MANAGEMENT

Management is a set of activities including {planning, decision making, organizing,

leading and controlling directed at an organization’s resources (human, financial,
physical) with the aim of achieving organizational goals in an effective and efficient
manner.

Efficiency means using resources wisely and without unnecessary waste.

Effectiveness means doing the right thing successfully.

A manager is someone whose primary responsibility is to carry out the management

process. In particular, a manager is someone who plans and makes decisions,
organizes, leads and controls humans, financial, physical and information resources.

Purpose of Management
The purpose of management is to plan, direct, organize and ensure the success of a
business at various levels through a number of methods including customer
satisfaction and employee training.

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Process of Management

• Planning means setting an organization's goals and deciding how best to

achieve them.
• Decision making is a part of the planning process involving selecting a
course of action from a set of alternatives.
• Organizing is coordinating activities and resources
• Leading is managing; it is a set of processes used to get people to work
together to advance the interest of the organization.
• Controlling is monitoring and evaluating activities.
It is monitoring the progress of the organization as it works towards its goals
to ensure that it is effectively and efficiently achieving these goals.

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 Types of Managers

1. Middle managers
2. Firstline managers

- Middle managers: They are the largest group of managers in most companies they
primarily take the
goals and strategies designed by the top manager and put them into effect

- First line managers: They supervise and coordinate the activities of the operating
employees. The majority of their work or direct supervision of the work of their
subordinate.

Managerial roles
1. Interpersonal roles.
2. Informational roles
3. Decisional roles

Interpersonal roles
A liaison coordinates the activities of two or more people, groups of people or
organization.

Informational roles
They actively seek information that will be of value to the organization. They also
transmit information to others in the organization. A spokesperson transmits
information about the organization to people outside the organization
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Decisional roles
They develop new ideas and initiate changes in the organization

MANAGEMENT THEORIES

1. Scientific management theory (Frederick Taylor)

2. Principles of administrative management (Henry Fayol)
3. Bureaucratic management theory (Max Weber)

Principles Of Scientific Management Theory

1. It emphasizes that forcing people to work hard would not result in the most
productive workplace. Instead, he recommended simplifying tasks to increase
productivity.
2. Each task should be studied to determine the most efficient way of doing the
task
3. Workers should be matched to jobs that align with both their abilities and
motivation.
4. Workers should be monitored closely to ensure they follow best practices

Pros (Scientific Management Theory)

1. Increased efficiency of production.
2. Improved worker performance
3. Introduction of roles and standard operating procedures
4. Selecting workers with skills that match their tasks

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 Cons
1. It ignores humanity of humans
2. Increased performance means more work, same pay.
3. Encourages micromanagement
4. Eliminates creative thinking.

Administrative Theory (Henri Fayol)

Responsibilities
• Forecasting
• Planning
• Organizing and interacting
• commanding
• Coordinating
• Controlling

Surbordination of individuals
Authority and
Principles of responsibility
Administrative Theory

• Initiative
• Scalar chain
• unity of command
• stability of tenure
• Equity
• Discipline
• Unity of direction
• Centralization
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 • Espirit de corps
• Division of work
• Order etc.

Pros
• Promotes teamwork
• motivates employees through fair compensation
• employees are treated with respect

Cons
• The idea of a good workplace varies
• Not every company requires a clear organizational hierarchy

Bureaucratic Management Theory (Max Weber) Principles

• Task specialization
• Hierarchy
• Formal selection
• Rules and requirements
• Impersonality.

Pros
• Emphasizes the importance of rules within the organization
• Discourages favouritism.

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 Cons
• Almost impossible to keep emotions out of business
• Difficult to maintain high morale
• High potential for inefficiency.

Human Relations Management Theory (Elton Mayo)

He proposed that employees are more motivated by personal attention and being
part of a group.

Pros
• Improves productivity
• Considers employee wellbeing
• Improves employee retention

Cons
• Oversimplifies human behaviour
• - Favours personality over accomplishment.

Systems Management Theory (Ludwig Von)

It proposes that a business is a system composed on interacting environments that

are affected by environment.

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 Pros
• Stronger focus on teamwork
• identifies the weak point in system, not people.

Cons
• Difficult to successfully implement as companies grow
• Not the best tool when in a crisis

Contingency Management Theory (Fred Fiedler)

His theory is based on the idea that effective leadership is linked to the traits a leader
displays in particular situations and how effectively they lead their team.

Pros
• Allows business to stay flexible and adaptive
• Allows for thorough analysis before reaching the appropriate decision.

Cons
• That same thorough analysis can take time, resources and cost.
• Difficult to measure its performance.

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 X & Y Theory (Douglas McGregor)

It assumes that there are 2 types of workers. X workers lack drive and ambition,
require excess direction from their managers. Y enjoy work, are naturally
motivated and look forward to fulfilment in their roles.

Pros.
• Theory X management creates a structural workplace
• Theory Y management creates a collaborative, motivating
environment.

Cons
• Generally, employees tend to fall somewhere between X and Y
• Largely obsolete in 2021

Modern Management Theory

It involves the combination of mathematical analysis with an understanding of

human emotions and motivations to create optimum productivity.

Pros
• Thorough understanding of employee behaviors to maximize productivity.
• It helps improve employee engagement

Cons
• Time, cost and technology constraints:
• Limited reference to organizing and staffing.
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Tips for using management theories in the workplace

• Invest in employee training.

• Give employee power in making decision.
• Flatten the organizational hierarchy.

Classification Of Management
• Planning
• Organising
• Staffing
• Directing
• Controlling

Responsibilities of the managers:

• Staffing
• setting policies
• Compensation and benefit
• Retention
• Training
• worker protection
• Employment laws

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 Material Management
Material management is the process by which an organization is supplied
with the goods and services that it needs to achieve its objectives of buying,
storage and movement of materials.

Roles of a nurse in material management

• Sound knowledge of the requirements and fixing of her unit.

• Must prepare budgets for materials required.
• Forecast the demands for smooth running of her unit.
• Ensure perfect fixing of the equipment in her unit.
• Control the inventory in her unit
• Provide feedback about the materials regarding quality
• Accurate recording of materials required

Responsibilities Of a Nurse Planning for Consumables

• Keep an adequate supply of materials on hand.
• Delegate someone to handle materials and consumables.
• Be observant of waste and misuse.
• Educate the nurse, patients in economical use of material.

Benefits Of Management Theories

• Increased productivity
• Objectivity
• Collaboration
• Simplified decision making

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CLASSIFICATION OF MANAGEMENT AND ITS FUNCTION
- Introduction to management
Management is a vital aspect of the economic life of man, which it an organized
group activity. It is considered as the indispensable institution on the modern social
organization marked by scientific thought and technological innovations. one or
the other form of management is essential wherever human efforts are to be
undertaken collectively to satisfy wants through some productive activity,
occupation or profession.
Management is essential not for business alone but for banks, schools, colleges,
hospitals, hostels, religious bodies, charitable trusts etc.

DEFINITION OF MANAGEMENT.
According to Peter. F. Drucker, management is an organ; organ can be described and
defined only through their definitions".
Ralph C. Davis has defined management as
"Management is the function of executive leadership anywhere".

Classification Of Management Function.

There is no universally acceptable list of the functions of management. Various
persons have classified
the resources in different ways. However, the following heads of functions are
generally accepted
1. Planning
2. Organizing
3. Staffing
4. Directing
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 5. Controlling
These fields easily define the importance of management in today’s business.

Planning
Planning is the most important function of management. It involves the managers to
think before they can act or take any decisions. It recognizes the ability of a manager
not to take any hasty decision or anticipate the plans of the future keeping in mind
the theory of probability.

Features of Planning.
• Planning seeks to achieve certain objectives.
• Planning is oriented towards the future.
• Planning is a mental exercise
• Planning involves choice among the different course of actions.
• Planning is the basis of all other functions
• Planning is a continuous process
• Planning is all pervading.

Steps in planning.
The following steps are involved in the planning of management.
• Collecting information about past, present and future forecasts to ensure
profits for the firm.
• Explaining objectives of the firm with regard to the present as well as future.
• Developing planning premises
• discovering alternative courses of actions
• Choosing the best alternatives
• Defining subsidiary plans:
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 • Reviewing and rectifying the plans in a timely and periodic manner.

Advantages of Planning
The following are the advantages of planning
1. Planning helps the managers to minimize deviation from the basic objective
of the business that is mentioned in the memorandum of understanding.
2. Planning helps a minimize risks and losses.
3. Planning helps to improve the efficiency of operation
4. Planning facilitates cooperation and teamwork

Limitation of Planning
1. Lack of accurate information.
2. Time consuming
3. Expensive
4. Rigidity due to strict compliance with the plans.
5. Psychological barrier or willingness of the person to change
6. External limitations, changes in government policies, technology, labor
regulation etc.

Organization
Once the plans are formulated, a network of authority- responsibility relationships
are developed through which the managers can implement the plan.
Steps
1. Identifying the activities required for achieving the objectives
2. Classifying the activities into convenient groups.
3. Assigning these groups of activities to appropriate persons

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 4. Delegating authority and fixing responsibility for carrying out the assigned
duties.

Importance of Organizing
A sound organization involves and contributes to the success of business in the
following ways: Organization is the mechanism through which the management
directs, controls and coordinates the activities of the enterprise.
Sound organization involves and facilitates the growth and diversification by proper
delegation of the authority.
Organization permits the optimum use of human resource by matching the work with
talent. organization structure in group activity is the equivalent of social structure.
A harmonious organization structure enables the firm to adopt new technology
Sound organization encourages the activities and create thinking leading to the
development of managerial talent.

Staffing
It involves the manning of the positions with the human resources of the enterprise.
It is concerned with acquiring, developing, utilizing and maintaining human
resources. The managers keep on trying different jobs with the talents and
educational qualification of the individual to ensure that only the right man gets the
right jobs.

Steps In Staffing
1. Manpower planning which is associating and assessing the manpower
requirements in term of number and quality
2. Recruitment, selection, placement and orientation
3. Training and development
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 4. Appraisal, promotion and transfer.
5. Employees remuneration (remuneration is the pay provided in
exchange for an employees’ services performed)

Importance
1. Due to the process of matching jobs with individuals, the managers probably
get the correct man for the defined jobs who can profit the firm.
2. It helps to improve the quality and quantity of output putting the right man in
the right job.
3. It improves the job satisfaction of the employees.
4. It reduces the cost of personnel by avoiding wastage of human resources.
5. It facilitates the growth and diversification of organization by developing
talent of employees.
6. Coordinating these authority responsibility relationships throughout the
enterprise.

Directing
It is concerned with the execution of the plans though organised actions. It is also
called the commanding and activating. It is the part of the management process
which actuates the members of the organization to work efficiently and effectively
for the attainment of the desired objectives.

Features of Directing
1. Directing is an executing function as it initiates actions
2. Directing is an ongoing function
3. Directing is the function of all managers

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 4. Directing is an interpersonal aspect of management as it is concerned
with human behaviour.

Importance of Directing.
1. Initiates actions
2. Improves efficiency
3. Facilitates change
4. Ensures coordination

Supervision (Element of directing)

It means overseeing subordinates at work. It refers to the direct and immediate
observation and watching of subordinates in the performance of their tasks.
supervision is required at all levels of management.

Steps In Supervision
1. Planning and allocation of work.
2. Issuing orders and instructions to the subordinate
3. Providing necessary guidelines to the employee
4. Maintaining discipline

Controlling
It is the process of measuring performance, comparing it with the defined objectives
and standards that are widely acceptable and taking reform measures when
everything goes out of order.

Steps in Controlling
1. Setting standards of performance
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 2. Measuring actual performance
3. Comparing actual standards with the results.
4. Analyses cause of deviations
5. Taking corrective actions

Communication
It is the process by which information and other relevant details are passed from
hand to hand including the understanding that is involved in between the transactions
as any communication without understanding is meaningless. It involves exchange
of information or ideas between two or more persons. Communication is a two-way
process, and it completes when the feedback becomes known to the sender of the
message. communication is essential at all levels of management; it is just like the
circulation of blood in the human body. It facilitates decision making, promotes
efficiency of employees, helps to coordinate, improves employee’s morale, promotes
industrial harmony and boosts image of the organization.

Motivation
It is the process of stimulating people to take the desired results / course of actions.
It involves inspiring
desired to work hard towards the accomplishment desired objectives. Motivation is
the task, of every manager is required at all levels. In order to motivate his
subordinate, a manager must understand their needs as motives to the task and
provide appropriate financial and non-financial incentives to satisfy them.
Motivation is the vital element in the management. It keeps the people satisfied so
that they make the best utilization of their talent and resources. No organization can
be successful unless its members are induced to contribute their best efforts for the
attainment of the predetermined targets.
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Leadership
It is the process of influencing the behavior of people in the desired manner. It
involves guiding inducing and actuating subordinates to work with enthusiasm and
zeal. A leader interprets the objectives of the organization, suggest the right course
of action, stimulating and guiding the people to achieve the objectives. To be a
successful leader, a manager must possess several qualities like foresight, initiative,
self confidence, drive, courage, determination, integration the character etc. win
talent.
Organization structure in group activity equivalent of solid structure.
A harmonious organization structure enables the firm to adopt new technology.
Sound organization encourages the activities and creative thinking leading to the
managerial talent.
There are various functions of management dealing with planning, controlling;
coordinating, supervising etc.
The article provides a complete detail on what are the functions of management and
how the various functions of management are performed. Not only this, but the
article also provided a complete detail in importance of management in business.

Human Resources Service Management

What are Human Resources (HR)?
Human resources (HR) is the division of a business that is charged with finding,
screening, recruiting, and training job applicants, as well as administering employee-
benefits program - HR plays a key role in
helping companies deal with a fast-changing business environment and a greater
demand for quality employees in the 21st century.

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What is Human Resources Management?
Human resource management services (HRMS) is the strategic approach to the
effective and efficient management of people in a company or organization such that
they help their business gain a competitive advantage. It is designed to maximize
employee performance in service of an employer's strategic objectives. Skills needed
include:
• organization
• multitasking
• communication
• ethical skills

Functions Of Human Resource Management Services

Human resource management services is primarily concerned with the management
of people within organizations, focusing on policies and systems.
HR departments are responsible for overseeing employee benefits design, employee
recruitment, training and development, performance appraisal and reward
management such as managing pay and employee benefits systems.
HR also concerns itself with organizational change and industrial relations, or the
balancing of organizational practices with requirements arising from collective
bargaining and governmental laws.
The overall purpose of human resources (HR) is to ensure that the organization it
able to achieve success through people.

Skills Needed for Human Resources Services Management

Organization: The need for those skills makes sense, given that you are managing
people's pay, benefits and careers. Having organized files in your computer and good

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time management skills are crucial for success in any job; but especially if you take
on a role in human resources.

Multitasking: like most jobs, being able to multitask that is, work on more than one
task at a time is important in managing human resources. A typical person managing
human resources may have to deal with an employee issue one minute; then switch
and deal with recruiting. Unlike many management positions, which only focus on
one task or one part of the business, human resources focus on all areas of the
business, where multitasking is a must.
Communication: The ability to communicate goes along with people skills The
ability to communicate good news.
(hiring a new employee), bad news (layoffs) and everything in between, such as
changes to portray, makes for an excellent manager and Human Resources
Management (HRM) professional.
Strategic mind set; A strategic mindset as an HR professional is a key skill as well.
A person with a strategic mind-set can plan far in advance and look at trends that
could affect the environment in which the business is operating too often, managers
focus on their own area and not enough on the business as a whole.
The strategic HR professional is able to not only work within his or her area but also
understand how HR fits into the bigger picture of the business.
Ethical Skills, Ethics and a sense of fairness are also necessary. In human resources.
Ethics is a concept that examines the moral rights and wrongs of a certain situation.
Consider the fact that many HR managers negotiate salary and union contracts and
manage conflict.
In addition, HR managers have the task of ensuring compliance with ethics standards
within the organization.

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Benefits of Human Resources Services Management.

1. Provide visibility into work requests through dashboards

2. Manage workload with process, improving resource utilization
and performance.
3. Save time by automating work assignments instead of manually
assigning staff responsibilities.
4. Improve communication with employees, partners, and vendors.
5. Address cost control and utilization projections.
6. Report on HR services by tracking and reporting on KPIs
7. Lower expenses by implementing automated and streamlined
processes.

Human Resource management is also the process of employing people, training

them, compensating them, developing policies relating to the workplace, and
developing strategies to retain employees.
There are seven main responsibilities of Human Resources managers, and they are

1. Staffing
2. setting policies
3. Compensation and benefits
4. Retention
5. Training
6. Employment laws
7. workers protection

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STAFFING
You need people to perform tasks and get work done in the organization. Even with
the most sophisticated machines, humans are still needed, because of this, one of the
major tasks in human resources management is staffing. staffing involves the entire
hiring process from posting a job to negotiating a salary package within the staffing
function, there are four main steps.
Development of a staffing plan; This plan allows HRM to see how many people they
should hire based on revenue expectations
- Development of policies to encourage multiculturalism at work; multiculturalism
in the workplace is becoming more and more important, as we have many more
people from a variety of backgrounds in the workforce
Recruitment, this involves finding people to fill the open positions.
Selection: in this stage, people will be interviewed and selected, and a proper
compensation package will be negotiated. This step is followed by training, retention
and motivation.

Setting Policies
Every organization has policies to ensure fairness and continuity within the
organization. One of the jobs of HRM Is to develop the verbiage surrounding these
policies in the development of policies, HRM, and executives are involved in the
process. e.g. The HRM professional will likely recognize the need for a policy or a
change of policy, seek opinions on the policy, write the policy and then communicate
that policy to other employees – It is key to note here that HR departments do not
and cannot work alone. Everything they do needs to involve all other departments in
the organization. Examples of workplace policies might be:

- Discipline process policy

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- Vacation time policy
- Dress code
- Ethics policy
- Internet usage policy

Compensation And Benefits.

HRM professionals need to determine that compensation is fair, meets industry
standards, and is high enough to entice people to work for the organization.
Compensation includes any thing the employee receives for his or her work. In
addition, HRM professional need to make sure the pay is comparable to what other
people performing similar jobs are paid.
This involves setting up pay systems that take into consideration, the number of
years with the organization, years of experience, education, and similar aspects.
examples of employee compensation include.
• Pay
• health benefits
• 401(k) retirement plans
• Stock purchase plans
• Vacation time
• Sick leave
• Bonuses.
• Tuition reimbursement.
Since this is not an exhaustive list, compensation is discussed further.

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 RETENTION

Retention involves keeping and motivating employees to stay with the organization.
Compensation is a major factor in employee retention, but there are other factors as
well. 90% of employees leave a company for the following reasons.
- issues around the job they are performing
-challenges with their manager
- poor fit with organizational culture
- poor workplace environment
Despite this, 90% of managers think employers leave as a result of pay. Leight
Rivenbark, the 7 hidden reasons why employees leave.” As a result, managers
often try to change their compensation packages to keep people from leaving,
when compensation is not the reason, they are leaving at all.

TRAINING
Once we have spent the time to hire new employees, we want to make sure they not
only are trained to do the job but also continue to grow and develop new skills in
their job. This results in higher productivity for the organization- Training is also a
key component in employee motivation. Employees who feel they
Examples include
• Job skills training, such as how to run a particular computer program
• Training on communication
• Team – building activities
• Policy and legal training such as sexual harassment training and ethics training

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 EMPLOYMENT LAWS

Dealing with laws affecting employment, HR people must be aware of all the laws
that affect the workplace

A HRM professional might work with some of these laws.

• Discrimination bus
• Health - care requirements
• compensation requirements such as the minimum wage.
• worker safety laws
• Labour laws
The legal environment of HRM is always changing, so HRM must away be aware
of changes taking place and then communicate those changes to the entire
management or organization.

WORKER PROTECTION
Safety is a major consideration in all organizations. Often times, new laws are
created with the goal of setting Federal or state standards to ensure worker safety.
Unions and union contracts can also impact the requirements for worker safety in a
workplace is up to the human resource manager to be aware of worker protection
requirements and ensure the workplace is meeting both federal and union standards
Worker protection issues might include the following.
• Chemical hazards

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 • Heating and ventilation requirements
• Use of “no fragrance” zones
• Protection of private employee’s information knowing the law regarding
worker protection is generally the job of HR. In some industries, it is
extremely important, in fact, it can mean life or death.

COMMUNICATION
Besides these major roles, good communication skills and excellent management
skills are keys to successful HRM as well as general management.

Challenges Faced By HRSM

All departments within an organization must prove their value and contributions to
the overall business strategy and the same is true with HRM. As companies are
becoming more concerned with cutting costs, HRM departments must show the
value they add to the organization. Through alignment with business objectives.
Being able to add value starts with understanding some of the challenges of
businesses and finding ways to reduce a negative impact on the business. Some of
these challenges include
-Technology
- Containment of costs
-Economy
-Ethics
- The changing and diverse workforce

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Healthcare Delivery System.

Background history of the statistics of health care delivery system consists of a

network of primary, secondary, and tertiary facilities. As of 1992, primary care was
largely provided through approximately 4,000 health clinics and dispensaries
scattered throughout the country. As for secondary care, there were about 700
healthcare centres and 1,670 maternity centres; tertiary care was handled through 12
university teaching hospitals with about 6,500 beds. As of 1977, there were an
estimated 0.2 physicians and 1.7 hospital beds per 1000 people. The target areas for
mass procurement of medical equipment are the teaching hospitals. The lack of
proper facilities and in adequate remuneration of public sector healthcare workers
have also spurred the development of a limited number of privately-owned hospitals
which cater to those who can afford them. The country is in need of medical supplies
and equipment. some pharmaceuticals are manufactured
As of 1999, total health care expenditure was estimated at 2.8% of GDP.
Malaria and diarrheal diseases accounted for, respectively, 30% and 20% of
childhood mortality. Immunization rate for 1997 for children up to one year old were
as follows,
TB-53%, diphtheria, pertussis and tetanus - 45% polio, 45% and measles 69%. only
1% of children were immunized for yellow fever in 1993.
Schistosomiasis, guinea worm (19,766 cases in 1995), trachoma, river blindness, and
years are other diseases of high frequency. Progress has been made in the treatment
of sleeping sickness (trypanosomiasis) and leprosy. The former has been eliminated
by the introduction of new drugs, while the introduction of sulfone therapy has
nearly halted the incidence of new cases of leprosy in the eastern states. A program
for the eradication of river blindness and malaria has been undertaken in cooperation

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with the world health organization The government is also working on the control
of STDs, including HIV/AIDs, through public education and behavior change.
HIV/AIDS has reached epidemic levels in Nigeria. At the end of 2001, the number
of people living with HIV/AIDs was estimated at 3.5 million (including 5.8% of the
adult population) and deaths from AIDs that year were estimated at 170,000.
HIV prevalence in 1999 was 5:1 per 100 adults. Only 15% of married women used
contraceptives in 2000. The fertility rate in 2000 was 5.3 children/woman surviving
their childbearing years. The life expectancy for the Nigerian was only 47 years in
2000. As of 2002, the overall mortality rate was estimated at, respectively, 39.2 and
14.1 per 1000 people

Three Tiers of HC In Nigeria

Nigeria is a federal Republic with 36 states plus the Federal Capital Territory. They
are:
1. Federal
2. State
3. Local
The Federal government has a responsibility to organize tertiary health services.
Federal tier appears to be under control of federal ministry of health.
The state government provides secondary health services and local government.
State ministry of health manages the operation of primary healthcare. local
government is meant to be in charge of primary heath services; however, it is not the
case.

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Structure of Health Care System in Nigeria.

Healthcare is the provision of health-related services by a healthcare provider in

various field to patient, which includes pharmacy, nursing etc.
Health system, also referred to as health care system is the organization of people,
institutions, and resources that deliver heath care service to meet the health needs of
target populations.
The structures of heath care system involve:

- Primary health care

Providers are to treat common ailments. The qualifications of those healthcare
providers have little to no years of experience in health care provision except from
years spent in the setting.
They diagnose and treat minor conditions.
Services rendered are family planning, immunization, health education, sex
education, sanitation, ANC etc. They refer cases beyond their capacity to the other
forms of healthcare.

Secondary Health Care (SHC)

Provide special medical care to patients.
They treat general diseases providing more advanced care compared to primary
health care, the establishment is bigger and standard employing more staff than PHC.
diseases that require very special care are referred to as tertiary health care. They
operate both day and night rendering services such as emergency, neonatal care,
obstetric acute care, etc. patients can spend nights in the hospitals as they contain
rooms and beds for patients.

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Tertiary health care (THC)
They provide specialize or general service on ailments. They do treat general cases
but can provide consultative services to patients. The staff here are people with both
advanced degrees and years of experiences in the services they render.
The facilities are very sophisticated and expensive.
They are the biggest among the 3 levels. They provide special services like eye
specialist, dentist.
Federal government provides these and manages them. Example is Federal medical
centers (FMC)

Types Of Health Care Delivery Facilities

• Hospital
A hospital's primary task is to provide short term care for people with severe health
issues resulting from injury, disease or genetic anomalies.
Open 7 days a week for 24 hours, employ highly skilled nursing staff

• Ambulatory Surgical Center.

Some surgeries are too complex to be done safely in a doctor's office but simple
enough that patients generally do not require hospital care after undergoing them.
They are also referred to as outpatient or
some day surgery centers. These services are less expensive than a hospital.

• Doctor's office
It is a medical facility where one or more doctors provide treatment to patients. They
are focused on one type of medicine; The health providers are either general
practitioners or practice a common specialty. They provide routine care for acute
conditions that do not require immediate intervention.
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 • Urgent care clinic
When patients are unable to get to their doctor’s office or they want basic
medical care without an appointment this would be their choice. It is
sometimes called "walk in clinics.
This facility offers outpatient care immediately.

• Nursing home
It is required or patients who require constant care but do not need to be hospitalized
and cannot
be cared for at home. It can serve patients of all ages who require this level of care.
They have medical personnel on site 20 hours a day.
A physician, skilled nurses and therapists are on staff to oversee and provide medical
care assistance with medications and services like physical, speech and occupational
therapy.
Nursing home staff provide help that are challenging for individuals with health
issues including feeding bathing and dressing.

Another type of care is "Quaternary care"

The term quaternary care is sometimes used as an extension of tertiary care in
reference to advanced levels of medicine which are highly specialized and not
widely accessed. Experimental medicine and some types of uncommon diagnostic
or surgical procedures are considered quaternary care. These services are usually
only offered in a limited number of regional or national health care centres.

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Models Of Health Care Delivery System
There are 4 models of health care system.
1. The Beveridge model:
2. The Bismarck model
3. The national health insurance model
4. The out-of-pocket model

- The Beveridge model, single - payer national health service

Examples: The UK, Cuba, New Zealand, Spain. This model was first developed by
Sir William Beveridge in
1948. Established in UK and spreading throughout many areas of Northern Europe
and the world, this system is often centralized through the establishment of a national
health service
The government acts as a single payer, eliminating competition in the market and
generally keeping prices lower.
Funding health care through income taxes allows for healthcare to be free at the point
of service after an appointment. This is because of their contribution through taxes.
A central tenant of this model is health as a human right. The government is a sole
payer in this health care system.
A criticism of this system is the tendency towards long waiting lists- Everyone is
guaranteed healthcare access and over utilization of this system may lead to
increasing costs.
Another concern is in the face/case of a national emergency funding for health
services may decline as public revenue decreases

- Bismarck Model: Social Health Insurance Model

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Examples: Germany, Belgium Japan, Switzerland. A more decentralized form of
healthcare. This model was created near end of 19th century by "Otto von
Bismarck.” Employees and employers fund health insurance in the model and those
who are employed have access to "sickness funds" created by compulsory payroll
dedications.
Private insurance plan covers every employed person, regardless of pre-existing
conditions.
Health providers are generally private institution, though the social health insurance
funds are considered public.
In countries like France, Korea have single insurer. and some like Germany, Czech
Republic have competing insurers or multiples insures. Japan has non- competing
insurer regardless of the number of insurers, the government tightly control prices
while insurers do not make a profit. The government have control over prices for
health services.
Bismarck model focuses resources on those who can contribute financially.

- The National Heath Insurance Model; Single - Payers National Heath

Insurance:
e.g. Canada, Taiwan, South Korea.
This model incorporates aspects of both the Bismarck and Beveridge models, like
the Beveridge model, the government acts as the single payer for medical
procedures.
Like Bismarck model, providers are private. The universal insurance does not make
profit or deny claims. countries like Hungary and Germany tend towards the mixed
model.
In Canada, private insurance contracting is permitted for those who would prefer to.
34
In this model, patients are allowed to choose their healthcare providers (either
private i.e. Bismarck or public i.e. Beveridge).
The problem of these systems are long waiting lists before they are attended to.
A study by Viber et al from 2013, majority of countries including Australia, Italy,
Canada consider waiting as a serious health policy issue.

- The Out-Of-Pocket Model; Market -Driven Healthcare.

E.g., rural areas in India, China, Africa, South America.
In less developed areas with too few resources to create mass medical care, patient
must pay for procedures out – of- pocket without enough money the poor cannot
afford appropriate health care.
Note: Heath care is delivered. by health providers or professionals in various fields.
According to WHO, health care system requires a well-trained and adequately paid
workforce, deliver quality medicines and technologies etc.

Health Care Systems

A health system also health care system is the organization of people, institutions
and resources that deliver health care services to meet the health needs of the target
population.
It consists of all organizational people and actions whose primary intent is to
promote, restore or maintain health. This includes efforts to influence determinant
of heath as well as more direct health improving activities.
A health system is therefore more than the pyramid of publicly owned facilities that
deliver personal heath services. It includes a mother caring for a sick child at home,
vector-controlled campaigns, health insurance organization, safety legislation. It
includes intersectoral action by health staff.

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Health care systems ideally include universal access to comprehensive prepaid
medical care along with health promotion and disease prevention.
National health insurance and national health services of various models have
evolved to the developed world and increasingly in developing countries as well.
Some authors have developed arguments to expand the concept of health systems,
indicating additional dimensions that should be considered:
• Health systems shouldn’t be expressed in terms of their components only, but
also of their interrelationships.
• They should include not only the institutional or supply side of the health
system, but also the population.
• It must be seen in terms of their goals, which include not only health
improvement, but also equity, responsiveness to legitimate expectations,
respect of dignity, and fair financing among others.
• Health systems must also be defined in terms of their function, including the
direct provision of services, whether they are medical or public health
services, but also "other enabling functions such as stewardship, financing and
resource generation, including what is probably the most complex of all
challenges, the health workforce.

There are generally 5 primary methods of funding health systems.

1. General taxation to the state, country/municipality
2. National health insurance:
3. Voluntary or private health insurance
4. Out of pocket payments
5. Donations to charities

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Payment Models
In most countries wage costs for healthcare practitioners are estimated to present
between 65% and 80% of renewable health system expenditures. There are 3 ways
to pay medical practitioners.
• fee for service
• capitation
• salary

Fee - for-service
Fee for service arrangements pay general practitioners (GPs) based on the service.
They are even more
widely used for specialists working in ambulatory care.
There are two ways to set fee levels
- By individual practitioners:
-Central negotiations (as in Japan, Germany, Canada, France) or hybrid model
(Australia, France’s sector 2, and New Zealand) where GPs can charge extra fee on
top of standardized patient reimbursement rates.

Capitation
In capitation payment systems, GPs are paid for each patient on their “list” usually
with adjustments for factors such as age and gender.
According to OECD, "These systems are used in Italy (with some fees). In all four
countries of the UK (with some fees and allowances or specific services), Demark
(1/3 of income with remainder fee for service), Ireland (since 1989), The
Netherlands (fee for service, privately insured patients and public employees and
Sweden (1994)

37
Capitation payments have become more frequent in "managed care" environments
in the US. According to OECD, capitation systems allow funders to control the
overall level of primary health expenditures, and the allocation of funding among
GPs is determined by patient registrations. However, under this approach, GPs may
register too many patients and under-serve them, select the better risks and refer on
patients who could have been treated by the GP directly. Freedom of consumer
choice over doctors, coupled with the principle of "money following the patient”
may moderate some of these risks, aside from selection, these problems are likely to
be less marked than salary-type arrangements.

Salary arrangements
In several OECD countries, general practitioners (GPs) are employed on salaries for
the government.
According to OECD, Salary management allows funders to control primary care
costs directly. however, they may lead to under provision of services (to ease
workloads) excessive referrals to secondary providers and lack of attention to the
preferences of patients there has been movement way from this system.

Value Based Care

In recent years, providers have been switching from fee for service payment models
to a value-based payment system, where they are compensated for providing value
to patients. In this system, providers are given incentives to close gaps me and
provide better quality care for patients.

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DEFINITION AND IMPLICATION OF LEADERSHIP AND
FOLLOWERSHIP

As we all know, Leadership happens at all levels within organizations and society,
not just among those who work in defined “leadership positions.”
Leadership means different things to different people, different cultures, and in
different situations. But it is always a multidimensional role.
Effective leadership enables followers to succeed. It sets direction, builds a vision,
and adapts as circumstances require. Leadership is about mapping out where you
need to go to win as a team or an organization. Leadership is dynamic, exciting and
inspiring.

DEFINITION OF LEADERSHIP

▪ Leadership refers to the act of motivating people in an organization to work

towards a common goal.
▪ Leadership can be defined as one’s ability to influence and motivate others to
bring the best out in them. It focuses on encouraging individuals to add more
to the overall effectiveness of an organization.
▪ Leadership is often defined as a process wherein an individual, influences and
encourages others to achieve the organizational objectives and directs the
organization so that it becomes more coherent and cohesive to work.
▪ It is based on ideas which can be a person’s own or inspired by other leaders.
Effective leadership is not only inspirational for the self but also for others.
Leadership is all about taking risk and challenging the status quo.
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 ▪ Leadership refers to the act of motivating people in an organization to work
towards a common goal.
▪ Leadership can be defined as one’s ability to influence and motivate others to
bring the best out in them. It focuses on encouraging individuals to add more
to the overall effectiveness of an organization.
▪ Leadership is often defined as a process wherein an individual, influences and
encourages others to achieve the organizational objectives and directs the
organization so that it becomes more coherent and cohesive to work.
▪ It is based on ideas which can be a person’s own or inspired by other leaders.
Effective leadership is not only inspirational for the self but also for others.
Leadership is all about taking risk and challenging the status quo.
▪ Moreover, a person who can bring out the change is the one who possesses
the ability to be a leader. A good leader is the one who always looks out after
others before himself and is proactive. Proactive refers to a leader’s tendency
of being three steps ahead of others, thinking of all the possibilities of a
scenario.
▪ Leadership is all about developing people, in turn helping them to reach their
maximum potential. In the simplest of terms, Leadership is an art of
motivating the people to help achieve a common goal.

DEFINITION OF FOLLOWERSHIP

WHO IS A FOLLOWER?
 A follower is someone who accept the authority of another person, abide by
his instructions and directives. Followers obey the directives of leaders for the
organizational goal to be achieved.
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  Followership is defined as the willingness to cooperate in working toward the
accomplishment of defined goals while demonstrating a high degree of
interactive teamwork. Effective followers are active participants (partners) in
creating the leadership process. Followers permit leaders to establish and keep
themselves in control of a situation that is productive, efficient, and people
oriented.
 Followership demonstrates the capacity to willingly follow a leader.
 The role of followers is not to be mindlessly implementing the ideas of
leaders. Their role is to help the leaders become effective while remaining true
to their own values and essential needs, demonstrating self-management
skills, and being effective individual contributors, even in the absence of
leadership.

IMPLICATION OF A LEADER
 Implication is the conclusion that can be drawn from something although it is
not explicitly stated.
 The implication of leadership is that most people confuse the term leader
with manager, nevertheless the reality is that both are different terms having
different meanings.
 As “Warren Bennis and James O’Toole” said, leaders are individuals who is
responsible for doing the right thing, whereas managers are individuals who
do things rightly. A leader has the vision and a strategic plan for achieving a
goal, however, the manager plans the process and makes sure the job is
performed well.

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IMPLICATION OF FOLLOWERSHIP
 Early on in life, it is a common occurrence that children are taught that leaders
are better than followers. Even interviews centre their focus on leadership
skills and not the skills of the followers.
 Clearly, it is leadership skills that is applauded by the society, not
followership skills.
 There is an imbalance of power between a leader and their followers.
Followers normally listen to directions and demands while leaders help guide
and tend to their followers.
 The concept of followership can be viewed as a valuable part of many
different situations. For example, followership is required in the military when
soldiers are given orders to complete mission by their superior.
 The leaders on the team need their followers just as much as they need them.
If a team consist of many leaders and little or no followers, then the leaders
will have hard time getting anything accomplished because they would not
have anybody striving towards the same goal as them.
 On the other hand, followership can be viewed negatively depending on the
situation. There are numbers of times when leaders suffer for the mistakes or
misconduct of the followers e.g. In a case of a cult leader or an institution.
Therefore, Followership plays out differently in different settings.

TYPES OF LEADERS & FOLLOWERS

TYPES OF LEADERS
 DELEGATE LEADERSHIP: This type of leadership allows the followers
to do more. The leader gives guidelines and ensures communication flow
among the leaders and their group members.
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  AUTOCRATIC LEADERSHIP: This type of leadership does not give the
followers a free hand. They give them directives and are very controlling. The
followers just follow the directives
 DEMOCRATIC LEADERSHIP: Democratic leaders give directives but
constantly consult the follower. The followers’ input in decision making.
 TRANSACTIONAL LEADERSHIP: It is based on action-and-reward
concept. The leaders focus on the objectives. It provides for rewards and
sanctions. Motivation is linked to interest and performance
 TRANSFORMATION LEADERSHIP: Leaders in transformational
leadership focus on the goals to be achieved and more. The leader aims at
improving functions and capabilities. Most growth-minded companies tend to
adopt this kind of a leadership style.
 BUREAUCRATIC LEADERSHIP: This kind of leadership style goes by
the books. Although leaders with this approach do listen to employees and
their opinions, they may negate or reject it, in this case they go against the
company’s policy.

TYPES OF FOLLOWERSHIP

• ISOLATES: This group of followers is non-responsive to leaders and

organizations. They do not care. They are completely detached and alienated
from what is going on around them.
• BYSTANDERS: Bystanders observe but disengage themselves from
political activities. They do not participate actively. They are not motivated
enough to take an active part.
• PARTICIPANTS: They participate in political activities. They care enough
to put in their time and resources. They make an impact. If they agree with the
43
 leader, they support him/her but if they disagree with the leader, they oppose
him/her.
• ACTIVISTS: They feel strongly about their leaders and organization and act
accordingly. These followers are eager, energetic, and engaging. They work
hard to support the leaders or pull down the leader or even unseat him.
Activists are usually not many. They commit their time and resources.
• DIEHARDS: Diehards are very passionate, deeply devoted to their ideas,
leaders, or organization.

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INFORMATION MANAGEMENT AND DISSEMINATION WITHIN THE
HEALTH CARE SYSTEM

• What is health information management?

Health information management (HIM) is the practice of acquiring, analyzing, and
protecting digital and traditional medical information vital to providing quality
patient care. It is a combination of business, science, and information technology

Reasons Healthcare Information Management is Crucial

• Knowledge of management system in healthcare are essential to aligning
people, data, and technologies. They help providers make more accurate
clinical and medical decisions, tap into collaborative data sharing, and
stimulate innovation.
• Technological advancements in the healthcare sector help improve the quality
of patient care, reduce operational costs, and shape the entire internal
management process.
• Health information systems (HIS) can make your business activities smooth
and profitable. From more efficient patient scheduling and medical billing to
remote patient monitoring, here are just five of the reasons an information
management system is critical for your organization.

1. Improved Patient Care and Safety

Medical errors are a serious public health problem and a leading cause of
death in the United States. It’s challenging for healthcare providers to identify
consistent causes of errors. And even when they do, it’s equally challenging to
provide consistent, viable solutions that minimize the chances of recurrent events

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 Faster and easier access to accurate patient data lets health-related
organizations collect and share information across multiple databases to improve
patient safety. By collecting and saving patient information, including medical
history, diagnosis reports, vaccinations, treatment plans, and more, healthcare
providers can make interacting with patients more personalized, which eventually
makes it possible to deliver care in a more efficient way.

2. Performance Analysis
An HIS provides multiple avenues through which your organization can
access staff performance, analyze patient care, and check the stability of your
organization’s services. A healthcare information management system also reduces
the amount of paperwork staff deals with and makes staying aware of employee
performance far less complicated.

3. Mitigation of Medical Errors

Because data is collected automatically and stored in a centralized location,
reports are less prone to errors. That can mean fewer misdiagnoses and improved
providing of medications and treatments.

4. Improved Patient Satisfaction

Knowledge management in healthcare adds value to the clinical process and
improves patient satisfaction levels. It eases staff’s daily workload demands and
gives them more time to respond to patients’ needs. And when patients know they
can expect personalized attention and service, it enhances your organization’s
reputation for quality care. Patients also benefit from a patient portal that gives them
easier and more secure access to their medical records. It also facilitates quicker
appointment scheduling, doctor communications, and payment processing. All a
46
patient needs is access to a mobile device to avail themselves of the system’s
benefits. Patients also benefit from a patient portal that gives them easier and more
secure access to their medical records. It also facilitates quicker appointment
scheduling, doctor communications, and payment processing. All a patient needs is
access to a mobile device to avail themselves of the system’s benefits.

5. Remote Patient Monitoring

Healthcare providers can use a healthcare information management system to
more easily access patient information, which, in turn, helps them provide better
healthcare. Remote patient monitoring is particularly useful for patients who suffer
from chronic health issues that make frequent doctor visits strenuous or difficult.
Physicians and supporting staff can use the information collected by an HIS to
predict or prevent serious health conditions and follow-up with patients once they’re
discharged. Healthcare information management systems are revolutionizing the
healthcare sector, increasing efficiency, and making daily tasks easier and more
organized. They offer a win-win solution for both patients and healthcare providers
unlike anything that’s come before them.

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 DISSEMINATION OF INFORMATION WITHIN THE HEALTH
CARE SYSTEM

• Dissemination is the targeted distribution of information and intervention

materials to a specific public health or clinical practice audience. The intent is
to spread knowledge and the associated evidence-based interventions.
Dissemination occurs through a variety of channels, social contexts, and
settings

METHODS OF DISSEMINATION

Once the dissemination objective and the audience are identified, there are
a variety of ways to share the developed content.
Common methods of dissemination include
• Publishing program or policy briefs
• Publishing project findings in national journals and statewide publications
• Presenting at national conferences and meetings of professional associations
• Presenting program results to local community groups and other local
stakeholders
• Creating and distributing program materials, such as flyers, guides, pamphlets
and DVDs
• Creating toolkits of training materials and curricula for other communities
• Sharing information through social media or on an organization's website
• Summarizing findings in progress reports for funders
• Disseminating information on an organization's website
• Discussing project activities on the local radio
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 • Publishing information in the local newspaper
• Issuing a press release
• Hosting health promotion events at health fairs and school functions
• Using the 2-1-1 system to publicize available services and resources

What Is the Purpose of Health Information Systems?

• Within any given health care environment, health care professionals gather,
store, manage, and analyze health data.
• They use this information to develop comprehensive care plans; improving
patient outcomes and judiciously allocating the organization’s resources
(including staff)
Health information systems help organizations ensure superior patient outcomes.
Some examples include the following.

DATA ANALYTICS AND HEALTH INFORMATION SYSTEMS

• Health care organizations are constantly generating data. This includes data
about surgical volume, length of hospital stay, patient health trends, insurance
claims and billing, costs and revenue associated with patient care, and beyond.
A primary purpose of health information systems is to help organizations
capture this data, interpret it, and put it to practical use.

COLLABORATION WITH HEALTH INFORMATION SYSTEMS

• Often, patients need treatments from different health care providers. For
example, a patient might receive preliminary diagnosis and treatment from a
primary care doctor before being referred to a specialist. Easily transferable
patient records ensure each provider works with the same basic information,
making collaborative patient care seamless.
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POPULATION HEALTH MANAGEMENT WITH INFORMATION
SYSTEMS
Information systems offer a way for providers to identify trends in community health
concerns. For example, some basic statistical analysis can reveal whether a local
population is uniquely prone to diabetes. In recent months, the coronavirus pandemic
has provided a clear example of how the smart use of health information systems
supports population health, giving public health officials the tools they need to track
cases and monitor regional outbreaks.

COST CONTROL AND HEALTH INFORMATION SYSTEMS

Access to health information systems plays an important role in helping contain
costs. Doctors and nurses can analyze patient histories, as well as similar case
studies, and make more finely honed treatment decisions. Meanwhile, administrators
can monitor patient volumes in different departments, and judiciously allocate
staffing and other resources to where they are most needed

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PROVISION OF FACILITIES, EQUIPMENT, AND CONSUMABLES
MANAGEMENT

What are facilities in health care system?

• Health facilities are places that provide health care. They include hospitals,
clinics, outpatient care centers, and specialized care centers, such as birthing
centers and psychiatric care centers.
What are equipment used in health care system?
• Equipment are tools and apparatus used in the delivery of adequate health care
to populations who need health care.
What are consumables in health care system?
• Medical consumables and equipment's are the most used regularly at the
hospitals/laboratories. They are usually disposable in nature, cannot be use by
more than one individual. Note that some of these consumables cannot be
disposed such as the scissors etc. they are properly sterilized and kept for
future use.

MANAGEMENT OF CONSUMABLES IN NIGERIA HEALTH CARE

SYSTEM
As discussed earlier, medical consumables and equipment's are the most used
regularly at the hospitals/laboratories. They are usually disposable in nature, cannot
be use by more than one individual. Examples of these consumables include:
• Syringe - frequently used in clinical medicine to administer injections, infuse
intravenous therapy into the bloodstream, apply compounds such as glue or
lubricant, and draw/measure liquids.

51
• Needles - commonly used with a syringe to inject substances into the body or
may also be used to extract fluid samples from the body.

• Medical towels - a sterile drape used to cover the body while surgery is being
performed. Being they are low lint they make a great wipe to clean
sterilized surgical instruments. They can also be used in surgery to cover
certain areas of the patient
• Disposable plastic gloves - gloves are worn to prevent cross-contamination
between patients and medical staff. They are also used for general hand
protection when handling various sensitive things in a medical setting
• Disposable plastic tube suction
• Disposable face mask
• Disposable nose mask
• Test strips
• Laboratory pH meter
• Long cotton swab
• Elastic cotton bands
• Thermometer
• Pipettes
• Adhesive tapes
• Medical cups
• Toilet papers
• Urine bags
• Bandage
• Catheter etc.

52
MANAGEMENT OF EQUIPMENTS AND CONSUMABLES
Management Process: The overall Medical Equipment Management guidelines
are based on the monitoring and evaluation of organizational experiences, applicable
laws and regulations, and accepted practices. The management process involves a
continuous assessment utilizing a design, teaching, implementation,
measurement/evaluation, and an improvement cycle encompassing the
identification, analysis, resolution, monitoring and evaluation of safety related issues
within the environment.

STEPS IN THE MANAGEMENT

MEDICAL EQUIPMENT DOCUMENTATION: When receiving new
equipment, all information should be filed with regard to vendor, service provider,
etc., to maintain a database of manual and contract details. The inventory must be
accurately maintained to obtain adequate property control. A crucial task is to ensure
that all information can be found on the Asset Control Form. No field should be left
blank. Maintenance Records for each asset should be included in the system.
EFFECTIVE MEDICAL EQUIPMENT MANAGEMENT: All medical
equipment considered to be an “inventory item” should be tagged or labeled for the
purpose of inventory as well as for inspection and maintenance records. The title of
the user responsible for the operation and management of each piece of equipment
should be specified on the label or tag
INSTALLATION OF MEDICAL EQUIPMENT: All medical equipment should
be installed according to the Manufacturer’s specifications as well as Building/
Electrical and Occupational Health and Safety specifications. New equipment
should be tested prior to being placed in service and also after any repairs and
modifications. Intervals of testing of equipment will be based upon product
literature. Installation normally consists of physically attaching the equipment to the
53
building and hooking utilities (plumbing, cables or wiring that had been provided
during the preparatory phase). Equipment Users are responsible for any
infrastructural changes required for installation.
Upon receipt, a designated administration officer and /or a medical maintenance
technician will tag the equipment with the proper inventory code. Once the unit has
been accepted, the warranty period commences. Acceptance testing usually consists
of testing by users and designated administration officers, including the medical
maintenance technician. The manager responsible for use of the equipment will
arrange for acceptance testing. An appropriate and stable power supply system is
essential. The electric current will normally be 220 V and 50 Hz, unless otherwise
specified, and electric plugs should be 3 pin grounded to avoid electrical hazard or
shock. All electric appliances should come with both the UPS (Uninterrupted Power
Supply) system and the surge protector to ensure continuous medical support even
in the case of a power shutdown or outage. The following details the specific
procedures for special Medical Equipment

PROCEDURES FOR SPECIAL MEDICAL EQUIPMENT

• X-ray Installation: Diagnostic X- ray systems must be installed according to
the International regulation. Radiation protection surveys are to be performed
on new x-ray installations before they are authorized for human use.
• Electrical Equipment: such as ECGs, Defibrillators, etc., must include a
grounding system to provide protection against a shock hazard.

• Operating Equipment: The installation of gas systems requires the services

of an expert. It should not be attempted by a plumber unfamiliar with medical
gas systems or anyone not trained in the installation of anesthetic gases and
equipment.
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 • Sterilization Equipment: Upon completion of installation, complete
orientation and demonstration, including calibration and the testing processes
of the sterilizer should be provided

ORIENTATION AND TRAINING FOR MEDICAL EQUIPMENT USERS

• Orientation and training on the safe and effective use of medical equipment
should be performed for workers or users during installation and servicing.
Some specialized training which is not locally available shall be carried out at
the manufacturers’ training schools.

MEDICAL EQUIPMENT SAFETY DURING OPERATION ELECTRICAL

SAFETY

The hospital’s electrical safety program is designed to provide an electrically safe

environment for patients and staff. Scheduled inspections and safety tests are to be
performed on all electrically operated equipment at specified intervals and the
corresponding limits are to comply with International Occupational Health and
Safety Standards. Upon acceptance of fixed medical equipment, a grounding
performance test should be conducted. Electrical equipment commonly includes a
grounding system to provide protection against shock hazard if there is an insulation
failure, interruption of the leakage current flowing through the ground conductor
could pose a shock hazard to patients.
A fatal shock could result if the patient is in a weakened condition or unconscious,
or if the leakage current is applied to internal organs. The leakage current from frame
to ground shall not exceed International Safety Standard, measured from equipment
chassis to ground. It is recommended that all medical facilities have special
55
procedures in place to ensure that medical equipment is turned off/ monitored while
switching on generators so that people, as well as equipment, in the medical facility
could avoid possible electrical problems including electrical hazard, malfunctioning
of equipment and so on

RADIOLOGICAL SAFETY

The radiology staffs have the following functions and responsibilities:

i. The leaded apron should be worn for all X- ray work.
ii. A dosimeter should be worn outside of the apron at the collar/ neck region,
so that exposure to the head, neck, eyes and thyroid can be measured. It is
recommended that a second dosimeter be worn under the apron to record
possible inner exposure.
iii. iii. Calibrate and maintain all radiation safety equipment used by the
Radiology staff.

ENVIRONMENTAL AND OCCUPATIONAL SAFETY

Equipment and consumables should not negatively influence the local ecology. (See
Occupational Health and Safety Guidelines for further information.) Cell phone
usage inside hospitals should be prohibited in operating rooms, radiology
department, emergency rooms and Intensive Care Unit, as cell phones transmit
signals that interfere with certain types of medical equipment. The Chief Medical
Director should advocate adherence to the “no cell phone” policy within the medical
facility.

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WORKERS’ SAFETY AND INFECTION CONTROL

Safety on the job is everyone’s business. Each medical facility worker shall:
Ensure that the work is free of safety hazards. ii. Assist co- workers and verify that
all staff wear protective clothing (X- ray protective apron, face mask, etc.) iii. Be
aware of mechanical and electrical hazards (especially in close proximity to high
voltage equipment). The Chief Medical Officer shall:
i. Take appropriate steps to ensure that the Medical Facility complies with all
applicable safety standards/procedures/guidelines.
ii. Make every effort to ensure that every activity within the Medical Facility is
safe for workers and patients. The purpose of the Infection Control Policy is
to ensure the health and safety of maintenance personnel who may come in
contact with potentially infectious materials during the performance of their
duties and to safeguard patients, visitors and staff from transmission of
infectious agents while installing, servicing or using equipment in clinical or
laboratory areas

HEALTH CARE POLICIES AND THEIR IMPLICATION

PRIMARY HEALTH CARE POLICY
NATIONAL HEALTH CARE POLICY IN NIGERIA

Healthcare policy is an integral aspect of the U.S. healthcare system—one that helps
shape and protect the health and well-being of our population. Policy impacts issues
as fundamental as healthcare access, cost, delivery methods, and privacy. It involves
the rules and regulations set forth by lawmakers on a local, state, and national level.
• What Is Healthcare Policy?

57
The term “healthcare policy” refers to the decisions, goals, and actions that
determine how care is administered and accessed.
For example, policies can include legal and safety regulations by state or protocols
regarding how care and medicine are delivered to patients at a specific hospital.
“Healthcare policy” also refers to the policies set on a national level, in terms of
access to healthcare, coverage, and cost.
• Subcategories of health policy include:
• public health
• global health
• healthcare services
• health insurance
• mental health
• pharmaceuticals.

Why Healthcare Policy Is Important

Healthcare policy is important because it helps establish guidelines that benefit
patients, healthcare organizations, and our healthcare system. Having protocols in
place can help prevent human error and poor communication around medical
decisions.
For nurses and health administrators, understanding and following policies can help
ensure that you deliver the best care to patients while using your knowledge to help
inform future policies. On a broader level, when patients take the time to understand
healthcare policy, they learn more about their rights.
To be able to maintain quality care for patients, organizations must set policies to
address the following aspects of their operations.

58
The Role of Health Practitioners in Health Policy
Nurse practitioners play a vital role in impacting health policy. Specifically, nurse
practitioners implement health policies and have the ability to influence health care
systems and organizations to provide better health outcomes for patients. Nurse
practitioners are at the front lines of care, which means it often falls to them to
translate big-picture health policies and procedures into one-on-one patient
interactions.
A reason that nurse practitioners are so crucial to health policy development is that
they spend much of their time interacting with patients and understanding their
needs. As such, nurse practitioners generally have a good grasp on what’s working
and what’s not. They can relay successes and limitations to policymakers, who can
hone health policy accordingly.

• Patient Care Policies

Patient care policies cover protocols and workflow for treatment procedures,
outlining how healthcare professionals should respond to specific medical situations.
Of course, policies must be tailored to the care your facility provides. For example,
a cancer center would create different patient care policies than would a center
for rehabilitative medicine, because their treatment protocols are so different.
• Employee Health Policies
The health of employees is a crucial component of running an effective facility, as
staff must be able to care for patients safely, while maintaining their own well-
being.
Examples of policies designed to protect and promote employee health include rules
around the consumption of alcohol and tobacco in the workplace, wearing masks
and gloves to minimize the risk of exposure to illnesses and chemicals, and wellness
policies such as time off and healthy eating.
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 • Drug Policies
Drug policies outline procedures around the handling and administering of
pharmaceuticals, whether the medication is over the counter, controlled, or non-
controlled. This can include protocols for recording, handling, and delivering each
medication. Drug policies also cover what to do if inventory is missing, if medication
was incorrectly administered or prescribed, or if any other errors occur related to
drug handling.
• Security and Privacy Policies
Security policies clearly outline how employees should handle situations that pose a
security threat in their facility. This can include situations like abuse towards medical
staff, patient abductions or elopements, theft, and active shooters. If a facility has
security processes, these must be clearly outlined for all employees to know and
follow. Aside from physical security, data privacy and technology security policies
and procedures are extremely important in any healthcare facility. The HIPAA
Privacy Rule protects patient information from release to the public, while
permitting the exchange of this information if needed between medical professionals
and in certain other situations. Failure to comply with HIPAA can result in fines of
$50,000 or higher per violation.

PRIMARY HEALTH CARE POLICY

PHC Policies are decisions and plans that are undertaken by governments with input
from other stakeholders to achieve specific health care goals.
It refers to policies broadly as the laws, guiding principles, working frameworks and
ways of working that guide practice, service delivery decisions, and actions.

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 IMPORTANCE
1. Improves the design of health systems that support and sustain good governance
and leadership in primary health care.
2. Ensures policies, strategies, and plans are evidence-based and translated into
action
3. Establishes systems for the effective coordination, monitoring, integration, and
implementation of PHC-related policies, promoting effective and efficient PHC
service delivery.

CHALLENGES OF PHC POLICY

• Gaps between written policy and implementation capacity
• Quality data for decision-making
• Generating political priority and sustained support
• Unforeseen challenges in policy implementation

NATIONAL HEALTH POLICY

National Health Policy was launched in 2017 by the Central Government to replace
the existing health policy. This policy has introduced four significant goals:
• Changing health priorities
This policy aims to tackle the increasing non-communicable and infectious diseases
in India.
• Growth of the health care industry
National Health Policy plans to strengthen the health care industry by introducing
newer and more advanced technologies.
• Lower the expenditure
This policy also aims to reduce medical expenses and other health-related costs.
They aim to provide superior services to poor and backward communities.
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 • Economic growth
It aims to enhance fiscal capacity by boosting economic growth.

What are the Objectives of National Health Policy?

The National Health Policy aims to achieve the following goals:
• It aims to offer superior health services to every age group and gender.
• The policy focuses on providing universal access to excellent quality health
care services at a reasonable cost.
• Promoting health care orientation in every developmental policy.
• Offering access to better treatment, lowering expenses related to health care
services and improving quality.
• It aims to reduce premature mortality from cancer, cardiovascular diseases,
chronic respiratory diseases and diabetes by 25% within 2025.
• This policy recognizes the importance of sustainable development and time-
bound quantitative goals.

What are the Key Principles of the National Health Policy?

The following are the fundamental principles of the National Health Policy 2017.
• Professionalism and ethics
National Health Policy commits to integrity, highest professional standards
and ethics. It integrates these functions in health care delivery services by
maintaining transparency and a sustainable environment.
• Equity
This policy aims to reduce the inequity and disparity based on caste, gender,
disability, poverty and other forms of social exclusions. This also includes
offering financial protection to poor and underprivileged patients.
• Affordability
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The policy aims to make health services and medicine affordable. It seeks to
prevent disparity in social, economic or current health status.
• Quality of care
This initiative offers confidentiality in the form of safe, gender-sensitive and
convenient healthcare services. It intends to remove corruption in both private
and public healthcare systems.
• Collaborations
It follows a multistakeholder approach by collaborating with health ministries
and communities. Different academic institutions and non-profit agencies also
participate in the initiative.

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BUDGETING AND CONTROL
Introduction to Budget and Budgetary Control
Budgets are one of the most important aspects of any system – be it domestic life, a
corporate house or a nation. At home, we often make yearly, monthly, weekly or
even daily budgets that would influence our expenses and savings. Budget of any
organization will tell you about its growth and expansion plans. Union Government
Budget not only allocates resources for various programmes that decide our nation’s
progress, but it also even affects you and me, as it determines the rate of income tax
and other taxes which will affect everybody directly or indirectly. At personal level,
almost everybody makes budgets for future plannings.
Most people, rich or poor, make estimates of their income and plan expenditure for
food, education, entertainment, savings, housing, clothing and so on. As a result of
this exercise, people restrict their spendings to some predetermined, allowable
amount. Knowingly or unknowingly most of us go through a budgeting process.
Budget of a business firm serve much the same purpose as the budget prepared by
an individual. The business budgets are, however, prepared in detail and involve
more work unlike personal budgets. Success of a business does not come by
accident. That is why all commercial and service organizations need budgeting

DEFINITIONS OF BUDGET
CIMA has defined budget as – “a plan quantified in monetary terms prepared and
approved prior to a defined period of time usually showing planned income to be
generated and/or expenditure to be incurred during that period and the capital to be
employed to attain a given objective.” A budget may be expressed in monetary as
well as non-monetary terms, e.g., units of time, units of products, no. of employees,
etc. A budget relates to a definite future period and is prepared in advance of the
period during which it will operate.
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The purpose of the budget is to implement the policies formulated by the
management to achieve a specified objective. A budget is a detailed plan of
operations for some specific future period. Many of us are familiar with the term
‘Budget’. For instance, if we want to have a holiday trip to Kashmir, we are to
estimate the cost of travelling, boarding, lodging etc. so as to have sufficient amount
for the trip. On return from the trip, we may like to compare the actual amount spent
with the estimated or budgeted figures. Similarly, we can know the importance of
budgets even from the household management
The word ‘budget’ is derived from a French term “Bougette” which denotes a leather
pouch in which funds are appropriated for meeting anticipated expenses. The same
meaning applies to the business management. A budget is a numerical statement
expressing the plans, policies and goals of the enterprise for a definite period in the
future. It is a plan laying down the targets to be achieved within a specified period.
It is a final and approved share of a forecast. When forecasts are approved by the
management as a tentative plan for the future they become budget.

BUDGETARY CONTROL
Budgetary control is a system whereby the budgets are used as a means of planning
and controlling costs. Budgeting lays down as to what is to be attained and how it is
to be attained while control ensures that the objectives are realized, and actual results
do not deviate from the planned course more than necessary. According to J.L.
Brown and L.R. Howard – “Budgetary control system is a system of controlling
costs which includes the preparation of budgets, coordinating the departments and
establishing responsibilities, comparing actual performance with the budgeted and
acting upon results to achieve maximum profitability.”
Budgetary control is a system whereby the budgets are used as a means of planning
and controlling costs. Budgeting lays down as to what is to be attained and how it is
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to be attained while control ensures that the objectives are realized, and actual results
do not deviate from the planned course more than necessary. According to J.L.
Brown and L.R. Howard – “Budgetary control system is a system of controlling
costs which includes the preparation of budgets, coordinating the departments and
establishing responsibilities, comparing actual performance with the budgeted and
acting upon results to achieve maximum profitability.”

Budgetary Control – Main Features

The main features of budgetary control are:
i. Establishing budgets for each functional area e.g., sales, production, purchase,
etc., the policies and various activities which might be adopted for achieving
them.
ii. Recording actual performance of each functional area.
iii. Analyzing the reasons of variances and identifying the persons responsible.
A budget may be expressed in relation to:
(a) Time – Short-term and Long-term Budget.
(b) Behaviour – Fixed and Flexible Budget; and
(c) Functions – Sales Budget, Production Budget, Cash Budget, etc.

Some of the other features are:

i. Targets/Objectives – To determine the targets / objectives to be achieved
during the budget period, and the policy or policies that might be adopted for
the achievement of these objectives.
ii. Activities – To determine the various activities that should be undertaken for
achieving the objectives.
iii. Plan for each activity – To draw a plan or a scheme of operation for each
class of activity in physical as well as monetary terms for the full budget
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 period and its parts. The budgets prepared for various departments/ activities
are consolidated to prepare a master budget consisting of the budgeted profit
and loss account and the balance sheet.
iv. Comparison / ascertain causes – To lay a system of comparison of actual
performance of each person, section or department with the relevant budget
and to ascertain the causes for the variations / discrepancies, if any
Remedial action – To ensure that corrective action is taken where the plan is
not being achieved and, if that be not possible, the plan will be revised. In
brief, budgetary control system assists the management in the allocation of
responsibility, authority and planning for the future. It facilitates the analysis
of the variation between budgeted targets and actual performance. The
budgetary control system develops a proper basis of measurement or
standards for evaluating the efficiency of operations. It enjoys equal
prominence in both non-profit and profit seeking organizations.

Features of a Budget
• A budget is a blueprint for management action. It is a vital tool for carrying
out effective short-term planning and control in firms.
• The following are the features of a budget:
(a) One Year Duration – Generally, budgets are prepared annually. However, for
seasonal business, such as – fruit canning, ice-cream, apparels, etc., there may
be biannual budgets – a slack season budget and a peak season budget.
(b) Estimation of Business Unit’s Profit Potential – It shows how much profit or loss
a business unit is expected to make and thereby reveals its profit potential.
(c) Appraisal of Performance – At the end of a specified period, actual performance
is compared with the budget and deviations are ascertained.

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 • These deviations which are known as variances are analyzed by causes and
responsibility centers.
(d) Monetary Terms – The figures in the budget are expressed in monetary terms.
However, the monetary figures are supported by non-monetary information, namely
units purchased, units manufactured, units sold, etc.
(e) Alteration of Approved Budget Under Specified Conditions – After the budget
has been approved by the top management, the same cannot be altered except under
specified conditions.
(f) Review and Approval by a Higher Authority – The budget proposal which is
prepared by the budgetee is reviewed and approved by an authority same or lower
than the budgetee.
(g) Managerial Commitment – The budget is essentially a commitment made by the
manager of responsibility centres. They agree to shoulder responsibility for the
purpose of achieving the budgeted objectives.

Elements and Characteristics of a Budget

The following are the basic elements of a budget:
i. Budget is a comprehensive plan of what the enterprise endeavors to achieve.
ii. It provides yardsticks and measures for the purpose of comparison.
Characteristics:
The following are the main characteristics of a budget:
i. A budget is prepared for a definite future period of time (Budget period).
ii. It is prepared in advance and is based in future plan of action.
iii. It is a statement prepared in monetary value or physical units or both.
iv. It is approved by the management before its implementation.
v. It is prepared for implementation of policy formulated by the management
and achievement of objectives
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Main Objectives of Budget
The main objectives of budget are as follows:
1. One important objective of budget is planning. The existence of a budget
forces managers to think for future, trying to anticipate possible problems and
their solutions.
2. Another objective of budget is coordination. Without coordination the
departmental heads may follow courses which are beneficial for their
departments but may not be beneficial for the organization as a whole. For
example, the purchase manager could be interested in buying materials in
large quantity for availing good discount. However, holding of large quantity
of materials in stock will increase the loss of materials and ultimately the
organization may suffer.
3. Another objective of budget is to provide motivational impetus. The budget
can be a useful device for motivating managers to perform in line with the
objectives of the organization.
4. Budget is a good device for communicating plans to various managers. With
the help of budget, top management communicates its expectations to lower-
level management so that the goals of the organization are achieved.
5. Budget is most widely known as a device for control. Control is exercised by
comparing the actual cost or expenditure with the budgeted cost. Failure to
meet expectations as shown by the budget, points immediately to the need for
some corrective actions.

Budgetary Control Objectives

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 • Planning, Coordination, Control, Optimum Employment of Capital, and
Responsibility Accounting
The objectives of budgetary control system are usually summarized under five
heads:
1. Planning,
2. Coordination,
3. Control,
4. Optimum employment of capital, and
5. Responsibility accounting.
Objective # 1. Planning: A budget is nothing but a plan. Budgeting involves
drawing up detailed plans relating to different functions like production, sales, raw
material requirements, labour requirements, research programmes, etc. When plans
are made in advance, many problems are anticipated long before they arise, and
solutions can be sought through careful study.
Objective # 2. Coordination: Coordination is the process whereby different
sections of a business work towards achievement of the common goal. Budgets
provide a means of coordination for the business as a whole. While making budgets,
various factors like production, sales, etc., are balanced and coordinated.
Objective # 3. Control: Control is the action necessary to ensure that planned
objectives are being achieved. Budgetary control makes control possible by
comparing the actual performance against planned performance and taking action on
the basis of variations between the two.
Objective # 4. Optimum employment of capital – The resources required for
achieving the firm’s objectives are estimated and are made available.
Objective # 5. Responsibility accounting – Each individual is entrusted with well-
defined responsibilities, and they are made accountable.

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Budgetary Control – Techniques
The technique of budgetary control involves the following:
i. Establishment of a budget for each activity or section of the organisation.
ii. Establishment of budgets for each function like sales, production, purchase, etc.
iii. Measurement of actual performance.
iv. Comparison of actual performance with budgeted performance to find out
variations, if any.
v. Ascertainment of the reasons for such variations and taking suitable remedial
action. Broadly speaking, budgetary control is a system of achieving the firm’s
objectives with minimum possible cost. Like standard costing, budgetary control
also provides a powerful tool to the management for efficient performance of its
functions

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