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Chapter One Introduction to Health Management

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Dr. Anthony Augustine Sandi, M.D, [Link]

Jia Bainga Kangbai, MPH, DipTropMed

For staff and lecturers at various health institutions

Many professionals in various disciplines keep wondering why bother themselves about

management. The reason for this feeling is that, it is often assumed that anybody can

perform the role of a manager. In other words, they see no need for taking courses in

management as a discipline. Perhaps this is often because many senior administrative

officers got to their managerial positions through their duration or length of period at work

and through promotion. Although these assumptions may have some basis, yet the

perception is totally wrong. Nowadays, it is realized that prudent management of resources,

is the key to a successful organization and so the knowledge of management is very

fundamental as part of the training of every professional.

One of the most important and vital activity of man is managing. Man is a social being and

therefore the desire to form groups to accomplish his aims could not be achieved as

individual without management. In the process of achieving their aims as a group, they see

management as being essential to ensure the coordination of their efforts. Nowadays,

society has come to rely increasingly on group efforts, which has made the task of managers

to become large, complex and of course important. Everyone, including students and other

professionals who want to improve their understanding of the organization in which they

work, will benefit from this book. All managers undertake the same basic functions to obtain

their intended results. Managers obtained these results by a way of establishing their working

environment that is effective and efficient for their workers to perform and hence achieve the

organizational goals.

After reading this book one will gain: knowledge and skills to contribute to the health of

populations, communities and disadvantaged groups, the ability to apply the core disciplines

of management to the real world health problems, a deeper understanding of public health

issues and an academic qualification that will enhance your career development in health-

related fields.
 Acknowledgments

This work would not have been possible without the support of some staff members of the

School of Community Health Sciences, Njala University in Sierra Leone. We are especially

indebted to members of the Department of Environmental Health Sciences and Nursing who

have been supportive of our career goals and who worked actively to provide us with the

protected academic time to pursue those goals. We are grateful to all these with whom we

have had the pleasure to work during this and other related projects. Each of these staff

members including Lawerence Babawo, Momodu Massaquoi, Angella George provided us

extensive personal and professional guidance and taught us a great deal about both

scientific research and life in general. We would especially like to thank Dr. Rashid

Ansumana, the Dean of the School of Community Health Sciences, Njala University in Sierra

Leone.
Chapter One

Introduction to Health Management

Management is defined as the technique, practice or science of managing or

controlling an organization; the resourceful use of materials, time or the human

resources of an organization (Collins English Dictionary, 1981). In management, the

focus is on how to efficiently utilize the resources. The resources include materials,

time, infrastructures and personnel to carry out the process that will result into an

output i.e. the end result or products and services.

The following definitions of management can help us understand the nature of the

term and its significance.

1. Management is a process of designing and maintaining an environment in

which people, working together in groups, accomplish selected aims (Adeleke,

2004).

2. Management is the process of getting things done through people

(Follet, 1941).

3. Management is concerned with the process of planning, organizing,

controlling, leading and coordinating the efforts of organizational members and

the use of other resources to achieve given organizational goals. Management

in an organization means to coordinate the efforts of people to accomplish

goals and objectives using available resources efficiently and effectively.

Management comprises planning, organizing, staffing, leading or directing,

and controlling an organization or initiative to accomplish a goal.

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Management as a discipline is not as easy as one may imagine. A very good surgeon

specialist for instance, who is promoted to a managerial level of a Medical

Superintendent of a hospital, will only rely on luck and providence if he has no basic

managerial background. His surgical skills and knowledge in anatomy or physiology

will be absolutely useless to him in his new assignment. Similarly, a good Geography

Teacher who is promoted to the post of a Head Teacher or Principal of a school but

has no managerial background, will equally only rely on luck and providence, since

his knowledge in geography will not help him manage the school well.

In effect, management could be considered as both an art and a science in its right.

To be an effective Manager, one needs skills as distinct as those of any other

profession. In other words, management, like all other disciplines, medicine, law,

engineering and others, is about doing things that reflect the realities of the situation,

which makes it as a practice, an art. And in order to do things that reflect the realities

of the situation, one needs some organized skills and knowledge and it is these

organized skills and knowledge underlying the practice that are referred to as a

science. In the context of management, science and art are not mutually exclusive

but complementary.

A manager, without the formal fundamentals of management as a discipline, thus

relying on luck and providence, is like a doctor without the advantage of the sciences,

who is little more than a witch doctor.

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In effect, the main responsibility of a health manager is to facilitate the attainment of

organizational objectives. A health manager gives guidance and effective leadership

to his staff and controls their efforts towards achieving a common goal. An efficient

Manager is the one that delegates authority and follows it up with effective

supervision and monitoring. In other words, a Manager does not try to do all the work

himself. In management, time is considered an important resource that needs to be

managed well like all other resources.

Three Golden Rules of Management

As soon as you ask someone else to do something, rather than undertaking it

yourself, you become a Manager. We rely on people to perform the task in the way

we would do ourselves if we have the time, knowledge, skill and patience. At its

simplest, there are three fundamental rules, otherwise known as the golden rules of

Management to be followed when working through people.

The three golden rules are for managing people are:

1. Agree expectations.

2. Ensure skills and resources.

3. Feedback.

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Rule 1: Agree Expectations

Unless people know what is expected of them, they are unlikely to achieve it. We

need to agree with people just what it is we expect them to achieve and how. If for

instance you intend to engage the services of a Cleaner either in your Office or

Home, you probably must tell him/her what exactly you would want him/her to do.

However very often, we employ people and without telling them exactly what is

expected of them, we rely on the professional tag they wear And when our notions of

what is ever professional tag may mean does not coincide with our expectations, we

blame them.

In recent time, job descriptions have greatly improved and as a result, they have

become a useful basis for a discussion of this kind. Reaching agreement requires

both parties to express their views. Often at work, talking together and meeting face-

to-face is really the only way to observe rule 1. What is more, it will be necessary to

have regular discussions to check that both parties are in agreement.

Rule 2: Ensure Skills and Resources

Once people know what we expect of them, we must ensure that both parties are

confident that they can achieve it, that they have the knowledge, skills and resources

required. Mind you, in observing rule 2, some people may give an over confident

assertion that they have the required skills, while some may feel unsure of their

abilities.

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To be able to diagnose properly if any of such situations apply, you will need to

spend time with your staff, observing the skills they use, the reasoning they employ

and the way they deploy their resources including their time. If for any reason you are

unable to assess their skills because they are technical and outside your own area of

expertise, then you will need to seek Specialist advice. But this of course must be

discussed with the Staff Member involved. Although management is about trust, yet

Managers who failed to assess their staff often don’t have trust but hope.

Rule 3: Feedback

Once people know what is expected of them and have the skills and resources to

achieve it, then there is need for them to receive regular feedback on whether they

are on the right track. This will enable them to increase their effort in one or more

areas if necessary. The importance of giving a feedback cannot be over emphasized'

it is about receiving a feedback, either expressed or observed, that people improve

their skills, develop and grow. We therefore owe a feedback to the people we are

working with, especially those we are managerially responsible for. A feedback must

be giving to them to enable them to progress.

However, it must be borne in mind that the way a feedback is given, makes the

difference. Criticism may be so wounding that instead of enabling the recipient to

change and grow, it robs him of the confidence to attempt any change and this

situation can often exacerbate the problem.

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Organizational Management

Organizational Management is based on the concept of how organizations function

with reference to:

a) Organizational Structure.

b) The process of Leadership.

c) Change Management.

d) Team Work.

The structure of any organization consists of units and functions. These units and

functions contain positions in which job holders are accountable for achieving results.

In between these positions, relationships exist which require the exercise of an

authority and an exchange of information. There is what is generally referred to as a

“chain of command” which starts from the top defining a hierarchy of positions,

indicating who is accountable to whom and for what.

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How Simple is Management

Management is not, by any stretch of imagination, as simple as may be imagined.

Imagine for instance, that you are not a Medical Doctor and you are put in charge of

a critically skilled based health facility. How likely is it that you could manage that

facility effectively? Keeping in mind of the fact that you are managing highly skilled

professionals of whose professional skills you have little or no experience of.

Mind you, effective management practices can transform an inefficient organization

into a more productive one while bad management practices can transform a

productive organization into an inefficient one. A bad Manager, who lacks the

fundamentals of management as a discipline, will be going the wrong direction and

doing so efficiently. Good management is vital if an organization is to be successful

and effective. Management is one big advantage any organization can have. It is not

just a matter of seniority but a matter of acquiring skills and “practicalizing” those

skills.

Today, there are many different views about management. Many technical schools

and universities now provide courses for planners and managers. As a result, there

are increasing numbers of planning professionals; many of whom are Doctors,

Nurses and even Public Health Specialists. However, although these courses help to

develop skills in the technical aspects, such as cost benefit analysis, yet they do not

always help such planners to understand how professionals and beneficiaries think

and relate to each other.

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Theory of Management

It is quite appropriate to know what a theory is, before you can confidently discuss its

processes and the other important issues relating to it. In this respect therefore, it is

thus prudent that one knows what a theory is before we go on to look at the actual

processes involved. Homans, an outstanding scholar of management, defined theory

as a systematic grouping of interdependent concepts and principles that give a

framework to or tie together a significant area of knowledge. A theory according to

Homans “is a set of pigeon holes or a filing cabinet, in which facts are accumulated

and nothing is more lost, than a loose fact.” One must realize however, that naturally,

theories reflect the thinking and attitudes of their time but at any rate, they still tend to

have a lot of influence on today’s organizational methods and ideas.

Management theories can be classified into three distinct categories, as follows:

1. Scientific or Classical Management Theory

2. Human Relations Management

3. Open Systems Approach

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Scientific Approach

According to Frederick Winslow Taylor, it was proposed that Scientific Approach or

Classical Management Theory focuses on fundamental principles, which he thought

were the underlying facts that could be appropriately applied to any organization.

The main principle of Taylor’s Classical or Scientific Theory was the replacement of

custom and the rule of thumb by the application of scientific methods, which could

yield productivity without the expenditure of more human energy and effort. Taylor

believed that with division of labour, that is dividing a piece of work into its actual

constituent parts, productivity can be increased and there will be a rise in the pay of

the workers as well.

Taylor’s aim was to increase the efficiency of production methods, not just to lower

organizational cost and increase production but also to enable the workers to

increase their earning wages. It can conclusively be said that the scientific approach

to management focused more on organizational structure.

Human Relation Approach

According to Emile Durkheim, a French Sociologist (1825-1917), further propounded

by Elton Mayo (1880-1949), the Human Relations Approach focused more on the

people doing the work in the organization. Human Relations was about the social

needs of the people, their motivation and behaviour. The point made in this approach

was that workers could become highly motivated by being part of a social working

group and by being consulted by management about changes in work practices.

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 Open System Approach

This approach does not focus only on one aspect of an organization, like the

scientific or human relations approaches. The systems approach is focused on the

organization as one complete entity that is the people, structure, environment and

technology. The organization is seen as a collection of interrelated and interacting

part, which is viewed as a whole. The Open Systems theory dictates that all

organizational elements, people, structure, environment and technology have to be

considered as a cohesive whole and not as separate items. It can either be opened

or closed. Open system interacts with its external environments, while a closed

system is regarded as self-supporting from within. Management implies organizing

workers into groups in order to work together towards common goals. Various

management theories and how they have developed over the years, from the one-

dimensional scientific approach, through to the multi-dimensional systems approach

are thinly discussed. Now we are to look at crucial management processes, which

together constitute management as a discipline.

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