Environmentalism
3. An ethical reawakening
4. The Internet and the e-business revolution
5. The evolution of product quality ****Table
Entrepreneurship
Traits of Entrepreneurs
Focus is on envisioned futures.
Emphasize external/market dimensions.
Display a medium-to-high tolerance for ambiguity.
Exhibit moderate-to-high risk-taking behavior.
Obtain motivation from a need to achieve.
Possess technical knowledge and experience in the innovative area.
Myths About Older Workers
Are not less productive.
Do not incur higher benefits costs.
Do not have higher absenteeism.
Do not have more accidents at work.
Are not less willing to learn.
Are not inflexible about the hours they are willing to work.
Data
KNOWLEDGE
Analysis
Understanding
INFORMATION
Impact
Factor= Health intervention HI+ External factors
Sources of information
Epidemiological surveillance information (IDSR)
Sentinel reporting, (Polio, HIV…)
Special Surveys, (E.g. HIV- BSS)
Census and DHS (by CSA)
Administrative information systems (included in the HMIS of the SNNPR and partly in the annual
report)
Features of HMIS in Ethiopia
• Data coming from the HMIS may not be helpful to the management decision-making due to;
• Poor quality of data
• Deficiency of data set in providing the needed management support.
Features of HMIS in Ethiopia
• Data that are needed for key decisions are missed
• The information system is “Data driven” than “Action driven”,
• Unnecessarily huge and redundant, (with multitudes of indicators and reporting overburden)
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• The report is usually incomplete,
• Inaccurate and inconsistent
• Untimely, and outdated.
• Weak institutional capacity,
• Lack of HMIS strategy
• Deficiency in skills and knowledge of HIS/HMIS
• Lack of an implementation guideline,
• The generated information is not used to the optimum,
• Lack of timely feedback
• Lack of baseline data to compare progress
• Enabling environment, especially at facility level
Features of HMIS in Ethiopia
HSDP II indicators (125), for monitoring at national level
Category of indicators No
Input 2
Process 7
Output 17
Total 26
Health related indicators in MDG
► Prevalence of underweight children (under 5yrs age)
► Proportion of population below minimum level of dietary energy consumption
► Under five mortality rate
► Infant mortality rate
► Proportion of 1yr old children immunized against measles
► Maternal mortality ratio
► Proportion of births attended by skilled health personnel
Health and related indicators in PRSDP
► IMR
► U5MR
► MMR
► Access to health services
► EPI coverage
► Per capita health service utilization
► Share of health budget
► HIV prevalence
► Access to safe drinking water
► Malaria prevalence
► Tuberculosis prevention and control services coverage
► CPR
Suggested reforms issues
► Use of a unified HMIS
► Integrating the HSDP reporting system
► Harmonize with indicators of SDPRS and MDG.
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► Addressing the needs of various programs
► Addressing the workload that the producers can afford
2. Redefine indicators
► Cover only the most useful ones
► Ensure relevance to all level (demonstrable practical use)
► Focus on the information for use at the frontline level.
► Minimize indicators & shift part of the HMIS to sentinel surveillance or small surveys
HMIS reform issues
3. Match information needs, staffing pattern and service package with technical and technological
capability of the levels involved.
HMIS reforms issues
4. Develop/apply national HMIS guideline
• To define and guide consistency in use of indicators
• Consider all levels of the system
• Considering the changing pattern of service/referral system,
HMIS reforms issues
5. Involve regions and health facilities in the HMIS reform process
HMIS reform issues contd.
6. Interrelated actions
• Ensure availability of minimum list of equipment, supplies and reagents to provide the service
and to produce the standard data
2. Capacity building (HRH, (technological support etc).
3. Availability of budget for use flexibly & based on changing situations and evidences from HMIS
HMIS reform
4. Regular and meaningful feedback at all levels
5. A system to support the HMIS by OR.
6. M/E mechanism of the HMIS itself
References
1. Design and implementation of HIS, Ed, Theo Lippeveld, Rainer Sauer born, Claude Bodart, WHO,
2000
2. WHO, HFA series no 9; 1982
3. Yetnayet Asfaw, (MD, MPH), August 2001. Working document for strengthening the National
Monitoring and evaluation systems in support of the implementation of HSDP (draft proposal).
4. Bruce B. Campbell, 1997, HMIS in lower income countries. An analysis of system design,
implementation & utilization in Ghana and Nepal
5. Ethiopian health sector development programme 1997/98 to 2001/02. Report of the mid term review
mission (8th of March, 2001)
Country Background
Federal Government (9 Regional States & 2 City Councils.
Decentralization to Regional states and to District level since 2002/03.
Budget allocation based on block grant and federal Gov’t subsidy using federal council approved
formula.
Partnership of HSDP
•Three levels of partnership:
•1st, between the Central Government and (FMOH) and the Regional States (RHBs).
•2nd, between the Central Government and health Donor Partners. •3rd, between the Central/Regional, NGOs
and the private sector.
Governance of HSDP
•Existing two levels and a plan to expand to the third level:
•At Central level, CJSC (8 members, 2 government seats, 6 seats held by Donor partners on the basis of
regional representation
•HPN-Government consultative forum as a technical arm of CJSC.
•RJSC and expected expansion to DJSC.
•All follow more or less similar formula for representation, but appropriate to local condition.