Healthcare is an expansive industry that ranges from preventative care, to emergency services, to follow-up and rehabilitation. Health care organizations are complex and dynamic. The nature of organizations requires that managers provide leadership, as well as supervision and coordination of employees. Organizations are created to achieve goals that are beyond the capacity of any single individual. This is more so in health care organizations where the scope and complexity of tasks carried out in provision of services are so great that individual staff operating on their own can’t get the job done.

Managers are therefore needed to make sure certain that organizational tasks are carried out in the best way possible to achieve organizational goals and that appropriate resources including financial and human resources, are adequate to support the organization.

Definition

It is the profession that provides leadership and direction to organizations that deliver personal health services and to divisions, department, units or services within that organization.

The aim for teaching Health Services Management (HSM) is to equip the students with relevant skills that will enable them to effectively manage health services. Management means getting things done. It’s working with and through people in order to achieve organizational goals and objectives. Therefore management enhances teamwork as opposed to work in isolation. This therefore requires a manager to be flexible in order to succeed. HSM means getting people work together harmoniously using resources effectively to deliver health services to the individuals and the community they serve.

Concepts of Health service management

1. Leadership: is the process of influencing others towards a (Bennie and Nanas, 1985)
2. Leader: is an influential person who has the ability to lead a group or department without having a formal appointment.
3. Manager: is a formally and officially responsible individual for the work of a given group. For example; ward in charge, principal of a school is officially responsible to ensure that the unit accomplishes its tasks well.
4. Authority: is the legitimate right to a manager or a leader by an organization in order to command subordinates and to act in the interest of an organization to achieve its goals.
5. Power: is to influence others to act. Or it’s the ability to impose the will on others to bring about certain behavior. (This power can be reward power, coercive power)
6. Nursing management: is the process of working through nursing personnel to promote and maintain health, prevent illness and Therefore the role of nurse manager is to

plan, organize, direct and control available resources in order to provide effective care to groups of clients efficiently.

MANAGEMENT

• Management therefore is a process which enables organizations to achieve their objectives by planning, organizing and controlling their resources including gaining the commitment of their employees through motivation.
• OR: Management is a process that enables organizations to achieve their objectives through human and other resources (getting things done).
• OR: It is the process to fore-cast, to plan, to organize, to command, to coordinate and to
• OR: It is defined as a local process which consists of planning, controlling, coordinating process. (Eelbreach 1957)
• OR: It is defined as an operation initially dissected by analyzing the managerial activities i.e. planning, organizing, staffing, directing, leading and controlling. (Koontz Odenel 1976,)
• OR: It is also defined as an element that helps Health Workers to manage various resources used in health services, effectively and effectively.

NB: The principle underlying the definitions is commitment to purposeful action not to act for its own sake i.e. focusing on the goals. HSM can be observed as getting people both health workers and non-health workers work together harmoniously to make effective use of resources to deliver health services effectively to the community they serve.

Therefore management enhances teamwork as opposed to work in isolation. This therefore requires a manager to be flexible in order to succeed. HSM means getting people work together harmoniously using resources effectively to deliver health services to the individuals and the community they serve.

The manager who is stiff causes “a red tape” i.e. a breakdown in organization. In proper management information should flow from subordinates to the supervisors and vice-versa.

In management, there is control of resources including human resources for remembrance. Resources including human resources are considered under 4m’s i.e.

• Manpower
• Material
• Money
• Movement

Manpower resources cannot be bought from shelves like any other resources. This means manpower is not always available particularly in the right kind. Management has been applied since

the beginning of civilization. In communities, people have always worked together to grow crops, build temples, etc.

Theories of Management

There are two major but opposing schools of thought in management: scientific management and the human relations–based approach. As its name implies, the human-relations approach emphasizes the interpersonal aspects of managing people, whereas scientific management emphasizes the task aspects.

Scientific Management

• Almost 100 years ago, Frederick Taylor argued that most jobs could be done more efficiently if they were analyzed thoroughly (Lee, 1980; Locke, 1982). With a well-designed task and enough incentive to get the work done, workers could be more productive. For example, Taylor promoted the concept of paying people by the piece instead of by the hour. In health care, the equivalent would be by the number of patients bathed or visited at home rather than by the number of hours worked. This would create an incentive to get the most work done in the least amount of time. Taylorism stresses that there is a best way to do a job. Usually, this is also the fastest way to do the job (Dantley, 2005).
• The work is analyzed to improve efficiency. In health care, for example, there has been much discussion about the time it takes to bring patients to radiology or to physical therapy versus bringing the technician or therapist to the patient. Eliminating excess staff or increasing the productivity of remaining employees is also based on this kind of thinking. Nurse managers who use the principles of scientific management will pay particular attention to the type of assessments and treatments done on the unit, the equipment needed to do this efficiently, and the strategies that would facilitate efficient accomplishment of these tasks. Typically, these nurse managers keep careful records of the amount of work accomplished and reward those who accomplish the most.

Human Relations–Based Management

• McGregor’s theories X and Y provide a good example of the difference between scientific management and human relations–based management.
• Theory X, said McGregor (1960), reflects a common attitude among managers that most people do not want to work very hard and that the manager’s job is to make sure that they do work hard. To accomplish this, according to Theory X, a manager needs to employ strict rules, constant supervision, and the threat of punishment (reprimands, withheld raises, and threats of job loss) to create industrious, conscientious workers. Theory Y, which McGregor preferred, is the opposite viewpoint. Theory Y managers believe that the work itself can be motivating and that people will work hard if their managers provide a supportive environment. A Theory Y manager emphasizes guidance rather than control, development rather than close supervision, and reward rather than
• punishment. A Theory Y nurse manager is concerned with keeping employee morale as high as possible, assuming that satisfied, and motivated employees will do the best work. Employees’ attitudes, opinions, hopes, and fears are important to this type of nurse manager.
• Considerable effort is expended to work out conflicts and promote mutual understanding to provide an environment in which people can do their best work.

Principles of healthcare management

In HSM work involves more than one person and as a result, two or more complementary principles must be applied to management namely; Division of labour and convergence of work.

Division of labour

This was devised by Henry Fayol who said that the more people are involved in work specialization, the more efficient they become. When work is divided and coordinated, the group becomes a team. In a team, there is specialization and division of labour by each category of staff. It’s done to fully utilize the skills of each member in order to achieve the objectives. Management is the assigning of a balanced proportion of work to each kind of staff in the organization.

Team approach

This is the way in which management attains or brings about a balance amongst different members of the team and the work they do. e.g. consider different people involved        in management of patients from the time they come to the hospital till discharge or the number of people (different with different skills) involved in a successful surgical operation. Therefore in the division of labour, work must be shared or divided among a number of different categories of technically skilled people. To achieve the objectives, the study of work relations and equitable resource allocation should form a major area in management. Its governing principle is that of “convergence of work”. Convergence of work

It means that activities the various people who do the work, come together in order to achieve the objectives. The activities should be designed and directed in such a way that they support each in moving towards a common goal.

It also implies that work impressions are the way in which members of the team interact with one another; it should contribute to the success of each activity and general effectiveness. In general, health activities are studied described and performed under 3 main sub-headings mainly.

• Service activities
• Developmental activities
• Support activities

A service activity e.g. immunization usually requires some preceeding developmental activities e.g. training immunizers and some continuous support e.g. provision of supplies. These 3 activities need to be managed so as to bring about convergence of work, balance of resources and harmonious work relations and ultimately intended results.

Substitution of resources

It’s also widely applied in the effective use of resources after when resources that are normally used to provide services become too expensive. Here the cheaper alternatives are used to produce intended results.

Delegation

It’s also one of the principles of management in which someone with authority “temporarily gives” the authority to another person so as to enable that person take responsibility when need arises. The decision to delegate is reached after making sure that the person to be delegated is capable of performing as expected.

Henry Fayol’s principle of management

1. Authority with corresponding responsibility: If responsibilities are allocated, then the post holder needs the requisite authority to carry out the duties. He/she should be responsible for his /her actions. It is not uncommon in some organizations to find powerless managers.
2. Specialization/division of Labour: This is a principle of work allocation/specialization so that individuals do activities which they are best suited for hence more efficiency of the
3. Discipline: For an enterprise to prosper there must be orderly behavior for all its employees. Employees must adhere to the rules standards of the organization.
4. Unity of command: This is the idea that an employee should receive instructions from only one supervisor. This generalization still holds even where we are involved with team and matrix structures which involve reporting to more than one boss. The basic concern is that tensions and dilemmas arise where we report to two or more bosses.
5. Unity of direction: There should be only overall manager and only one plan to which everybody adheres to. Subordination of individual interest to the general organization’s interest. This principle denotes that one employee’s interest or those of one group should not prevail over the organization as a whole.
6. Staff Remuneration: The staff remuneration should be as fair as possible in view of the organization’s costs and profitability.
7. Scalar chain/line of authority: The line of authority in the organization runs from top to bottom in a straight line. Communications should normally follow this path, although managers should be able to communicate across the organization to peers at the same level of authority.
8. Order: To run well as organization, there should be a place for everything. Orderliness also implies steady evolutionary movement rather than wild anxiety provoking unpredicted movement

9. Equity: Fairness and a sense of justice should pervade the organization in principle and practice. An organization runs best when there is friendliness among employees and managers and when managers act fairly towards others.
10. Stability of staff: Employee turnover is unhealthy for organizations because time is needed for employees to adapt to their work and perform effectively. Stability of tenure promotes loyalty to the organization.
11. Initiative: At all levels of the organization, zeal, enthusiasm and energy are enabled by employees having the scope for personal initiative. Subordinates should be given the opportunity to conceive and execute plans as long as they are in line with the overall organizational plan.
12. Team work: For proper organizational functioning, there is need for building and maintaining harmony among the workforce, team work and sound interpersonal relationships.
13. Centralization /delegation: There should be a balance between centralization and Authority and responsibility should not be too centralized in one manager.

Qualities of a good manager

1. A good manager is that one who knows when, where, what and how to act i.e. good manager is
   • Flexible
   • Kind
   • Patient
2. Knows the importance of accountability
3. A good manager must be able to account for whatever he/she has used or
4. Should be transparent
5. Able to consult because he’s not working in isolation
6. Should be polite and able to share knowledge with others
7. Should be knowledge e. up dated and never challenged.
8. Be able to think creatively to provide a vision for the company and solve problems
9. Be calm under pressure and make clear decisions
10. Possess excellent two-way communication skills
11. Have the desire to achieve great things
12. Be well informed and knowledgeable about matters relating to the business
13. Possess an air of authority

Management styles

Management styles are mainly categorised in form of 3 Ds

1.Directing style

Managers tell people what to do, how to do it and when to have it completed. They assign roles and responsibilities, set standards and define expectations.

The people who use this style are called Autocratic (or authoritarian) managers i.e. they make all the important decisions and closely supervise and control workers. Managers do not trust workers and simply give orders (one-way communication) that they expect to be obeyed. This approach derives from the views of Taylor as to how to motivate workers and relates to McGregor’s theory X view of workers. This approach has limitations (as highlighted by other motivational theorists such as Mayo and Herzberg) but it can be effective in certain situations. For example: When quick decisions are needed in a company (e.g. in a time of crises)

When controlling large numbers of low skilled workers.

2. Discussing style

Managers using this style take time to discuss relevant business issues. People present ideas, ask questions, listen, and provide feedback, challenge assumptions and coach as needed. It’s important to make sure ideas are fully discussed and debated. Managers often perform the role of facilitator, making sure the discussion stays on track and everyone has a chance to contribute.

The people who use this style called Paternalistic managers.

3. Delegating/democratic style

Managers using this style usually explain or get agreement on what has to be accomplished and when it must be completed. The how-to-do-it part of the equation is left up to the employee. Responsibility and authority are given to employees to get the job done.

Other styles

Persuasive management style

• Persuasive management styles share characteristics with autocratic management. Persuasive managers control all decision-making, but they spend more time with employees than a purely autocratic leader. Instead of working behind a closed office door, for example, a persuasive manager is in the meetings and on the sales floor doing the work alongside his employees (even if he is calling the shots). This on-the-level approach allows managers to lead by example, and helps employees understand the benefits of their manager’s decisions. Persuasive managers are not necessarily more inclusive of their employees when it comes to decision-making, but they tend to be  more  aware   of  the work  they are doing. Laissez-faire management style

• A laissez-faire manager is seen as more of a mentor than a manager. With laissez-faire management, employees are empowered to take charge and managers take a backseat role so that employees  can   flourish creatively. Functions of management

There are five primary functions of management, these are;

• Planning: this the systematic way of making decisions that will affect the future of the organization. It involves foreseeing the effects of current actions in the long run in the
• Organizing: this involves determination of the activities that need to be done in order to reach the organizational goals. These activities should also be assigned to proper personnel.
• Staffing: Is the process of hiring and retaining suitable work place for the
• Directing: this is concerned with leadership, communication, motivation and supervision so that the employees perform their activities in the most efficient way in order to achieve organizational goals.
• Controlling: this consists of those activities done to ensure that the events do not deviate from the pre-arranged plans. For example, establishing standards for work performance, measuring performance, taking corrective actions to correct any deviations.

Other functions of management

• Decision making: This function is critical to all the aforementioned management functions and means making effective decisions based on consideration of benefits and drawbacks of
• Motivating: Stimulating individuals to put more efforts in their

Purpose of management in healthcare

1. The aim of all managers is the same regardless of rank and type organization – to increase productivity. This means effectiveness and efficiency that is achieving organizational goals and achieving them at low cost.
2. Effective management therefore is the concern of a corporation president, a medical superintendent, a commissioner in the ministry, a church Bishop, a school head prefect, and

Skills required for effective management

• Conceptual skills- to set a vision see the “big picture”.
• Communication skills
• Human skills
• Problem solving skills
• Planning skills
• Negotiation skills
• Leadership skills
• Technical skills tc.

The skills mix required for various management levels (organization hierarchy).

Top- level management;

• Conceptual skills
• Communication skills
• Planning skills
• Advocacy skills
• Negotiation skills
• Leadership skills Mid- level management
• Planning skills
• Communication skills
• Coordination skills First level management
• Technical skills
• Supervisory skills
• Demonstration skills

Functions of a manager

• Recruitment, maintaining and firing of staff. This is vital to ensure that you have competent and enough staff to do the available tasks.
• Formally evaluate performance of staff on a regular basis for example through appraisal, support supervision and provide feedback accordingly.
• Recommend staff for promotion or further study which will motivate the staff and also enable the organization to have staff with expertise.
• Prepare and adhere to the proposed budget so as to ensure appropriate resource utilization and minimize loss/wastage.
• Assign and program the work of staff members so as to prevent role
• Should be able to handle problems/conflicts occurring at work
• Plan for the activities of the organization
• Empower the employees through assigning responsibilities or
• Motivate workers so as to better perform their roles which will lead to attainment of organizational objectives.
• Create a suitable environment for retention of the staff which also motivates
• Advocate for staff to the high level managers

Characteristics/qualities of a good manager or leader

• Knowledgeable: since the management problems are complex and many faced, a manager should be knowledgeable in order to process the information into useful data for decision making and also differentiate between facts and non- facts.
• Decisiveness: a manager should have the ability to prompt and desirable

• Ability to handle conflict: should be able to listen, positively respond to criticism and handle conflict and differences in a constructive manner.
• Emotional stability: he should be able to adjust to life, calm, cool and calculated reaction to undesirable situations and obstacles.
• Honesty & Integrity: are crucial to get your people to believe you and buy in to the journey you are taking them on
• Have vision: know where you are, where you want to go and enroll your team in charting a path for the future
• Inspirational: inspire your team to be all they can by making sure they understand their role in the bigger picture
• Ability to Challenge: do not be afraid to challenge the status quo, do things differently and have the courage to think outside the box
• Communication Skills: keep your team informed of the journey, where you are, where you are heading and share any roadblocks you may encounter along the way