General concepts of manegerial science
- 2. Contents Definition of Public health Administration Management Management process Functions of manager POSDCORB Decision making Training of health professional Need of managerial skill in different field References
- 3. Administration • “Administration is the art and science of guidance, leadership, and control of the efforts of a group of individuals towards some common goal.” • The term public administration refers to the implementation of the public policy, which has been laid down by the constitution and implemented by the government. • Public administration derives authority from the authority of state and make use of laws, rules and regulations, and laid down procedure.
- 4. Health Administration Sound administration is essential for the success of any public health program whether on the national, intermediate or the local level.
- 5. Definition of Sound Administration We can define sound administration as: “ The process of achieving defined goals at a defined time through the guidance, leadership, and control of the efforts of a group of individuals and the efficient utilization of non-human resources bearing in mind adequacy, speed, and economy to the utmost possible level.”
- 6. Bureaucratic Administration The dictionary meaning is: A government characterized by specialization of function, adherence to fixed rules, and a hierarchy of authority. The selection of individual for employment and for promotion is made based on stated criteria and technical competence.
- 7. Contd… Administration is a business of government while management is administration of business. Attempt is made in bureaucratic administration to make public administration predictable, rational and appropriate and technically sound, getting rid of personal whims and fancies. The theoretical expectations do not usually persist in reality so that as it actually exists, bureaucracy provides examples of undesirable organizational characteristics.
- 8. Management Management is the operational part of administration. It is defined as: “ It is a set of interactive processes through which the utilization of resources results in the accomplishment of organization objectives.” It is a “conversion mechanism”.
- 9. Process Inputs Outputs A systems view of management: Human resources Non-human resources Conversion mechanism Objectives achievement
- 10. It is through “management” that the objectives of the health care organization are achieved by gathering and positioning of resources. There are several elements for administration and management. In practice all these elements are interrelated to one another. There are also 3 levels of administration.
- 11. Management Process 1. To define aims and objectives. 2. Strategic, tactical and operational planning. 3. Obtaining material, human and financial resources. 4. Organizational structure, behavior. 5. Definition of task of individuals, groups and organization for making effective use.
- 12. Contd… 6. Managing work relationship by motivation, delegation, supervision, team building etc. 7. Scanning the object being managed. 8. Identifying problems to assess their significance. 9. Developing and enlarging skills and capabilities. 10. Monitoring, control and evaluation. 11. Self management, time and stress management.
- 13. Functions of Manager To define goals and specific objectives to be achieved. To set priorities and to plan. To organize formal structure. To staff the organization. To ensure necessary training. To direct the working.
- 14. Contd… To coordinate functions. To establish effective communication. To motivate individual. To monitor, control and evaluate performance. To develop staff and organization. To budget the financial needs. To make decisions. To supervise work. To improve, develop and advance
- 15. POSDCORB(function/element of management or administration ) It means: Planning, Organizing, Staffing, Directing, Coordinating, Reviewing and Budgeting.
- 16. Planning Planning has to be done to decide how to go about it, breaking a job into several component activities, deciding their sequence, which person will do what, when, etc.
- 17. Organizing The plan has to be carried out by organizing resources, which comprises of personnel, materials, vehicles etc.
- 18. Staffing The staff is normally in place, and the responsibility of filling up vacant position lies with senior management.
- 19. Directing The manager directs the working of the staff. Instructing what is to be done by each of them. Keeping a watch on their performance Giving them guidance as they are being supervised
- 20. Coordinating The activities of different persons have to be coordinated, so that these are mutually supportive.
- 21. Reviewing The process of keeping an active watch on the way things is going, to detect undesirable departure and immediately take remedial actions.
- 22. Budgeting Involves act of managing finance Breaking down of each component activity into valuable monetary form.
- 23. Levels of Management Central level Intermediate level Local Level Ministry of health Directorates of health e.g. health office, Hospital, health care unit
- 24. Contd… Top management: Its function are : • the establishment of formal organizational structure • recruitment of staff • laying down general personnel policy • the formal training programmes.
- 25. Middle and Lower Management Its functions are: Direction of working Coordination Communication Motivation Conflict resolution Monitoring and evaluation
- 26. Decision Making Everyone does decision making where one of the alternative courses of action is chosen, which is known as Personal Decision. The decision made by administrator or manager is organizational decision and everyone recognizes this decision making function because it is very obvious. A situational thinking is to be done at the time of decision making, drawing on past experience, knowledge, expert advice.
- 27. Steps for Decision Making • Problem recognition • Problem identification • Specification of decision objective • Situational analysis • Identification of alternative actions • Selection of most appropriate actions • Implementation • Monitoring and feedback • Evaluation
- 28. Management Training of Health Professional The necessity of education and training of medical manpower for better administration of health services has been accepted as necessary. A public health manager needs training, which is tailored to the job requirement. This implies suitable amalgamation of the relevant aspects of several academic disciplines, requirements of management responsibilities and the needs of health program and service.
- 29. Training Institutions All India Institute of Hygiene and Public Health, Calcutta. Medical colleges primarily offering undergraduate medical education, carry out training of public health professional.
- 30. Contd… Public Health Foundation of India is a recent development. It is an autonomous Public Private Partnership. Beside a grant from Government of India, it has received substantial donations from a number of trusts, philanthropists, high network individual.
- 31. Assessment of training needs N.I.H.F.W., Government, collaboration with multilateral and bilateral organization had carried out research and found list of management problems and training needs at block, district, state and central level. The approaches adopted to identify needs are:
- 32. Contd… 1. Analysis of job functions of different personnel to study the component of management in their job. 2. Interviewing of the personnel to determine how they manage their various functions. 3. Observing the actual working of the personnel to know how they manage their functions. 4. Discussion with state, district and PHC level staff in a workshop to identify health management training needs for primary health level staff.
- 33. Needs of health services The activities of district and PHC level were adhoc and lacked planning, supervision consisted fault finding and record keeping. Suitable training programs along with other actions, could lead to improvement.
- 34. Needs of the hospital management The general climate of employees who are conscious of their rights, deriving strengths from union, but not knowing responsibilities has hampered smoothness of private hospitals.
- 35. Contd… The hospital service also includes hotel services and these are not the professional service of doctors and nurses. But, the medically qualified hospital administrators are not willing to yield an inch to make it possible for the people incharge of the hotel services to do their job. There is an immediate need for including administrative and management aspects in various training curricula.
- 36. Need for primary health care Political skill and capacity for leadership The understanding of health needs and programming of health care The provision of finances and the efficient use of resources Teaching, supporting, supervision and collaborating with the health workers and community. The organization and coordination of activities.
- 37. Needs of project management A project is temporary endeavour undertaken to create unique product. The planning and implementation of health projects requires management practice. Project management is the application of knowledge, skills, tools and techniques to project activities in order to meet stakeholders needs and expectation from a project.
- 38. Contd… The project management is concerned with various aspects of requirement of resources like staff, fund, equipment for timely successful completion.
- 39. Limitations of training Only 33% of the trainees were able to organize new activities or improve performance of already existing activities. This low effectiveness may be due to prevailing administrative system. Follow-up period may be short. Difficulties in adaptation of micro to macro level Socio-cultural factors
- 40. Problems of Adaptation In Health Field Adaptation of managerial practices to governmental and non- governmental organizations in health field has given useful results. It has also indicated certain differences in the methods of management as applied business in private sector and to health care in public administration
- 41. Reasons Posing Problems In Application To Health Care Field 1. Acceptance by public administration. 2. Difference in developmental and routine activities. 3. Micro level to macro level adaptation. 4. Type of activities. 5. Socio - cultural factors. 6. Others problems.
- 42. Acceptance By Public Administration Health care services in India, as in other developing countries, are mostly governmental concern. In some ways governmental departments are comparable to well-run big companies. Both have worthy goals; well-designed rational processes, and effective leaders. The experience of management of complex organizations, either manufacturing goods or providing services, has limitation in duplication of public administration.
- 43. The governmental policies, programmes and services are subject to influence by a different and far more complex set of factors with social, political and economic dimensions. The health sector activities are but part of the total governmental activities and cannot be considered in isolation.
- 44. Difference In Developmental and Routine Activities There are difference in managing organizations for development and for carrying out routine tasks. The attitudes required for goals are radically and entirely different. Success with managing routine, predictable activity does not guarantee success in developmental activities, which require different attitudes.
- 45. Micro Level to Macro Level Adaptation Many problems crop up while transferring lessons learnt in micro level projects to macro level for general use.
- 46. Type of Activities Difficulty crops up in the nature of the object being managed in health care organization. Health system is for service and not for production of goods. Conceptual problems come up in the definition and measurement of health or morbidity. There is a multiplicity of criteria for measuring them. The interrelationship between determinants of health is complex and cannot be known with certainty. It is difficult to single out the influence of a specific factor.
- 47. Further problems come up in the application of economic analysis. There are difficulties – emotional, conceptual, methodological and practical – on placing monetary value on health. The cost benefit and cost effectiveness type of analyses are difficult to apply, as the output of health interventions is difficult to measure. The lead time in many health projects is long, i.e., a long period will have to elapse between starting of a facility, service, health educational drive or programme and its measurable impact.
- 48. Socio – cultural Factors In transferring western management without modification to oriental situations, certain difficulties are likely to be faced. The materialistic outlook of the western societies cannot be presumed to be a motivating factor in all situations. The value placed on work is different, the priorities are different, and the influence of certain religious and social factors is sometimes unpredictable. Even the value placed on time is not found to be the same in different societies. The common Indian fatalistic attitude poses problems in the operation of certain incentives and disincentives for efficient working of organization.
- 49. Other Problems Health institutions do not manufacture and supply health to consumers. They provide services, the impact of which on health of individuals and communities may be direct or indirect and immediate or delayed. The demand for health services is mostly generated by health service itself. As distinct from business enterprises, there is a lack of market forces operating.
- 50. The public participation is essential, both for utilization of service and for regulation of standards of care. A strong and well informed public pressure is essential as the society is both the provider of resources and potential beneficiary. Such public pressure is usually lacking, especially in the rural area. Urban elite may be vocal, critical and well attended.
- 51. Organizational Structure Organization is defined as collection of individuals seeking a common goal. It denotes a group of individuals working purposefully at different levels of authority and specialization for achievements of common objectives in an orderly coordinated fashion It may be small, comprising of a few individuals or large, made up of thousands of individuals.
- 52. Tall Organizations Usually government departments, are “tall”, they contains large number of levels and a long chain of commands. In tall organization, also sometimes called as deep organizations, there is a place for individuals of different capacities.
- 54. Disadvantages of Tall organization It hamper speedy decisions as the decision making is passed upward. The organization tends to be inefficient. Discourages individual initiative and requires more supervision.
- 55. Flat Organization In a flat organization the levels in the hierarchy are limited. These are more or less independent, but working within the set common policies and goals of the organization. Such an arrangement permits getting over the drawbacks of tall organization structure.
- 56. 1. Top at central / state levels. 2. Middle at regional /district / sub district levels. 3. Field at primary health centre / sub centre and village level. LEVELS OF ORGANIZATION
- 57. The union of India is a federation consisting of a number of states bound together by the provisions of constitution, which has given specific responsibilities and powers to individual states and to the Federal Authority, viz, the central government. The GOI act 1935 introduced for the first time the three lists viz, central list, provincial list and concurrent list. The 3 lists are enumerated under article 246 in the 7th schedule of constitution as List I (Union list), List II (State list) and List III (Concurrent TOP LEVEL
- 58. List I (Union list):- parliament alone has the right to legislate in respect of subjects. List II (State list):-the state legislatures have the exclusive right, except under certain conditions, to make laws in respect of subjects. List III (Concurrent list):- both the parliament and the state legislature may make laws.
- 59. Top level is highest, i.e., apex of the health services fully carrying out all the necessary managerial function related to the services, e.g., policy, strategy, planning, coordination, monitoring, evaluation, etc. The top level comprises of two components: policy making and programme formulation.
- 60. Middle management is rather non-specific and denotes all intervening levels in the organization. The function at his level is partly technical– professional and partly managerial. The term middle level of management should be used in relation and with reference to the functions carried out. The middle level manager will have responsibility involving supervision, control; and direction, decision making, monitoring and evaluating the programmes. Depending upon the organizational pattern the middle level management may be divided into upper middle level (district level officers) and lower middle level (medical officers at sub district level MIDDLE LEVEL
- 61. At regional / circle / zonal / divisional level, which is in between the state head quarters and district levels, separate officers exist in most states. Such an officer takes direction, guidance and supervision to the civil surgeon and DHO. REGIONAL LEVEL
- 62. AT DISTRICT LEVELAT DISTRICT LEVEL DISTRICT HEALTH OFFICER DISTRICT HEALTH OFFICER DISTRICT CIVIL SORGEON DISTRICT CIVIL SORGEON DISTRICT FAMILY WELFARE OFFICER DISTRICT FAMILY WELFARE OFFICER
- 63. In some states there is a sub divisional officer, apart from the one looking after hospitals, who looks after the public health activities and supervises te rural health centers. In some states at this level the MO of taluka hospital has also been given certain public health activities. SUB DISTRICT LEVEL
- 64. The pattern of staffing is generally uniform according to GOI pattern. They may exercise the control of the PHC in districts where zilla parishads and panchayat samitis are functioning. Subcentres. PRIMARY HEALTH CENTRE LEVEL
- 65. The field level can be again divided into the first supervisory level and the frontline, peripheral or grass root level. Supervisory level comprise Health Supervisor / Assistance. At the frontline, peripheral or grass root level – ASHAs , Anganwadi Workers, trained dais, etc FIELD LEVEL
- 66. References: Sathe VP . Epidemiology and management for health care for all. 3rd edition; page 78-85. Park K. Textbook of preventive and social medicine. 20th Edition; page 773-775. http://nurfac.mans.edu.eg/files/ /ppp_Management. Retrived on 18-9-2014.